# ICD Code Finder: frequently asked questions URL: https://icdcodefinder.com/faq ## Plans, pricing and privacy Source: https://icdcodefinder.com/pricing **Is ICD-10-CM search really free?** Yes. Searching, browsing the tabular list and index, viewing code details, GEMs and FY updates are free for everyone, with no account required. **Do I need my own AI API key?** No. Every plan includes hosted AI credits. On Pro and Team you can also bring your own key (OpenAI, Anthropic, Google Gemini or OpenRouter); requests on your own key never use credits and are billed to you by your provider. **What happens when I reach my AI limit?** The AI tools pause until your allowance resets. Search, code pages, code sets and every non-AI check keep working. You can upgrade at any time. **Can I enter patient information?** No. De-identify notes before pasting. ICD Code Finder does not store clinical text, and the self-serve plans are not covered by a Business Associate Agreement (BAA). **Can I cancel anytime?** Yes. Manage or cancel your subscription from the billing portal on your account page. Paid features stay on until the end of the current billing period. **How does the Team plan work?** The subscriber becomes the team owner and invites colleagues by email. Members get Pro features plus shared team code sets, owners can review a team audit log, and hosted AI credits are pooled across the team. **Are the codes official? Can I bill from AI suggestions?** Codes come from the CMS/NCHS ICD-10-CM public release for the current fiscal year. AI output is a suggestion that must be verified against the Tabular List, the Official Guidelines and payer policy before reporting. ## Excludes1 vs Excludes2 in ICD-10-CM Source: https://icdcodefinder.com/guides/excludes1-vs-excludes2 **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. ## How ICD-10-CM Codes Are Structured Source: https://icdcodefinder.com/learn/icd-10-cm-code-structure **How many characters does an ICD-10-CM code have?** Between 3 and 7. A three-character category is valid on its own only when it has no further subdivisions; otherwise the code must be reported to the full number of characters required. **What is a billable ICD-10-CM code?** An informal term for a code that is valid for reporting because it is complete, meaning it has the full number of characters required. Codes that have more specific codes beneath them are category or subcategory headers and are not valid on a claim. **Is ICD-10-CM the same as ICD-10?** No. ICD-10 is the World Health Organization classification. ICD-10-CM is the US clinical modification maintained by the National Center for Health Statistics (NCHS) for diagnosis coding, with much more detail. Procedures in US inpatient settings use a separate system, ICD-10-PCS. ## ICD Code Finder for CDI Specialists Source: https://icdcodefinder.com/for/cdi-specialists **Does ICD Code Finder write queries for me?** The Query Builder drafts a provider query from a de-identified documentation excerpt and the clinical question. The draft is a starting point; you review and edit it so it is compliant, non-leading and appropriate before sending it through your organization's process. **Can I paste clinical notes into the AI tools?** Only de-identified text. ICD Code Finder does not store clinical text, removes common identifiers before text reaches the AI provider and asks you to confirm de-identification, but no automated scrubber is perfect. The self-serve plans are not covered by a Business Associate Agreement. **Does it show HCC information?** Code pages show an HCC V28 badge when a code maps to a payment HCC in the mapping loaded with the code set. Confirm against the CMS mapping for the payment year. ## 7th Characters and the Placeholder X in ICD-10-CM Source: https://icdcodefinder.com/guides/seventh-characters-and-placeholder-x **Is a code valid without its required 7th character?** No. When a category requires a 7th character, every code in it must have one. A code that has not been coded to the full number of characters required is invalid. **Why do some codes have an X in the middle?** ICD-10-CM uses X as a placeholder to keep the 7th character in the 7th position when the code has fewer than six characters, and in some categories to allow for future expansion. Where a placeholder exists, the X must be used for the code to be valid. **Does 7th character A mean the first visit?** No. For injuries, A (initial encounter) is used for each encounter where the patient is receiving active treatment for the condition. A patient seen by a new provider for the first time during the healing phase gets D (subsequent encounter), not A. **How do I code a sequela?** Use 7th character S on the injury code and also code the specific sequela (the late effect). The sequela code is sequenced first, followed by the injury code with S. ## GEMs and the ICD-10-CM Fiscal Year Update Cycle Source: https://icdcodefinder.com/learn/gems-and-fy-update-cycle **When do new ICD-10-CM codes take effect?** The annual update takes effect on October 1, the start of the federal fiscal year. CMS can also implement a mid-year update effective April 1 when needed. **Which code set applies to a claim that spans October 1?** For inpatient stays, the code set in effect on the date of discharge applies. For outpatient services, use the code set in effect on the date of service. **Can I code a patient record using GEMs?** No. GEMs translate between code sets for data and research purposes. Many mappings are approximate or map one code to several, so each case must still be coded from the documentation using the Alphabetic Index, the Tabular List and the Official Guidelines. **Where can I see what changed this fiscal year?** The ICD-10-CM release files from CMS and NCHS include the tables of new, revised and deleted codes. ICD Code Finder lists them on its FY updates page, and code pages carry New and Revised badges. ## ICD Code Finder for Billing and Revenue Cycle Teams Source: https://icdcodefinder.com/for/billing-teams **Can ICD Code Finder tell me if a code is billable?