One of the biggest changes in ICD-10 conventions
One of the biggest changes in ICD-10 conventions, compared to ICD-9, is the EXCLUDES note. In ICD-9, the alert was simply “EXCLUDES…”.
In ICD-10, the alert has been expanded to accommodate two concepts: EXCLUDES 1 and EXCLUDES 2.
Excludes 1 means NOT CODED HERE. The code(s) excluded should never be used with the code(s) where the note is located (the two conditions cannot be reported together).
Example:
Z03.7- Encounter for suspected maternal and fetal conditions ruled out
Excludes 1: known or suspected fetal anomalies affecting management of mother, not ruled out (O35-, O36-, O40-, O41-)
Excludes 2 means NOT INCLUDED HERE. The excluded condition(s) are not part of the condition represented by the code but the patient may have both conditions at the same time, in which case both codes may be assigned together (both codes can be reported to capture both conditions).
Example:
O09.2- Supervision of pregnancy with other poor reproductive or obstetric history
Excludes 2: pregnancy care for a patient with history of recurrent pregnancy loss (O26.2-)
NOTE: Excludes notes are always italicized.