Understanding ICD-10-CM Excludes 2 Notes
In ICD-10-CM, Excludes Notes play a vital role in helping coders choose the correct diagnosis codes. While Excludes 1 notes indicate that two conditions cannot be coded together, Excludes 2 notes have a completely different meaning — one that often confuses new coders. Let’s break it down.
What Is an Excludes 2 Note?
An Excludes 2 note means that the condition listed is not included in the code you’re currently looking at, but both conditions can be coded together if the patient truly has both.
In simpler terms:
“It’s okay to use both codes if the documentation supports both conditions.”
Official ICD-10-CM Definition
“An Excludes 2 note represents ‘Not included here.’ An Excludes 2 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 Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together when appropriate.”
Example of an Excludes 2 Note
Example:
I10 – Essential (primary) hypertension
Excludes 2: Hypertensive heart disease (I11.-), Hypertensive chronic kidney disease (I12.-)
Explanation:
If a patient has essential hypertension and hypertensive heart disease, you would code both I10 and I11.-, because the Excludes 2 note allows them to be reported together when both diagnoses are present.
Key Differences Between Excludes 1 and Excludes 2
| Feature | Excludes 1 | Excludes 2 |
|---|---|---|
| Meaning | “Not coded here” | “Not included here” |
| Coding rule | Two conditions cannot be coded together | Both conditions may be coded together |
| Documentation impact | Mutually exclusive conditions | Coexisting conditions allowed |
| Example | Congenital vs. acquired forms of a condition | Hypertension vs. hypertensive heart disease |
Why Excludes 2 Notes Matter
Understanding Excludes 2 notes prevents undercoding and ensures that all relevant conditions are captured for accurate data reporting and reimbursement. Many coders mistakenly omit secondary diagnoses due to misreading these notes.
Coding Tip
Always read the notes beneath every ICD-10-CM code, especially when conditions seem similar. The Excludes 2 list gives essential clues about what else may need to be coded for full documentation accuracy.
In Summary
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Excludes 2 = both codes may be used together if documented.
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Always verify documentation supports both conditions.
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Review Excludes notes for every code to avoid errors.
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Remember that proper use of Excludes 2 ensures complete coding and compliant claims.
Medical Coding ICD-10-CM Chapters
