ICD-10-CM Excludes 1 and Excludes 2 Meanings and Examples

September 20, 2021
 / 
Rick Gawenda
 / 
3 Comments
 / 

Fiscal Year (FY) 2022 ICD-10-CM codes become effective with dates of service between October 1, 2021 – September 30, 2022. In addition, the FY 2022 ICD-10-CM codes are to be used for discharges occurring from October 1, 2021 through September 30, 2022. In this article, I will answer the following questions:

  1. In the tabular section of the ICD-10-CM book, I often see Excludes 1 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 1”. What does Excludes 1 mean and can you give an example?
  2. In the tabular section of the ICD-10-CM book, I often see Excludes 2 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 2”. What does Excludes 2 mean and can you give an example?
  3. What resources are available to me in assisting me with understanding ICD-10-CM better?

Let’s begin!

Question
In the tabular section of the ICD-10-CM book, I often see Excludes 1 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 1”. What does Excludes 1 mean and can you give an example?

Answer

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Question
In the tabular section of the ICD-10-CM book, I often see Excludes 2 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 2”. What does Excludes 2 mean and can you give an example?

Answer

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Question
What resources are available to me in assisting me with understanding ICD-10-CM better?

Answer

The content here is for members only log in here or sign up.

Click HERE to access my ICD-10 FAQs. I hope you found this article helpful. Thank you for being a Gold Member!

All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. Reply

    Hi Rick!

    We received a Mgd B denial from Molina Healthcare for Excludes 1 diagnosis coding with: R26.2 (Difficulty walking not elsewhere classified) and R26.81 (Unsteadiness on feet). I researched this and found this (very large) table where I can look these up. https://www.icd10data.com/ICD10CM/Codes I also found your article on this topic very helpful and I have documented your examples to share with staff.

    My question is: Are rehab providers educating their staff, proactively on this topic? And, if so, how are they looking up the Excludes 1 pairs that affect rehab therapists?

    I think there should a table somewhere that we can more easily see all the therapy tx diagnoses that cannot be billed together? Or are the ones you shared pretty much all there is to worry about for rehab providers?

    Thanks for your thoughts,

    Kari Carroll
    EncompassCare

    1. Reply

      There is no table due to the number of Exclude1 pairs. I do provide education on ICD-10 coding. I have 2 webinars available for purchase under Past Webinars on my website and I will be doing a PT, OT and SLP Pediatric ICD-10 webinar on September 13, 2023.