No one has yet been able to articulate to me what subtle information I'm gaining from seeing a code as an Excludes2 that I am not getting from seeing a code as a Code Also (or vice versa). I cannot figure out how they are functionally different categories, but obviously when the-powers-that-be assign something as a either an Excludes2 or a Code Also, they are making that decision based on something. What is it?
To compare and contrast:
Can someone please list an example where changing an Excludes2 section into a Code Also section would lead to incorrect coding?
For initiation, I present the instructions for i25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
Excludes2: Atheroembolism (i75.-), Atherosclerosis of coronary artery bypass graft(s) and transplanted heart (i25.7-), non-ischemic myocardial injury (i5A)
Code Also: the presence of hypertension (i10-i1A)
Thank you,
To save some time, here are the definitions:
Excludes Notes
The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use, but they are all similar in that they indicate that codes excluded from each other are independent of each other.
Excludes2
A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
“Code also” note
A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. The sequencing depends on the circumstances of the encounter.
To compare and contrast:
- Both the "code also ____" code and the excluded "excludes2 ___" code need to be properly documented in my chart for me to add them on my list, but may not be present if the patient simply doesn't have the condition - in which case I would not add them.
- Neither instruction designates a hierarchy for sequencing order, as it will depend on the visit.
- They are both used to add clarity to the picture of what the patient has going on.
- Clearly, if something is listed in an instructional note to be coded at the same time, the book is acknowledging that the recommended code is not inherently included in the initial code.
Can someone please list an example where changing an Excludes2 section into a Code Also section would lead to incorrect coding?
For initiation, I present the instructions for i25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
Excludes2: Atheroembolism (i75.-), Atherosclerosis of coronary artery bypass graft(s) and transplanted heart (i25.7-), non-ischemic myocardial injury (i5A)
Code Also: the presence of hypertension (i10-i1A)
Thank you,