Changes to Excludes1 and Excludes2 for FY 2018 in ICD-10-CM

Changes to Excludes1 and Excludes2 for FY 2018 in ICD-10-CM

Article excerpted from the September 2017 issue of For The Record magazine. The ICD-10 changes for FY2018  are effective for discharges October 1, 2017 and after.

by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA

In addition to numerous code changes in the ICD-10-CM code set, there are 22 Excludes1 notes that will be changing to Excludes2 notes. The Cooperating Parties* had issued interim guidance in October, 2015 acknowledging that some modifications were required to the Excludes1 notes within the system.

First, a couple definitions from the ICD-10-CM Official Guidelines for Coding and Reporting FY 2017.

I.A.12.a: Excludes1

“A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” 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 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.”

I.A.12.b: Excludes2

“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.”

For FY2018, a significant attempt has been made to determine if an Excludes1 note is always appropriate in the current location, resulting in these 22 changes. Many of the Excludes1 note changes for FY2018 not only change these to an Excludes2 note, but also change the location of the Excludes2 to more specific code locations within the category. These changes will now provide specific guidance on additional code assignment to only some codes within the category, rather than the entire category.

This is a significant and truly beneficial effort on the part of CMS and the Cooperating Parties*.  I encourage you to explore these changes and understand their implications.

* Members of the four “Cooperating Parties” are responsible for the ICD-10-CM/PCS and ICD-9-CM Coding Guidelines.  The Cooperating Parties consist of

  • The American Health Information Management Association (AHIMA),
  • the American Hospital Association (AHA),
  • the Centers for Medicare and Medicaid Services (CMS), and
  • the National Center for Health Statistics (NCHS)


Looking for a comprehensive and insightful review of the October 1, 2017 Code Updates? Consider Lynn’s online courses: ICD-10-CM Code Update and ICD-10-PCS Code Update available from Libman Education. Learn more here.


About the Author

Lynn Kuehn is president of Kuehn Consulting, LLC, and a nationally recognized authority on ICD-10-PCS coding. Lynn was elected to the AHIMA Board of Directors, served as faculty for the original ICD-10 “Train-the-Trainers” program, and authored or co-authored several of AHIMA’s most popular books including ICD-10-PCS: An Applied Approach, recognized as the “go-to” resource for learning and mastering ICD-10-PCS. As a Subject Matter Expert with Libman Education, Lynn’s unique and engaging teaching methods as well as her leadership on the importance of accuracy and efficiency in coding is recognized by clients and students throughout the country.

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