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ICD-10 Articles: Coding Corner

Excludes Notes

ICD-9-CM

ICD-9-CM only has one excludes note. The ICD-9-CM Official Guidelines for Coding and Reporting state that an excludes note under a code indicates that the terms excluded from the code are to be coded elsewhere. In some cases, the codes for the excluded terms should not be used in conjunction with the code from which it is excluded. The guidelines provide the example of a congenital condition excluded from an acquired form of the same condition.  In other cases, the excluded terms may be used together with an excluded code if documentation supports the use of both codes.

ICD-10-CM

ICD-10-CM has two types of excludes note and each note has a different definition for use. They are both similar in that they indicate that codes excluded from each other are independent of each other. In contrast to ICD-9-CM coding, the ICD-10-CM guidelines are clearly distinguished to eliminate confusion as to the meaning of the exclusion.

ICD-10-CM Draft Official Guidelines for Coding and Reporting 2013 defines Excludes Notes as follows:

Excludes 1
A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!” An Excludes 1 note indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note. An Excludes 1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

Excludes 2
A type 2 Excludes note represents "Not included here". An Excludes 2 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 Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

Additional information about “excludes” notes may be found in coding guideline I.A.12-Excludes Notes.