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Contradicting Excludes 1 & 2 Notes

  1. #1
    Daytona Beach, FL
    Default Contradicting Excludes 1 & 2 Notes
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    I am finding some things in ICD-10 that are very confusing! I have a patient who was diagnosed with a periprosthetic supracondylar fracture of left knee. During surgery the doctor found that the prosthetic was broken and needed to be replaced. So, I looked up the code for the periprosthetic fracture and after a number of "see" something else notes, came up with T84.043A. There is an excludes 2 note for breakage of prosthetic joint - T84.01. So I go to code T84.013A for the left knee to code that per the excludes 2 note and there they have an Excludes 1 note for periprosthetic joint fracture (T84.04).

    So, can I use both codes or can't I code both??

    There are a lot of codes in this system that are like going on scavenger hunt to finally find the right code!

    Jodi Dibble, CPC

  2. #2
    Daytona Beach, FL
    Still looking for some answers/opinions!! Anyone?
    Jodi Dibble, CPC

  3. #3
    Default WHO released Interim advice on Excludes 1 notes ICD-10-CM
    Hello jdiddle and fellow coders:

    This just came in from the WHO regarding the confusion on the excludes 1 confusion as a known ICD-10-CM reporting issue. I found the release on the WHO website and they also posted it to the CDC site here
    Then click on ICD-10 CM and scroll down to 2016. It is the last file under the 2016 heading. Coding examples are given.
    "If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes 1 note".
    Examples: If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note. For example, the Excludes1 note at code range R40-R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder.
    In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.

    Please see more info on known ICD-10-CM reporting issue Excludes1 note.

    A coding organization wrote to Coding Clinic Support 10-19-15 about the Excludes1 interim advice. They reiterated the question and answer as quoted in the release and then added this:
    "The reason this guidance was developed is that circumstances have been identified where some conditions included in Excludes1 notes should be allowed to both be coded, and thus might be more appropriate for an Excludes2 note. However, due to the partial code freeze, no changes to Excludes notes or revisions to the official coding guidelines can be made until next October. The new guidance concerning Excludes1 notes is intended to allow conditions to be reported together when appropriate even though they may currently be subject to an Excludes1 note."
    Until they can fix next year we will have to use our best judgment and appeal as necessary.

    I realize this answer doesn't completely address your specific question fully, but it is the only interim Excludes1 note guidance regarding ICD-10-CM code book available at this present time that I could find for you.

    Hope it was helpful.

  4. Question
    can anyone explain J02.0 and J06.9 Excluding 1 both whi one needs to be code???????????/

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