A facility coder reviews an ICD-10-CM Tabular Excludes2 note under a respiratory code for a condition the record also documents. How should the Excludes2 note be applied?

Excludes2 means “not included here,” but both conditions may be coded together when documented. If a respiratory code’s Excludes2 note points to another documented condition, the facility coder should assign both codes when both are present in the record. Distinguishing Excludes2 from Excludes1 is a core CCS skill and prevents under-reporting clinically distinct problems in civic respiratory cohorts used for quality, public health, and reimbursement analytics.

Treating Excludes2 the same as Excludes1 and never reporting both fails by concept—the notes have opposite dual-coding implications, and collapsing them causes systematic under-coding. Dropping the secondary condition because Excludes2 “replaces the need for an additional code” fails; Excludes2 invites additional coding when the second condition is documented and clinically distinct. Querying to delete the Excludes2 condition from the record before coding fails because Excludes2 is not a documentation-deletion trigger; it is a classification instruction allowing both codes when supported.

Exam caveat: still verify the conditions are truly distinct and documented; Excludes2 permits dual coding—it does not invent a second diagnosis without provider support, and it does not override other excludes or etiology–manifestation sequencing notes elsewhere in the Tabular List. Operational check: confirm both conditions in provider documentation; assign both when Excludes2 applies; reserve Excludes1 mutual-exclusion logic only for Excludes1 notes; educate staff on the Excludes1 versus Excludes2 distinction with respiratory examples.