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.