Knowledge Base Article

Dilemma:

How to interpret the Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another.

Solution:

On October 26, 2015 the Centers for Disease Control and Prevention (CDC) posted the following Excludes1 notes guidance on their ICD-10-CM webpage. This guidance was originally posted on October 19, 2015. The Updated information appears in bold).

There are circumstances that 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 October 1, 2016. This new guidance concerning Excludes1notes is intended to allow conditions to be reported together when appropriate even though they may currently be subject to an Excludes1 note. This coding advice has been approved by the four Cooperating Parties – the American Health Information Management Association (AHIMA), the American Hospital Association (AHA), the Centers for Medicare and Medicaid Services (CMS), and the National Center for Health Statistics (NSHC).

This advice was published in the 4th Quarter 2015 issue of Coding Clinic for ICD-10-CM and ICD-10-PCS.

Question:
We have received several questions regarding the interpretation of Excludes1notes in ICD-10-CM when the conditions are unrelated to one another. How should this be handled?

Answer:
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 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.

Note: This information was discussed by MMP’s AHIMA Approved ICD-10-CM/PCS Trainer Coding Professionals in our 2016 IPPS Coding Updates Webinar last fall. If you missed the opportunity to join us live, this session will be available on our Classes page as an On-Demand Webinar soon.