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Tip: Using Excludes notes in ICD-10-CM

APCs Insider, November 1, 2013

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Excludes notes are one significant change in ICD-10-CM. In ICD-9-CM, Excludes notes can mean two different things:

• A particular code is not for use with this condition
• A particular condition is not included in this code

Currently, coders must interpret the meaning of the Excludes note. ICD-10-CM actually divides the Excludes notes into two types, taking the guesswork out.

An Excludes1 denotes "not coded here," ­meaning coders should never report the excluded code at the same time as the code above the Excludes1 note (e.g., the congenital form versus an acquired form of the same condition).

An Excludes2 denotes "not included here," meaning that the condition excluded is not part of the ­condition represented by the code even though a patient may have both conditions at the same time. When an ­Excludes2 note appears under a code, coders can ­report both codes together, when appropriate.

This tip is adapted from “Build a foundation for ­ICD-10-CM coding” in the November issue of Briefings on APCs.

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