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.
Excludes 1: Condition cannot occur at same time and should not be coded together
Excludes 2: Condition can occur together and can be coded together
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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.