Pediatric Coding Alert

READER QUESTIONS:

Adhere to Inclusion/Exclusion Instructions

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?


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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).”
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