Wiki EXCLUDES 1 CLARIFICATIO

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tmekelburg1978

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Local Chapter Officer
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I'm having an issue with this specific Excludes 1 problem:
  • M20.4 (Other hammer toe(s), Acquired) shows Q66 (Congenital deformities of feet) in the Excludes 1; However, Q66 does not have the M20.4 codes in their Excludes 1.

Why does a code appear in the Excludes 1 column of one code, but it's not true in the converse?

Can someone clear this up for me? Thank you.
 
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Unfortunately it's just a fact of life that there are inconsistencies and illogical things in ICD-10. This is just one example - there are plenty of others like this. I did read an article in one of the coding publications a while back - I can't locate it now - that described many of the confusions resulting from the excludes notes in ICD-10 and said that their organization had been working with the WHO/CDC to try to get clarifications and revisions made. But as with any large bureaucracy, this will of course be a slow process.

As coders, we have to do the best we can with these things in the meantime. I would treat the excludes note as applicable to the code pair and just follow the guidance - that if the two codes are referring to the same documented condition then they shouldn't be coded together, but if they're clearly two separate conditions and unrelated, then it's appropriate to code both.
 
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