EM Coding Alert

Question: I heard that there were changes to the Exclude notes in ICD-10, but they haven’t been published. Can you tell me what has changed? 

Oklahoma Subscriber

Answer: There was an issue involving the “Excludes1” notations in your diagnosis coding manual. Fortunately, the Centers for Disease Control (CDC) has addressed that issue, creating a new temporary guideline that will help you report multiple diagnoses together.

“There are circumstances that have been identified where some conditions included in Excludes1 notes should be allowed to both be coded, and thus might be more appropriate for an Excludes2 note,” the CDC said in an Oct. 26, 2015 memorandum. “However, due to the partial code freeze, no changes to Excludes notes or revisions to the official coding guidelines can be made until October 1, 2016.”

In the interim, the CDC advises practices to use its temporary guidance, advising that if two conditions are unrelated to each other, you can report them both, even if an Excludes1 note exists. “For example, the Excludes1 note at code range R40-R46 states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes,” the CDC says in its memo. “However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and the mental health condition.”

Resource: To read more from the CDC on this topic, visit www.cdc.gov/nchs/data/icd/Interim_advice_updated_final.pdf.