OASIS Alert

New notes clear up blurred exclusion instructions.

While many coding conventions will remain the same as you make the transition from ICD-9 to ICD-10, there are a few differences of which you'll need to be aware. One major change is that ICD-10 has two different types of excludes notes. Make sure you understand the difference to keep the diagnosis codes you list in M1020/M1022 accurate.

In ICD-9, an excludes note can have two different meanings. In ICD-10, there are two different types of excludes notes, each with a distinct meaning.

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 for injury and trauma) and V55.1 (Attention to gastrostomy) in M1020/M1022.

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 M1020/M1022 in addition to the Z48.-code if appropriate.