Pulmonology Coding Alert
Reader Question ~ 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 should 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. These codes often require additional digits before selecting and reporting.
Example: At 461.x (Acute sinusitis) in the tabular list in your code book, 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 this 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: Section 480-487 (Pneumonia and Influenza) in the tabular list says: “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 occurs when your coding manual alerts you with a note to “code also” or “use additional code for.”
Example: For 510.x (Empyema), the description beneath the heading tells you to “Use additional code to identify infectious organism (041.0-041.9).”
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