Brackets in the ICD-10-CM Tabular List show which terms are supplementary and point to manifestation codes.

Brackets in ICD-10-CM: a small symbol with a big impact

If you’ve spent time with the Tabular List of ICD-10-CM codes, you’ve probably noticed the little square brackets tucked into the pages. They aren’t there to look fancy or to clutter things up. Brackets are a practical tool. They guide you to the extra words that aren’t essential to the code’s meaning but can offer helpful context. Here’s the thing: understanding brackets helps you see when a term is optional and when you’re dealing with a manifestation code. The correct answer to the quiz-style question often reads: To identify manifestation codes. Let me explain how that works in real life, not just on a test.

A closer look at what brackets do

In plain terms, brackets enclose supplementary words. These are descriptors that provide additional information about the condition, but they don’t change the core meaning of the primary code. Think of brackets as margin notes in a study Bible—clarifying details that might be helpful but aren’t required to pin down the diagnosis.

• They add nuance, not necessity. If the main code identifies diabetes mellitus, a bracketed term might specify a related detail like a complication or a type. The code selection remains the same; the bracketed words are optional descriptors.

• They flag nonessential modifiers. If a term is inside brackets, you’re unlikely to need it to justify the main diagnosis. It’s extra information that might be useful to a clinician or a coder, but it doesn’t mandate a different code.

Why this matters for accuracy

Coding isn’t just about matching a name to a label. It’s about capturing the patient’s condition as fully and accurately as possible while staying faithful to the coding rules. Brackets help you separate what’s essential from what’s optional. That distinction matters when you’re deciding which code best represents the patient’s presentation.

• If the bracketed material would change the fundamental meaning of the code, you’d typically need a different approach. But when the brackets simply add detail, your main code stays the anchor.

• When you see bracketed terms, you’re reminded to review whether that extra detail is present in the chart. If it is, you may decide to note it as a manifestation or related descriptor—but only if the chart clearly supports it and the coding guidelines call for it.

A practical example that sticks

Let’s ground this with a straightforward example. Imagine you’re coding a patient who has diabetes mellitus. The Tabular List entry might look like this in a simplified sense:

• Diabetes mellitus [with complications such as nephropathy or retinopathy]

Here, the bracketed words “with complications such as nephropathy or retinopathy” are supplementary. They give a sense of what might accompany diabetes, but they don’t inherently change the code for diabetes itself. The core code remains focused on the diabetes diagnosis, while the bracketed language hints at possible manifestations (nephropathy, retinopathy) that clinicians might document or that a coder might consider as separate, related codes if the chart supports them.

This arrangement reflects a broader principle: some information in medical records is supportive rather than essential for classifying the patient’s primary condition. Brackets help you recognize that boundary.

Brackets and manifestation codes: what’s the link?

You may have heard that brackets help identify manifestation codes. Here’s the practical take: when you encounter bracketed terms, you can think about whether those terms point to manifestations—conditions that arise as a consequence of the primary disease. In many coding scenarios, brackets cue you to consider whether a manifestation code should be used in addition to, or instead of, the main diagnosis code, depending on what the medical record shows.

• The main code still has to match the patient’s core condition.

• Bracketed terms may signal where a manifestation is present, which can influence whether you add an accompanying manifestation code.

• In all cases, you must rely on the chart documentation and the official coding guidelines to decide if a separate manifestation code is appropriate.

A few tips to stay precise

If you’re aiming for solid, dependable coding, here are small steps you can follow when brackets show up in the Tabular List:

• Read the main code first. Identify what the code is clearly saying about the disease or condition itself.

• Look at the bracketed terms as optional descriptors. They’re there to add flavor, not to redefine the diagnosis.

• Check the clinician’s notes for evidence of a related manifestation. If the chart documents a specific complication, you may need to code that manifestation separately in addition to the primary condition.

• Don’t force bracketed words into a code if the chart doesn’t support them. The code must reflect the patient’s actual documentation.

• If you’re ever unsure, preserve the main code’s essence and flag the bracketed information for follow-up with a supervisor or a coding guideline reference.

A gentle digression that helps with memory

Hospitals, clinics, and coding teams rely on consistency. Brackets are one small but steady part of that system. When you see bracketed phrases, it’s a cue to review the related documentation. It’s a bit like seeing asterisk footnotes in a scientific paper: they don’t alter the core finding, but they point you to extra context that can be useful in the right circumstances. The trick is to know when that context matters for coding, and when it doesn’t.

Common scenarios where brackets matter most

• Chronic conditions with potential complications. Diabetes is a classic example where complications may appear in brackets. If a patient has nephropathy and that detail is documented, you’ll need to assess whether to code the complication alongside the primary diagnosis, depending on the record and the guidelines.

• Conditions with multiple presentations. Some diseases can present in several forms. Brackets help you see that a particular description is present but optional, so you focus on the core diagnosis first.

• Documentation gaps. If the chart mentions bracketed terms but lacks solid evidence for a related manifestation, you’ll likely avoid adding extra codes out of caution and adhere to the documented facts.

Keeping the meaning clear while staying thorough

The balance in coding is between accuracy and usefulness. Brackets are a small tool with big consequences. They can help you avoid overcoding by signaling that certain terms are not mandatory for the code’s meaning, while still nudging you to consider manifestations when the chart supports them.

• Clarity first. Your primary code should reflect the patient’s main diagnosis as documented.

• Context second. Bracketed terms are a source of optional detail that can enhance understanding of the patient’s condition.

• Documentation always rules. The chart provides the truth about what’s present. Let the documentation guide whether to attach manifestation codes or keep things simple.

A quick, friendly recap

• Brackets in the Tabular List enclose supplementary words.

• These terms provide extra information but aren’t essential for the main code’s meaning.

• They can help indicate potential manifestations, guiding you to consider additional codes if the chart supports them.

• Always align your coding with the documentation and the official guidelines.

If you keep these ideas in mind, brackets stop feeling like a trivia gimmick and start feeling like a practical tool you can lean on. They’re not a roadblock; they’re a helpful nudge toward accuracy, nuance, and good record-keeping.

The path forward, with confidence

Coding is a blend of science and storytelling. You’re charting the patient’s health journey with precision, yet you’re also interpreting how much detail to include. Brackets make that interpretation a little clearer by signaling which descriptors are optional and where manifestations might come into play. In the end, your goal is to reflect the patient’s true health status as documented by clinicians, while staying faithful to the coding rules that keep medical records consistent across providers and settings.

If you’re ever unsure, take a breath, review the main code, glance at the bracketed terms, and check the chart for evidence of any related manifestations. With practice, brackets become a natural part of your coding rhythm—like punctuation that keeps ideas from running too far ahead of themselves.

And that’s the heart of the matter: brackets aren’t about complicating the code. They’re about clarifying and guiding you to the right level of detail, so you can code with both accuracy and care.