READER QUESTIONS: Adhere to Inclusion/Exclusion Instructions

Question: When looking up codes in the tabular list of my ICD-9 manual, I often see “includes” and “excludes” notes. Would you explain how these notes should impact my coding decisions? Would you also explain the significance of the “code also” instruction?


New Jersey Subscriber

Answer: The tabular list (Volume 1) divides the codes from 001 to 999.9 into various diseases and body systems. This includes V and E codes as well. You will see the terms “includes” and “excludes” as you look through the codes for the system specific to a patient’s diagnosis.

The term “includes” further defines a code and provides examples that may apply to the chapter, section or category you are researching. The “includes” note appears immediately under a three-digit code title.

Example: For 461.x (Acute sinusitis) in the tabular list in your code book, you’ll see “Includes: abscess, empyema, infection, inflammation, suppuration” classified as “acute, of sinus (accessory) (nasal).”

“Excludes,” on the other hand, means you should report this condition with a coded listed elsewhere. In some books, the “excludes” note will appear in a black box with white letters. The terms listed to the right of the note will tell you where to look for the codes for the excluded diagnoses.

Example: For 477.x (Allergic rhinitis) in the tabular list, you will see “Excludes--allergic rhinitis with asthma (bronchial) (493.0).”