Excludes1 conditions may be reported together when unrelated, says CDC

If two ICD-10-CM diagnoses are not related to each other, but exist at the same time, they may be reported together despite an Excludes1 note, according to a recent release from the Centers for Disease Control and Prevention (CDC). The coding advice has been approved by the four Cooperating Parties—the American Health Information Management Association (AHIMA), the American Hospital Association, CMS, and the National Center for Health Statistics.

Typically, an Excludes1 note is a pure Excludes note, meaning it indicates that a coder should never use the code excluded at the same time as the code above the Excludes1 note.

An Excludes2 note means the condition is not included in the code. 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, coders may report both the code and the excluded code together when appropriate.

However, the Cooperating Parties agree that certain conditions may be reported together when appropriate even though an Excludes1 note exists, but due to the ongoing code freeze, these changes may not be made in the ICD-10-CM Manual until October 1, 2016.

The CDC release includes two sets of examples:

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 the mental health condition.

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.

Editor's note: This article originally published on JustCoding.com.