Each month, AmeriHealth will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from different specialties and popular disease categories to demonstrate the granularity that the new ICD-10 code set will provide.
CODING CONVENTION/GUIDELINE: Excludes1 and Excludes2, and Borderline Diagnosis Codes
Similar to ICD-9, there are coding conventions, general guidelines, and chapter-specific guidelines in ICD-10. These conventions and guidelines are rules and instructions that must be followed to classify and assign the most appropriate code. As with ICD-9, adherence to these guidelines is required under the Health Insurance Portability and Accountability Act (HIPAA). Many of the conventions and guidelines in ICD-9 are the same in ICD-10. This article will focus on a new Coding Convention: Excludes1 and Excludes2, and a new General Coding Guideline: Borderline Diagnosis Codes.
Excludes1 and Excludes2
- A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" It corresponds with what the current ICD-9 Excludes note indicates. An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 note is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- K51.4 - Inflammatory polyps of colon
- adenomatous polyp of colon (D12.6)
- polyposis of colon (D12.6)
- polyps of colon NOS (K63.5)
- 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.
- acute laryngotracheitis (J04.2)
- acute tracheitis (J04.1)
J37.1 - Chronic laryngotracheitis
Examples of Specific Borderline Entries:
- F60.3 Borderline personality disorder
- R41.83 Borderline intellectual functioning
- H40.021 Open angle with borderline findings, high-risk, right eye