Understanding the 'not included here' note in ICD-10-CM coding

Not Included Here: What that note really means in ICD-10-CM coding

If you’re learning ICD-10-CM, you’ll meet a lot of small notes that carry big weight. One note you’ll see sometimes after a code is the phrase “not included here.” It sounds simple, but it can change how you report a patient’s conditions. Let me break down what this note means, why it matters, and how to handle it in real-world scenarios.

What the note actually tells you

Here’s the thing: when you see “not included here” after a code, it signals that the condition or diagnosis mentioned in the note is not part of the description or scope of the code it accompanies. In plain language, the main diagnosis is covered by that code, but the excluded condition is intentionally kept separate.

This note helps prevent a coder from assuming that two different problems are bundled into one code when they aren’t. It’s a clarifying signpost. It’s not saying the patient can’t have both problems at once; it’s saying the code you’ve chosen does not cover the excluded condition.

Two quick points to keep in mind

• It’s not a blanket statement about all possible coexisting conditions. The excluded item may still exist in the chart, but it would typically require its own code.

• It’s not a signal that you should ignore the excluded condition. If the chart shows that condition, you often report both conditions with separate codes, following the rules for sequencing.

A practical way to see it: how it guides coding decisions

Think of the code as a spotlight on the primary issue. The “not included here” note tells you there’s another issue in the room that needs its own spotlight—its own code. This keeps the picture accurate and complete for billing and for clinical documentation.

Two short examples help make this concrete, without getting hung up on exact code numbers:

• Example 1: You’ve coded a respiratory condition with a note “not included here” indicating that another, separate condition—say an acute infection—belongs to a different code. If the patient truly has both COPD and an acute bronchitis, you’d report the COPD code for the chronic condition and a second, separate code for the acute bronchitis. The note warns you not to assume the bronchitis is included in the COPD code.

• Example 2: A chart shows chronic kidney disease and an unrelated nephritis. The code you’re looking at for CKD might carry a “not included here” note about nephritis. This signals that nephritis isn’t part of the CKD code’s scope. If nephritis is documented and clinically significant, you’d assign a separate code for it as well, rather than trying to squeeze it into the CKD code.

What this means for patient care and billing

Accuracy matters, and notes like “not included here” exist to prevent misrepresentation of a patient’s health status. When a chart contains multiple problems, every issue that meets coding criteria should be reflected with its own code if appropriate. That ensures:

• The medical record accurately reflects the patient’s conditions.

• Payers receive the right information to justify the services provided.

• Clinicians and care teams have a clear, complete picture to guide treatment decisions.

If you ever wonder why this matters beyond bureaucratic precision, consider this: the notes help keep clinical stories straight across different departments—emergency, inpatient, outpatient, and specialty clinics. They’re little signposts that help prevent mix-ups when a patient’s problems overlap.

How to handle “not included here” in real-life charts

• Read the code and its accompanying notes carefully. If you see “not included here,” pause and verify what is explicitly excluded.

• Check the patient’s documentation. Do you see the excluded condition documented as present or as a separate diagnosis? If yes, you’ll likely code both conditions separately.

• Confirm the relationship and sequencing. The primary diagnosis often drives the visit’s main purpose, but the excluded condition can still be a relevant secondary diagnosis. Sequence accordingly according to coding guidelines and the clinical scenario.

• Avoid assuming; verify with the chart. If the record doesn’t clearly demonstrate the excluded condition, you may need to leave it out or seek clarification.

• Use the note as a guide, not a rule that shuts down the possibility of coexisting conditions. It’s a boundary line, not a fence.

A light touch of memory aids (without turning this into a slog)

• Think of “not included here” as a boundary line: the code’s job is to capture one condition, and the note says, “This other thing isn’t inside the fence.”

• If two conditions are present and both meet criteria for reporting, you can (and often should) code them separately—one for the primary issue, one for the excluded one, as long as documentation supports it.

• When you’re stuck, pause and re-check the Excludes notes. They’re designed to steer you toward accuracy, not confusion.

Common misinterpretations worth avoiding

• Believing that “not included here” means the excluded condition cannot occur with the coded condition. Not true. It means it’s not part of that code’s scope; reporting both may be appropriate.

• Assuming the excluded condition is always independent of the primary condition. Sometimes there’s a clinical link—but the coding rules still require separate codes unless the notes specifically say otherwise.

• Ignoring the note because you’re in a hurry. Accuracy in documentation and coding pays off in the long run for patient care and reimbursement.

A quick, practical takeaway

• When you see “not included here,” treat it as a cue to review the chart for a potential second code. If the excluded condition is present and documented, you’ll likely report it separately.

• If the chart doesn’t clearly show the excluded condition, don’t force-fit it into the primary code. Documentation matters, and it’s okay to seek clarification when needed.

A short, helpful contrast to keep in mind

• Not included here versus conditions that may occur together: If a note says not included here, it’s excluding the condition from the primary code’s scope. If a note says the conditions may occur together, you’re more clearly guided to code them both as appropriate, but with the usual rules about coexisting conditions.

A tiny quiz, just to anchor the idea

Question: What does the note "not included here" imply in ICD-10-CM coding?

A. The condition excluded is part of the included one

B. Conditions that occur together may be reported

C. That further information is required

D. The excluded condition is not part of the reported code

Answer: D. The excluded condition is not part of the reported code.

Why this answer makes sense: The note “not included here” clearly signals that the excluded condition isn’t encompassed by the code you’re using. It’s a boundary that helps ensure you don’t mistake inclusion for exclusion. The other options miss the key point: the note isn’t saying you don’t need more information, nor that conditions can’t occur together, nor that you always need more data. It’s about scope.

Real-world relevance

For clinicians and coders alike, these notes are more than tiny print. They’re the kind of details that protect the integrity of medical records and the fairness of billing. When you’re documenting, you want your notes to “speak” clearly to anyone who reads them later: the primary issue, plus any coexisting conditions that require separate attention. The “not included here” tag helps keep that conversation precise.

Bringing it all together

ICD-10-CM coding often feels like learning a new language, one full of careful phrases and fine distinctions. The note “not included here” is one of those phrases that rewards careful attention. It’s a reminder that a code is a focused lens, not a full map of every possible diagnosis the patient has. When you apply this understanding, you’ll code more accurately, tell the patient’s story more faithfully, and keep billing aligned with the care delivered.

If you’re someone who loves the clarity of a well-structured chart and the satisfaction of neat, compliant coding, you’ll appreciate how these tiny notes shape big outcomes. They’re not flashy, but they’re essential. And as you build fluency with them, you’ll notice your confidence rise—one careful code at a time.