Basics of Excludes Notes

Excludes notes are introduced in ICD-10 to differentiate when two or more diagnosis codes should be coded together and when not. This feature help in coding the diagnosis codes correctly by medical coders.

ICD-10-CM has 2 kinds of Excludes Notes: Excludes1 and Excludes2. Each note has a different definition for use; but, they’re similar because they both show that codes excluded from each other are independent of each other.

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What is Excludes1 Note?

A type 1 Excludes note is a pure excludes note. It means, NOT CODED HERE! An Excludes1 note shows that you should never use the excluded code at the same time as the code above the Excludes1 Note. An Excludes1 note is used when the 2 conditions can’t occur together, like a congenital form versus an acquired form of the same condition.

The Excludes1 note in this example means that you can’t report the codes under this category describing a congenital form of a disease with the code for the acquired form of the same condition. In this example, code Q21.0, describing congenital ventral septal defect can’t be reported with I51.0, the code for acquired cardiac septal defect.

 “An exception to the Excludes1 Note definition is when the 2 conditions are unrelated to each other”.

Example of Exclude 1 note

Q21 Congenital malformations of cardiac septa

Excludes1: acquired cardiac septal defect (I51.0)

Q21.0 Ventral septal defect

The Excludes1 note in this example lists the codes that you don’t report under the category for type 1 diabetes mellitus because the 2 conditions can’t occur together.

These include codes for diabetes mellitus due to an underlying condition, gestational diabetes, and type 2 diabetes mellitus. In this example, you can’t report codes in category E10, like E10.10, describing type 1 diabetes mellitus with ketoacidosis without coma, with the codes listed in the Excludes1 Note.

E10 Type 1 Diabetes mellitus

Excludes1: diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
hyperglycemia NOS (R73.9)
neonatal diabetes mellitus (P70.2)
postpancreatectomy diabetes mellitus (E13.-)
postprocedural diabetes mellitus (E13.-)
secondary diabetes mellitus NEC (E13.-)
type 2 diabetes mellitus (E11.-)

E10.1  Type 1 diabetes mellitus with ketoacidosis

    E10.10 Type 1 diabetes mellitus with ketoacidosis without coma

Example of Excludes1 Note Exception

Code F45.8, Other somatoform disorders, has an Excludes1 Note for sleep-related teeth grinding (G47.63) because teeth grinding is an inclusion term under F45.8. But 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 2 conditions are clearly unrelated to each other. So, report F45.8 and G47.63 together when documentation exists for both conditions.

F45.8 Other somatoform disorders
Psychogenic dysmenorrhea
Psychogenic dysphagia, including ‘globus hystericus’
Psychogenic pruritus
Psychogenic torticollis
Somatoform autonomic dysfunction
Teeth grinding

Excludes1: sleep related teeth grinding (G47.63)

Code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 Note for traumatic intracranial hemorrhage (S06.-). Don’t use codes in range I60-I69 for a diagnosis of traumatic intracranial hemorrhage. But, if the patient has both a current traumatic intracranial hemorrhage and sequela from an earlier stroke, assign a code from both category S06- and category I69-.

(I60-I69) Cerebrovascular diseases

Excludes1: traumatic intracranial hemorrhage (S06.-)

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What is Excludes2 Note?

A type 2 Excludes note represents “Not included here.” An Excludes2 note shows that the condition excluded isn’t 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’s acceptable to use both the code and the excluded code together.

The Excludes2 note in this example shows that the code for dermatitis due to ingested food can also be reported with the code for dermatitis due to food in contact with skin.

Example  of Excludes2 note

L27.2 Dermatitis due to ingested food

Excludes2: dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)

The Excludes2 note in this example lists the codes you can report with the codes under the category for benign neoplasm of breast because the conditions excluded aren’t part of the condition represented by the code. You can report both codes together if the patient has both conditions. These include the codes for adenofibrosis of breast, benign cyst of breast, and fibrocystic disease of breast. In this example, you can report code D24.1 describing a benign neoplasm of the right breast, with the codes listed in the Excludes2 note.

D24 Benign neoplasm of breast

Excludes2: adenofibrosis of breast (N60.2)
benign cyst of breast (N60.-)
benign mammary dysplasia (N60.-)
benign neoplasm of skin of breast (D22.5, D23.5)
fibrocystic disease of breast (N60.-)

D24.1 Benign neoplasm of right breast