Centers for Medicare and Medicaid Services

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), for coding and reporting in the United States. The ICD-10-CM is a morbidity classification for classifying diagnoses and reason for visits in all American health care settings. Excerpted from ICD-10 Clinical Modification on Wikipedia, the free encyclopedia.

Instructional NotationsEdit


The word "Includes" appears immediately under certain categories to further define, or give examples of, the content of the category.

Excludes NotesEdit

The ICD-10-CM has two types of excludes notes. Each note has a different definition for use but they are both similar in that they indicate that codes excluded from each other are independent of each other.


A type 1 Excludes note is a pure excludes. 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 for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.


A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition it is excluded from 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.

Code First/Use Additional Code notes (etiology/manifestation paired codes)Edit

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.

In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.

Code Also:
A code also note instructs that 2 codes may be required to fully describe a condition but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter.

7th characters and placeholder X
For codes less than 6 characters that require a 7th character a placeholder X should be assigned for all characters less than 6. The 7th character must always be the 7th character of a code


  1. Certain infectious and parasitic diseases (A00-B99)
  2. Neoplasms (C00-D48)
  3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
  4. Endocrine, nutritional and metabolic diseases (E00-E90)
  5. Mental and behavioral disorders (F01-F99)
  6. Diseases of the nervous system (G00-G99)
  7. Diseases of the eye and adnexa (H00-H59)
  8. Diseases of the ear and mastoid process (H60-H95)
  9. Diseases of the circulatory system (I00-I99)
  10. Diseases of the respiratory system (J00-J99)
  11. Diseases of the digestive system (K00-K93)
  12. Diseases of the skin and subcutaneous tissue (L00-L99)
  13. Diseases of the musculoskeletal system and connective tissue (M00-M99)
  14. Diseases of the genitourinary system (N00-N99)
  15. Pregnancy, childbirth and the puerperium (O00-O99)
  16. Certain conditions originating in the perinatal period (P00-P96)
  17. Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
  19. Injury, poisoning and certain other consequences of external causes (S00-T98)
  20. External causes of morbidity (V01-Y99)
  21. Factors influencing health status and contact with health services (Z00-Z99)


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