Cracking the Code

Excludes Notes

In ICD-10-CM there are two types of “excludes” notes. They are called “Excludes1” and “Excludes2”.  Each type of note has a different definition for use, but they are all similar in that they indicate that codes excluded from each other are independent of each other. ICD-10-CM guidelines I.A.12.a and I.A.12.b explain the coding guidelines further.


Excludes1 reads, “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.”


One exception to this is when the NEC or NOS codes have multiple meanings, such as code F45.8. F45.8 can be used for both teeth grinding as well as psychogenic dysmenorrhea. There is an Excludes1 for code F45.8 that includes sleep-related teeth grinding (G47.63). If the patient is grinding her teeth, the Excludes1 would be in effect and the two codes would not be used together. However, if the patient has psychogenic dysmenorrhea and sleep-related teeth grinding, the two codes F45.8 and G47.63 can be used together.


Excludes2 note reads, “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.”


It is always recommended to check for any Excludes1 or Excludes2 notes for any code selection and parent code.

Q: G40.009, Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus and G40.109, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus can be coded together.
A: No, they cannot be coded together. Rationale: G40.009 has an Excludes1 note for the parent code of G40.0 that reads, Excludes1: adult onset localization-related epilepsy (G40.1-, G40.2-).
Reference: FY 2023 ICD-10-CM code book & guidelines
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