Wiki Excluded notes

[lmramsey]

Hi Everyone!

I keep having this same dicussion over and over with my supervisor and some of the auditors. What is the exact meaning of exlcudes notes?

I understood it to mean that whatever is in the exludes notes is not coded under that code, but under another one. The auditors keep saying that it means that you can only code one of the codes, not both.

The current disagreement is about using 724.00 (spinal stenosis) and 729.1 (myalgia) together. They say that 729.1 excludes all categories 720-724.9, and therefore, only one can be coded. I say that because 724.00 is about the spine and 729 is about muscles, spinal stenosis cannot be coded as 729, but both conditions can be coded. Coding one does not mean the other cannot be, just that the spine condition is a different number than the muscle one.

Please help!
Lucinda

 

[jdyoutsey]

I agree with you Lucinda. I learned it as (per your example) spinal stenosis is not a part of myalgia, therefore it is excluded from a diagnosis of myalgia, and requires its own diagnosis.

 

[mitchellde]

If you read your ICD-9 guidelines you will notice that an excludes means one of two things. That either you cannot code the two conditions together or that you should could them together, so for instance an acquired condition excludes the congenital condition and they can never be coded together, however in the musculoskeletal area if the two conditions are in the same area you cannot code them both but if they are on different areas then you can. ICD - 10 CM has fixed this confusion

 

[jdyoutsey]

Thanks for the clarification Debra! Just another example of how important it is to keep up on the guidelines.