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!
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.
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:
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.
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.
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:
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.
Recent updates to the Health Insurance Portability and Accountability Act (HIPAA) represent the most significant shift in healthcare privacy and security requirements in over a
It is a bummer when you get hoisted on the petard of intellectual inconsistency. Whether it is different medical professionals with different approaches to a
Please log in to your account to comment on this article.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
