Question INCD-10 Excludes 1 Notes

[Tammy70]

Good Morning Fellow Coders,
I was wondering if you could help me understand the ICD-10 tabular guidelines around Excludes 1.

The guidelines state:
A type 1 Excludes note is a pure excludes. It means 'NOT CODED HERE!' An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

I am reviewing a claim that lists K92.2 and K57.30 codes and I see that there's an Excludes 1 indication, but am not sure which of the codes I should remove and which one remains - K92.2 or K57.30 (In 3M, it is flagged as follows: "Section [K90 - K95]: K922 should never be used at the same time as K5730")?

Here is how it appears in the Tabular guidelines:

K92.2 Gastrointestinal hemorrhage, unspecified Gastric hemorrhage NOS Intestinal hemorrhage NOS
- Excludes1: acute hemorrhagic gastritis (K29.01)
hemorrhage of anus and rectum (K62.5)
angiodysplasia of stomach with hemorrhage (K31.811)
diverticular disease with hemorrhage (K57.-)
gastritis and duodenitis with hemorrhage (K29.-)
peptic ulcer with hemorrhage (K25-K28)

Thank you in advance for your help.

 

[jodielonkoski]

Since the K92.2 has the excludes one read it like this: unspecified gastrointestinal bleeding cannot be coded with (excludes 1) diverticular disease because then the bleeding is then not unspecified, but a complication of diverticlosis/itis. This is why the excludes is only under k92.2 and not k92.0 or k92.1, which are not unspecified. I don't want to say always, but typically if you have 2 codes involving an excludes 1, you code the diagnosis pointed to by the excludes 1, because it takes precedent over the other code. another example would be an aquired disease having an excludes 1 to a congenital disease, you would code the congenital. (see how k57 has an excludes 1 for congenital diverticulum). hope this helps.

an excludes 2 CAN be coded together, if appropriate, but are there to let you know you should check if the other code mentioned would be more appropriate, like how k57 has an excludes 2 for appendix diverticulum. This is to make sure you dont accidentally code an appendix diverticulum as a large intestine diverticulum, but you can have both at the same time requiring both codes.

 

[jodielonkoski]

just to add, while k92.0 and k92.1 dont have an excludes for k57, they are on the CC/MCC exclusion list which is why 3m says that!