Anesthesia Coding Alert

Answer: According to the ICD-10-CM Official Guidelines, each “has a different definition for use, but they are all similar in that they indicate that codes excluded from each other are independent of each other.”

Excludes1 means “not coded here” and is a “pure excludes note.” This means you cannot code the two conditions at the same time because they cannot occur together and are generally mutually exclusive: for example, a congenital form and an acquired form of the same condition.

Exception to the rule: You can code Excludes1 codes together when the two conditions are unrelated to each other. For example, your provider documents the patient is experiencing generalized pain in addition to back pain. If the documentation indicates the generalized pain is not caused by the back pain, then you can override the Excludes1 note and assign R52 (Pain, unspecified) along with M54.9 (Dorsalgia, unspecified).

Excludes2 indicates a certain condition is “not included here.” This means that one condition may not be part of the main condition, but the patient may experience both conditions at once. For example, a patient could present to your facility with cluster headaches, coded to G44.009 (Cluster headache syndrome, unspecified, not intractable), as well as migraines with aura, coded to G43.109 (Migraine with aura, not intractable, without status migrainosus). Parent code G44.- (Other headache symptoms) carries an Excludes2 note that lets you assign codes from the G43.- (Migraine) code family.

Make sure to pay attention to exclusions notes and query the surgeon’s office or request a copy of the operative report if you have questions.

Remember: Review the instructions under each level in a code group, in addition to the ones that may accompany specific codes to find any excludes notes that apply to the code(s) you’re assigning. Excludes notes at higher levels (such as the three-character level) apply to codes in lower levels (such as five-character levels), even if the codes further down in the family have additional excludes notes under them.