A Plethora of Changes to Excludes 1 and 2 Notes

A Plethora of Changes to Excludes 1 and 2 Notes

Today I am going to be referencing Excludes 1 and 2 note changes that occurred with the code set update for the 2024 fiscal year, which just occurred on Oct. 1. So, being a few weeks in, I want to make sure everyone is paying attention to the notes.

One thing that commonly gets overlooked in the code update webinars is the Excludes notes that are listed in the tabular index. These are extremely important to know, as they might be a source of denials if you are coding conditions that should not be coded together, leading to an MCC or CC, and I have also found that during auditing, coders are commonly missing these notes, leading to decreased accuracy scores. If you have not had a chance to review all the Excludes 1 and 2 notes for this year, I will be highlighting some of the bigger changes that occurred, but I highly recommend that each of you go back and review the chapter tabular sections – and pay close attention to the Exclude notes.

Let’s start with a reminder of what an Excludes 1 is versus an Excludes 2.

These are shortened definitions from the 2024 Official Coding Guidelines:

Excludes 1 = A type 1 Excludes note is a pure excludes note. It means “not coded here.”  An Excludes 1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes 1 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.

Excludes 2 = A type 2 Excludes note represents “not included here.” When anExcludes 2 note appears under a code, it is acceptable to use both the code andthe excluded code together, when appropriate.

So, let’s go ahead and jump in!

Chapter 1: Certain infectious and parasitic diseases.

Under code range A50-A64, which is Infections with a predominantly sexual mode of transmission,

there was an Excludes 1 note when coded with HIV code B20.

This year, this has been converted to an Excludes 2 note, and can now be coded with codes in that range. So, for example, when a patient has syphilis and HIV, both can be coded.

Chapter 2: Neoplasms.


Under D12, Benign neoplasm of colon, rectum, anus, and anal canal there was an Excludes 1 note when coded with benign carcinoid tumors of the large intestine and rectum (D3A.02-) and

Polyp of colon NOS (K63.5).

This has been converted to an Excludes 2. So, for those of you who code gastrointestinal procedures, during colonoscopies, where pathology shows benign or (adenomatous) polyps on one section of the colon and another section they find hyperplastic polyps, the two can be coded together. Your D12 code and K63.5:

Chapter 4: Endocrine, nutritional and metabolic diseases.


There was a new code added this year for Wasting Syndrome, E88.A. Under E88.A there is an Excludes 1 note for: Cachexia (R64) and Nutritional murasmus (E41). There is an Excludes 2 for Failure to thrive (R62.51, R62.7).

So, when you code wasting syndrome, you may also code failure to thrive. Please also note that there is a code-first note under wasting syndrome, and you first need to code the underlying condition.

Chapter 6 Diseases of the nervous system.


Under code G93.4, Other and unspecified encephalopathy, there was a Type 1 note when coded with

alcoholic encephalopathy (G31.2) encephalopathy in diseases classified elsewhere (G94) and

hypertensive encephalopathy (I67.4).

This converted to an Excludes 2, so now other and unspecified encephalopathy can be coded, for example, with hypertensive encephalopathy.

Chapter 10: Change Diseases of the respiratory system.

Under code J43, Emphysema, there was an Excludes 1 when coded with: emphysema with chronic (obstructive) bronchitis (J44.-) (COPD)

This is now converted to an Excludes 2. This is a big change, since Coding Clinic has given us guidance that COPD and emphysema should not be coded together, but this now takes precedence. Emphysema with a COPD exacerbation can be coded together now. Let me repeat that: COPD exacerbation with emphysema can now be coded together.

Last but not least, let’s look at:

Chapter 16: Certain conditions originating in the perinatal period.

Under code P28.5, Respiratory Failure of Newborn, there was an Excludes 1 note when coded with: respiratory arrest of newborn (P28.81) respiratory distress of newborn (P22.0-).

This has converted to an Excludes 2 note. So, we are now able to code acute respiratory distress (ARDS) along with newborn respiratory failure.

So, those are some of the bigger Exclude 1 and 2 note changes, but please make sure to go and read all them.

Facebook
Twitter
LinkedIn

Patty Chua, RHIT, CCS, CCDS

Patty Chua, RHIT, CCS, CCDS, is the founder and COO for Innova Revenue Group. She has more than 20 years or experience in the HIM/CDI/coding industry and is one of the nation’s foremost experts in coding and clinical documentation integrity (CDI). She is proficient in all aspects of CDI, revenue optimization, inpatient and outpatient coding, auditing, charge capture, and regulatory compliance.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024
Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.

September 12, 2024

Foundations of Outpatient Clinical Documentation Integrity: Best Practices for Accurate Coding and Compliance

This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.

September 5, 2024
Preventing Sepsis Denials: From Recognition to Clinical Validation

Preventing Sepsis Denials: From Recognition to Clinical Validation

ICD10monitor has teamed up with renowned CDI expert Dr. Erica Remer to bring you an exclusive webcast on how to recognize sepsis, how to get providers to give documentation that will support sepsis, and how to educate to avert sepsis denials. Register now and become a crucial piece of the solution to standardizing sepsis clinical practice, documentation, and coding at your facility.

August 22, 2024

Trending News

Featured Webcasts

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024
The OIG Update: Targets and Tools to Stay in Compliance

The OIG Update: Targets and Tools to Stay in Compliance

During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.

September 19, 2024
Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

This webcast, presented by Tiffany Ferguson, LMSW, CMAC, ACM, addresses the critical gap in Social Determinants of Health (SDoH) reporting for pediatric populations. While SDoH efforts often focus on adults, this session emphasizes the unique needs of children. Attendees will gain insights into the current state of SDoH, new pediatric Z-codes, and the importance of interdisciplinary collaboration. By understanding and applying pediatric-specific SDoH factors, healthcare professionals can improve data capture, compliance, and care outcomes. This webcast is essential for those looking to enhance their approach to pediatric SDoH reporting and coding.

August 8, 2024
Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, VP of CDM, for a webcast addressing oncology service coding challenges. Learn to navigate coding for infusions and injections alongside Evaluation and Management (E/M) services, ensuring compliance and accurate reimbursement. Gain insights into documenting E/M services for oncology patients and determining medical necessity. This webcast is essential to optimize coding practices, maintain compliance, and maximize revenue in oncology care.

July 30, 2024

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!