Wiki Understanding Excludes 1 and Excludes 2 in ICD-10

[dittotee]

I am studying on my own to take the CPC exam. I have 20+ years experience in medical billing and coding. I have realized that I don't know as much as thought I did! LOl. My question is understanding completely the Excludes 1 and Excludes 2 in ICD-10. This is my understanding and I am needing confirmation or correction on what I think I know . . . .
Excludes 1 means that if someone has a specific dx and whatever is stated in Excludes 1, those codes in Excludes 1 cannot be used in conjunction with the original specific dx code.
Excludes 2 means that if a pt. has two issues/dx and one of them is in the excludes 2, it can be coded in addition too, with the original specific code. (But by calling it an Excludes 2 makes it confusion as to what is excluded.)

 

[cgaston]

If you look under Section 1 of "Conventions, general coding guidelines and chapter specific guidelines" in the back of the ICD 10 book there are descriptions of both (it's page 1341 in my book)

A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE"! An Excludes 1 note indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note

A type 2 Excludes note represents "Not included here". An excludes 2 note indicates that the condition excluded is not part of the condition represented by the code

 

[Rhonda Buckholtz CPC]

HI! You are correct. Excludes1 means never ever. If you are looking to code conditions together most likely you are in the wrong spot if there is an Excludes1. Excludes2 means that yes, sometimes the patient can have both (for example, acute and chronic). Keep in mind though to always watch for any errata, sometimes there are errors found and corrected.

 

[pharbolic]

Is there a website to help our providers with the exclusions 1 & 2

 

[EmilyMontemayor]

Per ICD-10-CM coding Instructions: "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. An exception to the Excludes 1 definition is when the two conditions are unrelated to each other. "

For example, if a patient has both congenital femoral anteversion and internal tibial torsion of the right leg, codes Q74.2 and Q65.89 can apply, even though there is an excludes 1 note present. This is because the patient does not just have femoral anteversion. They have two entirely separate issues: femoral anteversion (hip level) AND an internal tibial torsion (shin level). Because they are two distinct congenital problems affecting different bones, they would meet the guideline exception for being "unrelated". It's important to consider these situations when coding.