As we have started using ICD 10 codes, we will have many new words to come across. There are many new codes have been added and so it is important to know how to use two or more codes together. There is a lot of differences between ICD 9 and ICD 10 codes with some new modification. Exclusion part is also modified in ICD 10. Excludes were the part of ICD 9 codes but now in ICD 10 we will be having Excludes 1 and Excludes 2. Both excludes have a separate definition in ICD 10 and help in following coding guidelines. We will just checkout today the main difference between Excludes 1 and Excludes 2. In addition, we will check out with few examples how to code ICD 10 codes with Excludes 1 and Excludes 2 notes.
Definition of Excludes 1 and Excludes 2
Excludes 1 is easily defined as codes, which are excluded. The excludes 1 codes should not be used with that ICD 10 diagnosis. We know there are few conditions, which cannot be used together. For example, the congenital and acquired condition should not be coded together, traumatic and pathological fracture condition cannot be coded together, and for pregnancy complication, we cannot use normal diagnosis with pregnancy complication codes. Hope, you would have got a small idea about Exclude 1 and how to use apply them with ICD10 codes. In simple meaning Excludes 1, note codes cannot be coded together with that ICD 10 code. Now, coming to Excludes 2 it is totally opposite to Excludes 1. The codes in Excludes 2 can be used together at same time.
But, as per the new update in 2016, the excludes 1 note codes can be coded together in some exception cases like below.
An exception to the excludes 1 definition is when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an excludes 1 note are related, query the provider. For example, code F45.8, Other somatoform disorders, has an excludes 1 note for “sleep-related teeth grinding (G47.63),” because “teeth grinding” is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However, psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep-related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.
Excludes 1: Condition cannot occur at same time and should not be coded together (code together in exception cases)
Excludes 2: Condition can occur together and can be coded together
Read also: Root operations of IC10-PCS
Example for Excludes 1 and Excludes 2
Like I said before, fracture conditions have also Excludes 1 and excludes 2 notes. While coding pathological fracture we have an excludes 1 note for not coding Traumatic fracture. Pathological and traumatic fracture cannot occur at same time and hence they should not be coded together. Below is an example of pathological fracture with exclude 1 and excludes 2 notes.
For Pregnancy complication we have separate ‘O’ codes. These codes should be used only when there is any complication occurred during pregnancy. While using pregnancy complication codes we arenot allowed to use normal ICD 10 codes. Below is the example for coding hypertension with excludes 1 and excludes 2 notes.