Health Information Management

Tip: ICD-10-CM simplifies meaning of excludes notes

APCs Insider, February 10, 2012

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ICD-9-CM contains one type of excludes note with two possible meanings. Nothing in the ICD-9-CM manual tells coders which mean applies, so they must apply logic to determine the meaning. 

An excludes note in ICD-9-CM could mean that coders should not use a particular code for a particular condition. Instead coders should look in a different category because they can’t code the two conditions together.

It can also mean that a condition is not included in a particular code. In these cases, coders should assign both codes, if applicable, when patients have both conditions simultaneously.

When coders are looking at the excludes notes, they can become confused. ICD-10-CM will resolve this confusion by instituting two different excludes notes—Excludes1 and Excludes2—to differentiate the meanings.

An Excludes1 note is a pure excludes note. An Excludes1 note indicates that a coder should never use the excluded code with the code above the Excludes1 note. The two conditions cannot occur together.

An Excludes2 note means a condition is not included in the code. An Excludes2 note indicates that the excluded condition is not part of the condition the code represents, but a patient may have both conditions simultaneously. When an Excludes2 note appears under a code, coders may report both the code and the excluded code together when appropriate.

This tip is adapted from “Start preparing for ICD-10-CM: Note differences between ICD-9-CM and ICD-10-CM” on

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