Excludes1 vs. Excludes2: Chiropractic Coding Made Simple

Hot Topics from the KMC University HelpDesk

When it comes to ICD-10 coding for chiropractic care, accuracy isn’t just recommended—it’s required. One common area of confusion for many providers is how to properly apply Excludes1 vs Excludes2 notes in diagnosis coding. These guidelines are more than just fine print; they directly impact your claim acceptance and compliance.

In this HelpDesk video, Rebecca from the KMC University specialist team explains what these terms mean, how they work, and why chiropractors must pay close attention when assigning diagnosis codes.

What Are Excludes1 and Excludes2?

Excludes1 means two diagnosis codes should never be reported together on the same claim. It indicates that the two conditions are mutually exclusive. If you see an Excludes1 note in your coding tool or ICD-10 book, it’s a red flag to stop and reassess your selections.

Excludes2, on the other hand, allows for more flexibility. It suggests that while two diagnoses may appear related, they can both be reported if the documentation supports their presence. Often, an Excludes2 code includes a more detailed or specific version of another condition, which may better match the patient’s actual complaint.

Why This Matters in Chiropractic Billing

Coding to the highest level of specificity is critical. Whether you’re using a printed ICD-10 book or a digital coding tool like Find-A-Code, understanding these exclusions will help you submit cleaner claims and reduce the chance of denial or audit.

Let’s take a common example:

You might be tempted to code both low back pain (lumbago) and sciatica together.

However, if you use the more specific diagnosis of lumbago with sciatica, right side, then low back pain becomes redundant—and in this case, excluded.

That’s an Excludes1 scenario. Reporting both would be incorrect because the more specific code already includes the general diagnosis.

Tips for Chiropractors and Billing Teams

  • Always check for Excludes1 and Excludes2 notes in your coding tools.
  • Code to the highest level of specificity. The more detailed your coding, the better your compliance and reimbursement outcomes.
  • Use software or books that show Excludes notes clearly, so you don’t accidentally combine incompatible codes.
  • Educate your team so that everyone understands the implications of using (or misusing) exclusion notes.

Final Thoughts

Understanding the difference between Excludes1 and Excludes2 isn’t just about following the rules—it’s about protecting your practice from denials, delays, and compliance risks. These distinctions help clarify which diagnoses can and cannot be billed together, saving time and money in the long run.

If you need support navigating diagnosis coding or want to make sure your team is on the right track, Reach out to our HelpDesk anytime for expert support and training. We’re here to help you make sense of the complex world of chiropractic reimbursement and compliance.