What an Excludes note is
An Excludes note sits directly under a code or a category in the tabular list and names other codes that relate to it. There are two types, and they behave in opposite ways. The official ICD-10-CM tabular list defines them in its introductory instructions, and that wording is worth reading once, slowly:
Excludes 1 — not coded here
Treat an Excludes 1 note as an absolute rule. If you report the code that carries the note, you cannot also report the code it excludes. There is no documentation that makes the pair acceptable, because the two conditions are mutually exclusive by definition.
The classic case is a congenital form versus an acquired form of the same condition, or an acute form versus its chronic counterpart. When documentation appears to support both, the note is telling you that one of the two descriptions is wrong for this patient — go back to the record rather than reporting both.
Excludes 2 — not included here
An Excludes 2 note is a clarification, not a prohibition. It tells you the excluded condition is not automatically part of the code you are looking at, so the code does not "cover" it. If the provider documented the additional condition separately, you code it separately as well.
In practice, Excludes 2 notes are where thorough coding is rewarded: a record that documents both a primary condition and a related secondary condition should carry two codes, not one.
The two notes side by side
- Excludes 1 — meaning "not coded here". The two codes are mutually exclusive. Never report them together.
- Excludes 2 — meaning "not included here". The conditions are distinct and may coexist. Report both when both are documented.
- Both types appear underneath the code or category they qualify, and both are published by CMS in the official tabular list. This site reads them straight from the official FY 2027 XML.
A worked example from the FY 2027 tabular list
Category A06, Amebiasis, is a good teaching case because it carries both kinds of note at once. Under A06 the tabular list publishes:
- Excludes 1: other protozoal intestinal diseases (A07.-) — so an A06 code and an A07 code may not be reported together.
- Excludes 2: acanthamebiasis (B60.1-) and Naegleriasis (B60.2) — these are separate conditions, so both may be reported when both are documented.
Two notes, one category, opposite instructions. Reading only the first line of an Excludes block is how the second type gets missed.
Notes are inherited from the parent category
Excludes notes are often published on the category rather than on each individual code, and they apply to every code inside that category. The tabular list also uses a trailing dash to mean "the whole category" — for example, A07.- means every code from A07.0 onward.
On this site, a code's detail page shows its own notes and any notes inherited from the parent category, with a note telling you which parent they came from. That matters: the most specific code you report is frequently not the place where the restriction is written.
Why this shows up as denials
- Both codes reported when the note is Excludes 1. The claim fails the edit, or is denied on review.
- Only one code reported when the note is Excludes 2. The second documented condition goes uncoded, which understates severity and can affect payment.
- Notes missed because they sit on the parent category. The child code looks clean in isolation.
How to check excludes quickly
- Open the code and read the Excludes 1 and Excludes 2 sections of its detail page, including anything marked as inherited.
- Click through any excluded code to see the condition it describes, so you can tell whether it is genuinely a different problem.
- Put the whole shortlist into the Claim Validator — it checks a set of codes for Excludes 1 conflicts in one pass.
- When a note and the documentation disagree, the record wins the argument; the note tells you which description to re-read.