Confused About Multiple Dx Coding? Check Out This ‘Excludes’ Guideline Update

Posted on 25 Jan, 2016 |comments_icon 4|By Chris Boucher

CDC makes decision on temporary rule.

Even though overall results for ICD-10 coding implementation have been positive, some practices have hit a few bumps along the way. Many of those bumps have involved the “Excludes1” notations in your diagnosis coding manual.

Help’s here: Fortunately, the Centers for Disease Control (CDC) has addressed that issue, creating a new temporary guideline that will help you report some multiple diagnoses together.

“There are circumstances that have been identified where some conditions included in ‘Excludes1’ notes should be allowed to both be coded, and thus might be more appropriate for an Excludes2 note,” the CDC said in a memorandum.

While the CDC memo laid bare its concerns on “Excludes” notes, there isn’t much official it can do about the issue until next year.

“Due to the partial code freeze, no changes to ‘Excludes’ notes, or revisions to the official coding guidelines, can be made until October 1, 2016,” the memo reads.

Follow this Guidance for Unrelated Issues

Until the powers that be can clear up the “Excludes” issue officially, the CDC advises practices to use its temporary guidance, which advises that if two conditions are unrelated to each other, you can report them both, even if an “Excludes1” note exists.

“For example, the ‘Excludes1’ note at code range R40-R46 states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes,” the CDC says in its memo. “However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and the mental health condition.”

Resource: To read more from the CDC on this topic, visit

(For more information on all topics related to Part B, check out Part B Insider at:


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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