10-13-2017, 03:36 AM | Community Wiki

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Excludes 1 & 2 note question

  1. #1
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    Default Excludes 1 & 2 note question
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    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??

    Any help is greatly appreciated!!!
    Jodi Dibble, CPC

  2. Default
    Was the broken/fracture around the internal prosthetic joint (which is T84.040-) or broken internal hip/knee prosthesis.

    That's the key to me in looking at this. How is it described. Around the internal joint or actual broken prosthesis.

    And I think that's why Excludes1 is on the T84.01- codes . The prosthesis itself is either broken, or the area around the prosthesis is broken.

  3. #3
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    Quote Originally Posted by consultingbykristin View Post
    Was the broken/fracture around the internal prosthetic joint (which is T84.040-) or broken internal hip/knee prosthesis.

    That's the key to me in looking at this. How is it described. Around the internal joint or actual broken prosthesis.

    And I think that's why Excludes1 is on the T84.01- codes . The prosthesis itself is either broken, or the area around the prosthesis is broken.
    The patient sustained a periprosthetic supracondylar fracture with a femoral shaft fracture. When the surgeon performed the ORIF he found that the prosthesis was also broken and it was replaced as well as repair of the fracture.

    A broken bone and a broken prosthesis - both!
    Jodi Dibble, CPC

  4. #4
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    Hi,

    Excludes Notes

    The ICD-10-CM has two types of excludes notes. Each type of note has a
    different definition for use but they are all similar in that they indicate
    that codes excluded from each other are independent of each other.

    a. Excludes1

    A type 1 Excludes note is a pure excludes note. 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.

    b. Excludes2

    A type 2 Excludes note represents ?Not included here?. An excludes2
    note indicates that the condition excluded is not part of the
    condition represented by the code, but a patient may have both
    conditions at the same time. When an Excludes2 note appears
    under a code, it is acceptable to use both the code and the excluded
    code together, when appropriate.


    Hope this helps!

    VJ

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