ICD-10-CM diagnosis codes
Excludes notes
ICD-10 Excludes notes: In a nutshell
- ICD-10-CM codes include two sets of exclusions.
- Excludes 1 exclusions indicate when two codes cannot be billed at the same time.
- Excludes 2 exclusions indicate that the codes are separately billable.
Excludes 1 Note
Within the ICD-10-CM manual, you will find some codes with small black boxes labeled Excludes 1 or Excludes 2.
Codes listed under Excludes 1 are not billed under the same patient visit as the code listed above the exclusion box, except under circumstances when a patient presents with both conditions at different anatomic locations.
There are two main reasons that a code would be listed under Excludes 1.
The conditions are mutually exclusive, and routinely do not present at the same time or are unrelated to each other. For example, an acquired form of a disease can’t occur at the same time as a genetic form, so the codes would contradict one another.
The properties of one code are already included in the definition of the first code. For example, you should not code pruritus alongside the codes for neurotic excoriation and psychogenic pruritus. This is because the codes for both of those are for a more specific diagnosis, and pruritus is a component of those conditions.
However, there is an exception if the two conditions present at the same time at different anatomic locations. For example, consider a patient who presents with blue nevus and a hemangioma. Both can be reported because they are unrelated to each other and present at different anatomic locations.
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Excludes 2 Note
A code listed under Excludes 2 actually can occur at the same time as the code listed above the exclusion box. However, it is separately billable.
The Excludes 2 box is a way to point out that these codes would be considered different than the primary code, and can be found somewhere else in the manual.
For example, a sebaceous cyst can occur at the same time as a pilar cyst and a proliferating trichilemmal cyst. They are still considered separate conditions, and you can bill them separately.
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