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Coding Tip Monday: Excludes1 vs. Excludes2
One of the most commonly tested concepts on the CPC exam and one of the most frequent coding errors in practice involves understanding Excludes1 and Excludes2 notes in the ICD-10-CM Tabular List.
WHAT IS AN EXCLUDES1 NOTE?
Think of Excludes1 as “NOT CODED HERE.” An Excludes1 note indicates that two conditions cannot be reported together because they are considered mutually exclusive.
J00 Common Cold (Acute Nasopharyngitis)
Excludes1: Influenza with respiratory manifestations (J09–J11)
WHAT IS AN EXCLUDES2 NOTE?
Think of Excludes2 as “NOT INCLUDED HERE.” An Excludes2 note means the excluded condition is not part of the condition represented by the code, but the patient may have both conditions at the same time.
If documentation supports both diagnoses, both codes may be reported.
Quick Comparison:
| Excludes1 | Excludes2 |
|---|---|
| Conditions cannot be reported together. | Conditions may be reported together. |
| Think: ONE diagnosis category only. | Think: TWO codes may be assigned when documentation supports both conditions. |
WHY THIS MATTERS
Misinterpreting an Excludes note can lead to incorrect diagnosis coding, claim denials, audit findings, and lost CPC exam points.
LINDA'S CODING CORNER TAKEAWAY
Whenever you locate a diagnosis code in the Tabular List, do not stop at the code description. Always review inclusion terms, exclusion notes, use additional code notes, code first notes, and chapter-specific guidelines.
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