ICD 10 Coding Alert

Hint: Two kinds of 'excludes' notes exist in ICD-10 aftercare codes. While many coding conventions will remain the same as you make the transition from ICD-9 to ICD-10 in 2013, you'll need to be aware of a few crucial differences for accurate reporting. Get a head start on your ICD-10 readiness by checking out the following three changes you'll have to deal with starting on Oct. 1, 2013. 'Excludes' May Mean Two Different Things One major change is that ICD-10 has two different types of "excludes" notes. While this might seem like another layer of complication in coding, it will actually clear up one of ICD-9's little quirks. In ICD-9, an "excludes" note can have two different meanings. Excludes1 means 'NOT CODED HERE.' As a matter of fact, you should never report the excluded code at the same time as the code above the Excludes1 note. Excludes1 means the 'two conditions cannot take place together.' Instead, an Excludes2 note tells you that the excluded term should be reported using another code. However if the patient has both conditions you may report both codes. In other words, when an Excludes2 note appears under a code it's acceptable to use both the code as well as the excluded code together. Currently, some ICD-9 "excludes" notes indicate that you should never report a code for the excluded term in conjunction with the code you have located in the tabular list. Example: An "excludes" note under V54.1 (Aftercare for healing traumatic fracture) indicates that this is not the correct code category for reporting aftercare following joint replacement surgery. In ICD-10, this type of "excludes" note is labeled as "Excludes1." For example, ICD-10 code category Z47.- (Orthopedic aftercare) carries the note: "Excludes1: aftercare for healing fracture -- code to fracture with 7th character D." In other instances, an ICD-9 "excludes" note can mean that you will need to list a second code in addition to the one you are considering if your patient has both conditions. Example: ICD-9 subcategory V58.4 (Other aftercare following surgery) has an "excludes" note indicating that these codes do not cover attention to artificial openings. So if you were coding for a patient who had suffered a subdural hematoma during an automobile accident and also needed care and teaching for a new gastrostomy, you would list both V58.43 (Aftercare following surgery for injury and trauma) and V55.1 (Attention to gastrostomy). In ICD-10, this type of "excludes" note is labeled as "Excludes2." For example, category Z48 (Encounter for other postprocedural aftercare) lists an Excludes2 note that reads "Excludes2: encounter for attention to artificial openings (Z43.-)encounter for fitting and adjustment of prosthetic and other devices (Z44-Z46)." You would list these codes in addition to [...]