Wiki Exclude1

[pawar.yogesh93@gmail.com]

I need some clarification on what diagnosis should be coded in below mentioned case.
In A/P provider is documenting 1-Diarrhea, 2-Colitis
so among R19.7 and K52.9 which code should be assigned.
Because K52.9 exclude1 to R19.7, so when we are coding R19.7 we cannot code K52.9, is this right?

 

[thomas7331]

You would only code the colitis. When you have a related definitive diagnosis, the guidelines state that you should not code the symptoms that are associated with that diagnosis, which in this case would include the R19.7.

Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0 - R99) contains many, but not all, codes for symptoms.

 

[pawar.yogesh93@gmail.com]

You would only code the colitis. When you have a related definitive diagnosis, the guidelines state that you should not code the symptoms that are associated with that diagnosis, which in this case would include the R19.7.

Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0 - R99) contains many, but not all, codes for symptoms.

Thank you Thomas. One more question.
If
CodeA:
Exclude1 - CodeB
then generally we code Code B
Is my understanding correct?

 

[thomas7331]

Thank you Thomas. One more question.
If
CodeA:
Exclude1 - CodeB
then generally we code Code B
Is my understanding correct?

As a general rule, yes, you only assign the code that is referenced in the Excludes1 note (see Coding Clinic, 4th quarter 2018). However, there are cases in ICD-10 where both codes contain an Excludes1 note for each other, in which case the code may need to make a judgment call based on the documentation as to which code, or both, best represent the documentation. Also, as per the ICD-10 guidelines, there are exceptions allowed to Excludes1 when documentation supports that the two conditions both exist but are unrelated.