Most of the coders are still facing challenges in both excludes 1 and excludes2 notes. Though it appears to be little bit confusing terms, it is simple when you read the definitions with relevant examples. I hope this article will definitely give a clear picture regarding the excludes1 and 2 notes.
ICD-10 CM has two types of excludes notes which are designated as Excludes 1 and Excludes 2. In simpler terms, it is defined as below:
Excludes 1: Not coded here
Excludes 2: Not included here
When you look up a code in the tabular list, you may see one or more other codes listed in an exclude note. Excludes 1 note denotes pure exclusion which means the codes listed under Excludes 1 should never be used with the code listed above the Excludes note 1. You can look for the below examples for better understanding:
Example 1: J03 Acute tonsillitis
In this example, codes included in category J03-Acute tonsillitis, cannot be coded together with any of the codes listed under the Excludes 1. If the medical record documents both acute tonsillitis and hypertrophy of tonsils, then the coders should report only acute tonsillitis and not the hypertrophy of tonsils as it is listed under the Excludes 1 note.
Example 2: H02.81 Retained foreign body in eyelid
In this example, code H02.81 has an Excludes1 note that lists Laceration of eyelid with foreign body (S01.12-), Retained intraocular foreign body (H44.6-, H44.7-), and Superficial foreign body of eyelid and periocular area (S00.25-). This means that if you bill one of the H02.81- codes, you can’t bill any of those other codes on the same day for the same eyelid.
What is the purpose of Excludes 1 note in ICD-10?
Excludes 1 note is included in ICD-10 when two conditions with separate codes cannot be reported together such as a congenital form versus an acquired form of the same condition.
Example: M20 Acquired deformities of fingers and toes
In this example, you can find separate codes for acquired and congenital deformity of finger and toes. However there are excludes 1 notes at this level to guide the coders that the conditions cannot be reported together.
Excludes 1 has an exception:
Excludes1 note has an EXCEPTION to its own definition. It states that two conditions covered by an Excludes1 note may be reported together if they are UNRELATED.
Example: F45.8 other somatoform disorders
In the given example, F45.8 has an Excludes 1 note for G47.63 (sleep related grinding) as teeth grinding is included under F45.8. Similarly G47.63 has excludes 1 note for “psychogenic bruxism (F45.8).” So you should choose only one of those codes (F45.8 or G47.63) for teeth grinding.
Now, consider a case where the patient has both sleep related bruxism (G47.63) and psychogenic dysmenorrhea (F45.8). These two conditions are clearly unrelated to each other and so it would be appropriate to report both F45.8 and G47.63 together which considers being an exception rule to Excludes note 1.
.Note: If it is not clear whether the two conditions involving an Excludes1 note are related or not, then you need to query the provider.
The Excludes 2 means “NOT INCLUDED HERE”. The Excludes 2 note instructs that the condition excluded is not part of the condition represented by the code. A patient may have both conditions occurring at the same time of the visit. In such cases, it is acceptable to use both the code and the excluded code(s) together when appropriate.
Example: J03 Acute tonsillitis
In this example, code J03 (acute tonsillitis) lists an Excludes 2 notation for code J35.0 (chronic tonsillitis) because the patient can present with both conditions at the same time. If the medical record indicates that the patient does have chronic tonsillitis and presents to your office today with acute tonsillitis, it would be appropriate to code both J03 and J35.0 for the visit. The Excludes 2 notation, however, indicates that a patient with simple chronic tonsillitis should never receive a diagnosis of acute tonsillitis unless both conditions are actually present.
Note: An Excludes2 note instructs you to assign more than one code when medical record supports all conditions.
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