ICD-10-CM Guidelines 2023 I.A. Conventions

Question 1

NEC

Answer 1

• Not elsewhere classifiable
• ‘Other specified’

Question 2

NOS

Answer 2

• Not otherwise specified
• equivalent of unspecified

Question 3

Brackets [ ]

Answer 3

• enclose synonyms, alternative wording or explanitory phrases
• identifies manifestation codes

Question 4

Parenthesis ( )

Answer 4

• enclose supplementary words
• nonessential modifiers

Question 5

“Other” codes

Answer 5

• “other” or “other specified
• info provides greater detail for a code that doesn’t exist

Question 6

“unspecified” codes

Answer 6

information is insufficient to assign a more specific code

Question 7

Includes Notes

Answer 7

appears immediately under a 3-character code to further define or give examples

Question 8

Inclusion terms

Answer 8

terms of conditions for which the code is to be used or synonyms of the code title

Question 9

Excludes 1

Answer 9

• NOT coded here
• code pairs should never be used together
• Ex. a congenital form vs. an acquired form of the same condition
• EXCEPTION: when two conditions are clearly unrelated to each other

Question 10

Excludes 2

Answer 10

• Not Included here
• the condition excluded is not part of the condition represented by the code
• both codes may be used when appropriate

Question 11

Etiology/manifestion

“code first”, “use additional code” and “in diseases classified elsewher

Answer 11

• conditions with an underlying etiology and manifestations due to the etiology
• sequence underlying condition first, followed by manifestation
• manifestations = “in diseases classified elsewhere”
• “In diseases classified elsewhere” may NEVER be used as first listed or principal diagnosis
• manifestion code in [brackets]

G20, [F02.80/1] Parkinson’s, with dementia (with or without behavioral d

Question 12

And

Answer 12

interpreted to mean either “and” or “or” in a code title

Question 13

With

Answer 13

• “with” or “in” means “associated with” or “due to”
• classification presumes a causal relation b/w two codes even in abscence of provider documentation unless another guideline requires documented linkage
• EXCEPTION - sepsis guideline for “acute organ dysfunction that is not clearly associated with sepsis”

Question 14

See

Answer 14

Index instruction; it is necessary to go to the main term referenced

Question 15

See Also

Answer 15

Index instruction; not necessisary to follow but may provide additional Inded entries that may be useful

Question 16

Code Also

Answer 16

Index instruction; two codes may be required to fully describe a condition. Does NOT provide sequencing direction; sequencing depends on the circumstances of the encounter

Question 17

Default code

Answer 17

The code listed next to the main term in the Index; the most commonly associated condition or the unspecified code for the condition.

Question 18

Code assignment and Clinical Criteria

Answer 18

Assignment of a diagnosis code is based on the provider’s diagnostic statement the condition exists. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis. If there is conflicting documentation, query the provider.