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L24.81 vs L27

L24.81 (Irritant contact dermatitis due to metals) compared with L27 (Dermatitis due to substances taken internally), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes can be reported together when both conditions are documented, because L24.81 lists L27 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named and billing status.L24.81 is “Irritant contact dermatitis due to metals”; L27 is “Dermatitis due to substances taken internally”. L27 is a non-billable header; L24.81 is billable.

Registry fact

Can these codes be reported together?

Yes, when both are documented.L24.81 lists L27 under Excludes2: “dermatitis due to substances taken internally (L27.-)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

Yes.L24.81’s tabular entry: “dermatitis due to substances taken internally (L27.-)”. The note covers L27.

Official ruleGuide: Excludes1 vs Excludes2

Is one a parent or header code?

One is a header.L27 is a non-billable header, but L24.81 is not one of its subdivisions.

Registry fact

Nothing found in 3 other checks; 1 check does not apply
Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. L24.81 carries 3 Excludes1 notes and L27 carries 1 Excludes1 note covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Informational

Excludes2 relationship

L24.81
Irritant contact dermatitis due to metals
↔
L27
Dermatitis due to substances taken internally

What we found

Yes, when both are documented.L24.81 carries an Excludes2 note covering L27: “dermatitis due to substances taken internally (L27.-)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
L24.81

Irritant contact dermatitis due to metals

L27

Dermatitis due to substances taken internally

StatusDiffers
L24.81
Billable
L27
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: L27.0, L27.1, L27.2, L27.8, L27.9

Excludes1Differs
Only at L24.81
  • contact dermatitis NOS (L25.9)
  • dermatitis NOS (L30.9)
Only at L27

No note of its own beyond the shared notes

Shared by both codes (1 note)
  • allergy NOS (T78.40)
Excludes2Differs
Only at L24.81
  • allergic contact dermatitis (L23.-)
  • dermatitis due to substances taken internally (L27.-)
  • dermatitis of eyelid (H01.1-)
  • diaper dermatitis (L22)
  • eczema of external ear (H60.5-)
Only at L27
  • adverse food reaction, except dermatitis (T78.0-T78.1)
  • contact dermatitis (L23-L25)
  • drug photoallergic response (L56.1)
  • drug phototoxic response (L56.0)
  • urticaria (L50.-)
Shared by both codes (8 notes)
  • perioral dermatitis (L71.0)
  • radiation-related disorders of the skin and subcutaneous tissue (L55-L59)
  • chronic (childhood) granulomatous disease (D71-)
  • dermatitis gangrenosa (L08.0)
  • dermatitis herpetiformis (L13.0)
  • dry skin dermatitis (L85.3)
  • factitial dermatitis (L98.1)
  • stasis dermatitis (I87.2)
CategoryDiffers
L24.81

L24 Irritant contact dermatitis

L27

Is itself a category

ChapterSame for both

L00-L99 — Diseases of the Skin and Subcutaneous Tissue (L00-L99)

IncludesDiffers
L24.81
  • Irritant contact dermatitis due to chromium
  • Irritant contact dermatitis due to nickel
L27

None at this code

No Code first, Use additional code, Code also and 7th character note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources