OASIS Alert

Published on Thu Jul 28, 2011 PDF

New notes clear up blurred exclusion instructions.

While many coding conventions will remain the same as you make the transition from ICD-9 to ICD-10, there are a few differences of which you'll need to be aware. One major change is that ICD-10 has two different types of excludes notes. Make sure you understand the difference to keep the diagnosis codes you list in M1020/M1022 accurate.

In ICD-9, an excludes note can have two different meanings. In ICD-10, there are two different types of excludes notes, each with a distinct meaning.

Currently, some ICD-9 excludes notes indicate that you should never report a code for the excluded term in conjunction with the code you have located in the tabular list.

Example: An excludes note under V54.1 (Aftercare for healing traumatic fracture) indicates that this is not the correct code category for reporting aftercare following joint replacement surgery.

In ICD-10, this type of excludes note is labeled as "Excludes1." For example, ICD-10 code category Z47.- (Orthopedic aftercare) carries the note: "Excludes1: aftercare for healing fracture -- code to fracture with 7th character D."

In other instances, an ICD-9 excludes note can mean that you will need to list a second code in addition to the one you are considering if your patient has both conditions.

Example: ICD-9 subcategory V58.4 (Other aftercare following surgery) has an excludes note indicating that these codes do not cover attention to artificial openings. So if you were coding for a patient who had suffered a subdural hematoma during an automobile accident and also needed care and teaching for a new gastrostomy, you would list both V58.43 (Aftercare for injury and trauma) and V55.1 (Attention to gastrostomy) in M1020/M1022.

In ICD-10, this type of excludes note is labeled as "Excludes2." For example, category Z48 (Encounter for other postprocedural aftercare) lists an Excludes2 note that reads "Excludes2: encounter for attention to artificial openings (Z43.-) encounter for fitting and adjustment of prosthetic and other devices (Z44-Z46)." You would list these codes in M1020/M1022 in addition to the Z48.-code if appropriate.