Pediatric Coding Alert

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 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: Under 461.x (Acute sinusitis) in the tabular list, 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 the condition with a code 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: In section 480-487 (Pneumonia and Influenza) in the tabular list, you will see: “Excludes--pneumonia: allergic or eosinophilic (518.3); aspiration: NOS (507.0), newborn (770.18), solids and liquids (507.0-507.8); congenital (770.0); lipoid (507.1); passive (514); rheumatic (390).”

Sometimes you must use more than one code to fully identify a condition or disease. This situation is when your coding manual alerts you with a note to “code also” or “use additional code for.”

Example: For 599.0 (Urinary tract infection, site not specified), the description beneath the heading tells you to “use additional code to identify organism, such as Escherichia coli [E. coli] (041.4).”