# Excludes1 vs Excludes2 in ICD-10-CM

URL: https://icdcodefinder.com/guides/excludes1-vs-excludes2  
Updated: 2026-10-30  

> An Excludes1 note means "not coded here": the excluded condition is never reported with the code above the note, because the two cannot occur together. An Excludes2 note means "not included here": the excluded condition is a different condition, and both codes may be reported together when the patient has both.

## Key takeaways

- Excludes1 = NOT CODED HERE. The two conditions are mutually exclusive, such as a congenital form and an acquired form of the same condition.
- Excludes2 = NOT INCLUDED HERE. The patient may have both conditions, so both codes can be reported when both are documented.
- Excludes notes at a category apply to every code in that category, so check the notes above the code you picked, not just the code itself.
- The guidelines allow an exception to Excludes1 when the two conditions are unrelated to each other.

ICD-10-CM has two kinds of Excludes notes, and they mean opposite things for whether two codes can appear on the same claim. This guide walks through how to read each one, where the notes live in the Tabular List, and the one exception the Official Guidelines allow for Excludes1.

## Step 1: Find every Excludes note that applies to the code

Excludes notes appear in the Tabular List under a chapter, block, category, subcategory or individual code. A note applies to the code it sits under **and to every code below it** in the hierarchy. So before you settle on a code, read the notes at:

1. The code itself.
2. Its subcategory and category (for example, the notes at a three-character category apply to all of its four-, five-, six- and seven-character codes).
3. The block and chapter, where present.

On every code page, ICD Code Finder lists the notes found on the code itself first, then the notes inherited from parent codes, labeled with the code they come from.

## Step 2: If it is Excludes1, treat it as "not coded here"

The ICD-10-CM Official Guidelines (Section I.A.12.a) describe an Excludes1 note as a pure excludes note. It means **"NOT CODED HERE!"**: the code excluded should never be used at the same time as the code above the note.

An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

A familiar example: category E11 (Type 2 diabetes mellitus) carries an Excludes1 note for type 1 diabetes mellitus (E10.-). A patient's diabetes is classified as one type or the other, so E11.- and E10.- are not reported together for the same patient.

What to do:

- If the documentation supports the excluded condition rather than the condition you were coding, switch to the excluded code.
- If the documentation is contradictory (for example, it describes both the congenital and the acquired form), query the provider instead of reporting both.

## Step 3: Check whether the Excludes1 exception applies

The guidelines add an exception: when the two conditions are **unrelated to each other**, it is permissible to report both codes even though an Excludes1 note exists between them.

This exception exists because some Excludes1 notes are broad, and a patient can have two separate problems that happen to sit on opposite sides of a note. The test is clinical relatedness, not convenience. When it is not clear from the record whether the conditions are related, the right step is a provider query, not an assumption.

## Step 4: If it is Excludes2, report both when both are documented

An Excludes2 note means **"Not included here."** The excluded condition 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 (Section I.A.12.b).

What to do:

- Report the second code only when the second condition is documented and meets the reporting rules for the setting (for example, it affects care during the encounter).
- Excludes2 is not an instruction to add a code. It only tells you the other condition is classified somewhere else.

## Step 5: Re-check the final code set

After you have chosen all the codes for the encounter, check every pair against the Excludes1 notes of each code and its parents. ICD Code Finder's Code Set Builder flags Excludes1 conflicts between codes in a set (including notes inherited from parent codes), along with non-billable headers and codes that are missing a required 7th character. A flag is a prompt to review the documentation and the exception above, not an automatic error.

## Quick comparison

| | Excludes1 | Excludes2 |
|---|---|---|
| Meaning | Not coded here | Not included here |
| Can both codes be reported? | No, except when the conditions are unrelated | Yes, when both conditions are present and documented |
| Typical reason | The two conditions cannot occur together (for example, congenital vs acquired form) | The conditions are different and can coexist |
| Guideline | Section I.A.12.a | Section I.A.12.b |

## Frequently asked questions

**What is the difference between Excludes1 and Excludes2?**

Excludes1 means the excluded code should never be used at the same time as the code above the note, because the two conditions cannot occur together. Excludes2 means the excluded condition is not part of the condition represented by the code, but a patient may have both, so both codes may be reported together when appropriate.

**Can I ever report two codes that have an Excludes1 relationship?**

Yes, in one situation. The ICD-10-CM Official Guidelines (Section I.A.12.a) allow both codes when the two conditions are unrelated to each other. If you are unsure whether the conditions are related, query the provider.

**Do Excludes notes apply to subcodes?**

Yes. A note at the category or subcategory level applies to every code below it, so a code inherits the Excludes notes of its parent codes.

**Is an Excludes2 note an instruction to add the other code?**

No. Excludes2 only tells you the other condition is coded elsewhere. Report the second code only when the second condition is documented and meets reporting requirements.

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Informational, not coding advice. This page summarizes ICD-10-CM conventions for education. Always code from the medical record using the current ICD-10-CM Tabular List, Alphabetic Index and Official Guidelines for Coding and Reporting, plus payer policy.

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