CCO Admin asked:
I am currently studying for the CPC exam. I am looking for a definitive answer explaining (CPT book) what exactly does "Excludes" mean. Are "excludes" to remind you to add codes that are not included; or are they codes to literally are not allowed to be used with current code. It may be a goofy question but want a definitive answer on how to interpret what "excludes" mean.
Answer:
Excludes 1 notes means "NOT CODED HERE!" This tells a coder that the two conditions cannot happen together; however; if the provider specifically is clear the two conditions are not related; then it would be appropriate to code both conditions. As per the ICD-10-CM coding guidelines section I.A.12.a; "An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes 1 note are related or not; query the provider. For example; code F45.8; Other somatoform disorders; has an Excludes I note for sleep related teeth grinding (047.63);"because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However; psychogenic dysmenorrhea is also an inclusion term under F45.8; and a patient could have both this condition and sleep related teeth grinding. In this case; the two conditions are clearly unrelated to each other;
and so it would be appropriate to report F45.8 and 047.63 together."
Excludes 2 notes mean that both codes can be coded together. Per the coding guidelines section I.A.12.b "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."
For example; if a patient had pain in their right shoulder (M25.511) and pain in their right hand (M79.641); it is appropriate to code both codes even though codes from M25.5- (Pain in Joint) has an excludes 2 note for pain in hand (M79.64-).
I am currently studying for the CPC exam. I am looking for a definitive answer explaining (CPT book) what exactly does "Excludes" mean. Are "excludes" to remind you to add codes that are not included; or are they codes to literally are not allowed to be used with current code. It may be a goofy question but want a definitive answer on how to interpret what "excludes" mean.
Answer:
Excludes 1 notes means "NOT CODED HERE!" This tells a coder that the two conditions cannot happen together; however; if the provider specifically is clear the two conditions are not related; then it would be appropriate to code both conditions. As per the ICD-10-CM coding guidelines section I.A.12.a; "An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes 1 note are related or not; query the provider. For example; code F45.8; Other somatoform disorders; has an Excludes I note for sleep related teeth grinding (047.63);"because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However; psychogenic dysmenorrhea is also an inclusion term under F45.8; and a patient could have both this condition and sleep related teeth grinding. In this case; the two conditions are clearly unrelated to each other;
and so it would be appropriate to report F45.8 and 047.63 together."
Excludes 2 notes mean that both codes can be coded together. Per the coding guidelines section I.A.12.b "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."
For example; if a patient had pain in their right shoulder (M25.511) and pain in their right hand (M79.641); it is appropriate to code both codes even though codes from M25.5- (Pain in Joint) has an excludes 2 note for pain in hand (M79.64-).
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