Wiki Needing some guidance on exclusion notes

Jecoe06

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Hello-

I'm trying to make sure I'm understanding exclusion notes in the ICD 10 book. Lets use Z01.411 for example, under Z04.41(subcategory) there is an exclude 1 note (gynecologic examination status post hysterectomy for malignant condition Z08....) however under Z01.4 (category level) there is an exclusion 2 note ( pregnancy examination or test Z32.0-.....), then if we go further back in the book to Z00-Z13 (block) under that is an exclusion 1 note (examinations related to pregnancy and reproduction Z30-Z36, Z39.-). My question is, do the exclusion notes at the block, category and subcategory all apply? My understanding of exclusion notes is if there is an exclusion note at the subcategory level that exclusion note applies and trumps the category level or the block level exclusion note? If there isn't an exclusion note at the subcategory level then you would go back to the category level and if nothing there then back to the block level.
If exclusion notes from all levels apply, then what is the rule on if there is and exclusion 1 at one level and an exclusion 2 at another level. To further clarify, in our example above Z32.0 is an exclusion 1 at the block level but is an exclusion 2 at the category level?

Thanks for your help :)
 
I'm not sure I understand your question but the way I understand excludes 1 and 2 notes is that anytime you have an excludes 1 note the book is saying you can't code that here at the same time as the listed diagnosis above the excludes 1 note. For example, an excludes 1 note has basically the same meaning as the above description where the excludes 1 note falls under. Like this one for example, "Encounter for suspected maternal and fetal conditions ruled out" the excludes 1 note under this description reads, "known or suspected fetal anomalies affecting management of mother, not ruled out." See how they are worded differently but still have the same meaning. This is when you wouldn't include the two together. The guidelines under "excludes 1" state that you can't code a congenital form and an acquired form of the same condition at the same time.

For excludes 2 notes, when appropriate you can code two conditions that are not related at the same time. Excludes 2 notes mean "not included here." So for example, if a patient has two conditions occurring at the same time, for example, teeth grinding and psychogenic dysmenorrhea which are unrelated would be appropriate to report them together.

I hope this further explains when to code and when not to code two conditions together.
 
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