Health Information Management

Understand ICD-10-CM excludes notes

HIM-HIPAA Insider, February 14, 2012

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ICD-9-CM incorporates only one type of excludes note—which, confusingly, can mean two different things. ICD-10-CM, on the other hand, incorporates two types:

  • Excludes1. An Excludes1 code should never be used along with the code above the Excludes1 note. For example, ICD-10-CM code S60.371A (other superficial bite of right thumb, initial encounter) should never be reported with the categories S61.05- or S61.15- (open bite of the thumb). In this example, you would not assign code S60.371A along with S61.051A (open bite of right thumb without damage to nail, initial encounter) at the same time. The coder only assigns one code to identify the most severe description (open) of the wound.
  • Excludes2. An Excludes2 condition is not part of the condition above the Excludes2 note, but a coder may assign an additional code (if applicable) for it in addition to a code for the condition that appears above the Excludes2 note. For example, assign ICD-10-CM category S60.2 to denote contusion of the wrist and hand. This code excludes contusion of the fingers (S60.0-, S60.1-); however, a coder may report both codes when applicable. This means a patient can have a contused hand and/or wrist without having contused fingers; however, if the patient's fingers are ¬also contused, two codes are necessary to identify both conditions.

These excludes notes may be familiar concepts, but ICD-9-CM has never explicitly distinguished between the two. Distinguishing them in ICD-10-CM may make it easier for coders to determine which exclusion applies to a specific scenario.

Editor’s note: This tip has been adapted from an article which originally appeared in the February issue of Medical Records Briefings.

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