ICD 10 Training: ICD 10 has New Excludes Notes’ Rules


ICD 10 has some new rules compared to ICD-9. “Excludes1” indicates that the code identified in the note and the note where the note appears cannot be reported together because the two conditions cannot occur together. Read this expert healthcare coding article to know more.


And here is an example here, such as an acquired deformity and a congenital deformity – those cannot be coded together; they exclude each other. So that's an Exclude1 note that cannot be reported together.
“Excludes2” means both codes may be reported together. So that's one way to remember it. If you have an Excludes2 note, it means you can have two or more codes to define that particular situation. In the Exlcudes2, the condition identified in the code is not part of the condition represented by the code where the note appears. So both ICD 10 codes may be reported together. And there is an example listed there.


Laterality examples: There are some examples – malignant neoplasm of lower outer quadrant of right female breast. You have another code and it's your sixth digit that's different, of the left. And then again, your sixth digit is the unspecified.


So as we did in ICD-9, you have the unspecified ICD codes that end in -9, you do have some of those in ICD-10. There are fewer. You should be using them less often because of the specificity because the codes are so much more specific. But the ICD-10 does have the -9 for unspecified when you need to use that.
Diabetes: As you know, there are lots of conditions that diabetes complicates, that are affected by diabetes and so on. And there are some medical coding examples here.


Diabetes due to an underlying condition with diabetic chronic kidney disease; and this would be a diabetes code. Drug or chemical-induced diabetes with diabetic peripheral angiopathy with gangrene and so on. And so it really spells out the entire situation.


There are 50 different codes for complications of foreign body accidentally left in the body following a procedure. This is in ICD-10.


As you know, in ICD-9 for those of you who are coders, there aren't any close to that many. There's basically one code – 998.4, foreign body accidentally left during a procedure.


But as you can see from these coding and compliance examples, it will tell you exactly what happened following a heart catheterization left in the body following a surgical operation, obstruction due to the foreign body accidentally left in or adhesions due to the foreign body. So this describes that very specifically.


Here is an medical billing and coding example, hypertension/hypertensive accelerated, benign, essential, idiopathic, malignant, systemic. I10 – that's an easy one to remember. You've already memorized an ICD-10 code now, I10 for hypertension.


And it includes all those different types of hypertension. And you have further explanation here. You have an Excludes1 note which means that two ICD codes that cannot be coded together. Excludes2 means that you can add an additional code.


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