** Yes. Every code page shows whether the code is a complete (billable) code, a header that needs more characters, or a code that requires a 7th character, for the current fiscal year. **Does it check payer policies?** No. It checks codes against the ICD-10-CM code set and its instructional notes. Payer coverage and medical necessity policies must be checked separately; the Medical Necessity AI tool can help review diagnosis support, but its output must be verified. **How do teams share code sets?** On the Team plan, the owner invites colleagues by email, members can work with code sets shared with the team, and the owner can review an audit log of changes. ## HCC V28 Overview for Coders Source: https://icdcodefinder.com/learn/hcc-v28-overview **What does HCC stand for?** Hierarchical Condition Category. HCCs group related ICD-10-CM diagnosis codes into categories, and hierarchies make sure only the most severe category in a related group counts for a patient. **When did V28 fully replace V24?** CMS blended the two models during the transition, with V28 weighted more each year from payment year 2024, and used V28 alone for payment year 2026. **Do I code differently because of HCCs?** No. ICD-10-CM codes must be assigned from provider documentation according to the Official Guidelines, regardless of whether a code maps to an HCC. Coding a condition to affect risk scores without supporting documentation is not acceptable. **Does ICD Code Finder show HCCs?** Code pages show an HCC V28 badge when the code maps to a payment HCC in the mapping loaded with the code set. Always confirm against the CMS mapping for the payment year you are working on. ## ICD Code Finder for Coding Students Source: https://icdcodefinder.com/for/coding-students **Is ICD Code Finder free for students?** Yes. Searching and browsing ICD-10-CM, code pages, the alphabetic index, GEMs and FY updates are free for everyone without an account. A free account adds favorites, history and a few code sets. **Can I use it in a certification exam?** Check your exam's rules. Many coding certification exams allow only specific printed manuals, so practice with the official code book as well. **Should I learn from AI suggestions?** Use them to check your reasoning, not to replace it. Work the case yourself first, then compare, and always confirm codes in the Tabular List and the Official Guidelines. ## ICD-10-CM Code Sequencing Basics Source: https://icdcodefinder.com/guides/code-sequencing-basics **What is the difference between principal and first-listed diagnosis?** Principal diagnosis is the inpatient term, defined as the condition established after study to be chiefly responsible for occasioning the admission. First-listed diagnosis is the outpatient term for the condition chiefly responsible for the services provided during the encounter. **Can a manifestation code be the first-listed diagnosis?** No. Manifestation codes cannot be reported as first-listed or principal diagnoses. The etiology (underlying condition) is sequenced first, followed by the manifestation. **How are probable or suspected diagnoses coded in an outpatient visit?** They are not coded as confirmed. For outpatient encounters, code the condition to the highest degree of certainty known at the visit, such as the symptoms, signs or abnormal findings. **What if two diagnoses equally meet the definition of principal diagnosis?** When two or more interrelated or comparative conditions each potentially meet the definition, either may be sequenced first unless the circumstances of admission, the therapy provided, the Tabular List or the Alphabetic Index indicate otherwise. ## How to Find the Right ICD-10-CM Code Source: https://icdcodefinder.com/guides/finding-the-right-code **Why can't I code straight from the Alphabetic Index?** The Index does not show the instructional notes, 7th character requirements or the full set of more specific codes. The Official Guidelines require you to locate each term in the Index and then verify the code in the Tabular List. **What is a default code in ICD-10-CM?** The code listed next to a main term in the Alphabetic Index is the default code. It represents the condition most commonly associated with the main term, or is the unspecified code for the condition, and is used when the record documents the condition without more detail. **When is an unspecified code acceptable?** When the documentation does not support a more specific code. Unspecified codes are appropriate when information about a more specific condition is not known or not documented, though querying the provider is often the better option. **What does NEC mean?** Not elsewhere classifiable. It is used when the record gives a specific condition but ICD-10-CM has no specific code for it, so it falls into an "other specified" code. ## About ICD Code Finder Source: https://icdcodefinder.com/about **Who operates ICD Code Finder?** Public Health Solution LLC, 2003 Plank Road **Where does the ICD-10-CM data come from?** From the public ICD-10-CM releases published by CMS and the National Center for Health Statistics (NCHS) for each fiscal year. ICD Code Finder is not affiliated with, endorsed by or sponsored by CMS, NCHS or the World Health Organization. **Does ICD Code Finder store patient data?** No. Do not enter protected health information. Clinical text sent to the AI tools must be de-identified, is not stored, and the self-serve plans are not covered by a Business Associate Agreement. --- Disclaimer: ICD Code Finder is an informational tool and is not a substitute for professional coding judgment, payer policy, or the official ICD-10-CM classification and guidelines. Not affiliated with, endorsed by, or sponsored by CMS, NCHS, or the World Health Organization. AI suggestions require review by a qualified coder.