detail to ensure the code assignment is not affected. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. The instructional notes include terms and diagnoses included and excluded for each code. It instructs you to code first underlying disease, which in this case, is the cirrhosis of the liver from the alcohol. 850 is a valid billable ICD-10 diagnosis code for Homicidal ideations . 32. Explain the use of V and E codes. Instructional note under I12. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. Multiple codes are required when two codes, the second in brackets and italics, appear after a main term. Located at the etiology code and directs you to assign a manifestation code. code set based on a system maintained by the World Health Organization. Found at the etiology code as a clue to identify the manifestations commonly associated with the disease. In the Alphabetic Index both conditions are listed together with the etiology code first followed by the manifestation codes in brackets. These conventions are incorporated within the Alphabetic Index and Tabular List of ICD-10-CM as instructional notes. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. – The code for the underlying disease will also have an instructional note in the Tabular List to “use additional code” for the manifestation. A “code also” note is an instruction that two codes may be required to. " ICD-10-CM Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. xxxx Drug or chemical-induced diabetes mellitus Code first a dx from (T36-T65) Use additional code for adverse effect (T36-T50) E10. 1 - N18. NEC means not elsewhere classifiable 2. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. 4. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . 2 is classified says to use additional code to identify resistance to antimicrobial drugs (Z16. Inclusion notes. “See” and “See Also” –The “see” instruction following a main term in the And if you scroll down a little farther to N18. In the Tabular List, an instructional note may appear under these category codes to “code first condition resulting from (sequela of)” that particular category. b. This instructional note appears for entities that may develop manifestations, and the. Instructs that there is another main term that may also be referenced that may provide additional alphabetic index entries that may be useful. 30. 1R29. Coding Guidelines and Instructional Notes for ICD-10-CM Chapter 1 0 Instructional note appears at beginning of chapter, "when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site" Use additional codes, where applicable, to identify o Exposure. 3. An instructional note with category Z16 says to code first the infection. In this case the patient has end stage renal disease so N18. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases. followed by the manifestation. The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. N30. Explain the use of V and E codes. 9. For such codes, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code and the rules for sequencing apply The Code Also note is used in ICD-10-CM to instruct the coder that two codes may be needed to fully code a diagnostic phrase. Use Additional Code. About us. In most cases the manifestation codes will have in the code title, "in diseases. ) Only use NEC/NOS codes when no further detail is possible. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . By understanding how to use instructional notes, coders can ensure that they select the correct codes for a. 83. ICD-10-CM Code. The see also instruction in the ICD-10-CM index follows a subterm and refers the coder to another main term that: a. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. There is an instructional note to code also the type of asthma, if applicable (J45. 0 to code first the underlying neoplasm. 15. Abbreviations The "Use additional code" _____. ICD-10-CM;The "See Also" instructional note is a coding guideline that refers the coder to another code or group of codes in the Tabular List of the International Classification of Diseases (ICD). Read and be guided by the instructional notes in both indexes The Alphabetical Index does not always provide the full code. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. Z71. Code first any follow-up examination after treatment of malignant neoplasm (Z08). 11, and reads: “A type 1 Excludes note is a pure excludes note. use additional code for. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation. 01 Conn’s syndrome. defines and or gives examples of the content of a particular category. 0. Most notable was the escalation of available diagnosis codes from 14,000 to 68,000 when ICD-10-CM was first initiated in 2015 (CMS, 2015). Chronic kidney disease, stage 3b Billable Code. 1 states to not assign codes from category Z34 with Chapter 15 codes. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. When you see a “use additional code” note, followed by a list of codes, in the Alphabetic Index, you know to. The anemia is documented to be due to end stage renal disease (ESRD) after workup. There are also instructional notes to use additional code to identify specific organ dysfunction. In addition,. I-8 conventions. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . J30. These items provide guidelines for using the code set. 2 also applies to the following:See” and “See Also” “Code also Note” Default codes Code assignment and Clinical Criteria Points to Remember -When selecting codes, the coder must follow all instructional notes present -Instructional notes, abbreviations, and punctuation provide direction to coders -When cross-references are present in the Index, the additional. Guideline Section IA:13 – Etiology/Manifestation Convention – Code first and Use additional code notes are sequencing rules in the classification of certain codes that are not part of an etiology/manifestation combination. underlying disease, such as: amyloidosis E85Question options: 1 / 1 point What additional code(s) are we advised to use?. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. The definition can be found under number 12A, pg. In most cases the manifestation codes will have in the code title, "in diseases. Study with Quizlet and memorize flashcards containing terms like List the three diagnoses that are included as described by the "inclusion note" for code R56. ICD-10-CM guideline I. a list of abbreviations, punctuation, symbols, typefaces and instructional notes appearing int he beginning of ICD-9. Diseases of the Digestive System. A) Use "additional code" note. ↓ See below for any exclusions, inclusions or special notations. Code N18. What is the ICD-10-CM code for fatigue? R53. The use of ICD-10 code E86. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. ) Assign codes to the highest possible level of detail. 8, B96. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. In most cases, the manifestation codes will have in the code title, “in. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases. -) Use additional code to identify stage of chronic kidney disease ( N18. There are times when a single condition may require multiple coding. Use "additional code" note OB. 1. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. Additional Instructional Notes Excludes -1 Under a three digit category code, an Excludes 1 designation means that the code is NOT CODED HERE and indicates that two codes are mutually exclusive and therefore cannot be coded as separate codes in same encounter (example E66). such a combination exists there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases. but provide additional instruction. 3 is exempt from POA reporting ( Present On Admission). #1. 7. Square brackets are used in the Tabular List of Diseases to: To enclose alternative wordings, abbreviations, and explanatory phrases. 891)The ICD-10-CM is divided into the Alphabetic Index, an alphabetical list of terms and their corresponding code, and the Tabular list, a chronological list of codes divided into chapters based on body system or condition. Selected Answer: is not used in ICD coding. ) Courtesy of the Centers for Medicare & Medicaid Services, 3-1d See Also Instructional Note Another cross-reference note used in ICD-10-CM, the See Also note refers the coder to another location in the Alphabetic Index when the initial listing does not contain all the necessary information to. On the etiology side, the etiology/manifestation combination is signaled by the instructional note “use additional code,” present at the level of the category. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. Instructional notes indicate the proper sequencing order of these conditions-etiology (underlying condition) followed by manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Code Also –A “code also” note instructs that two codes may be required to fully describe a condition, but the sequencing of the two codes depends on the severity of the conditions and the reason for the encounter. ↓ See below for any exclusions, inclusions or special notations. Wherever such a combination exists, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. In most cases the manifestation codes will have in the. means "not coded here" The "code first". Codes mentioned in articles are linked to Code Information pages. Some codes in chapter 10 have been expanded to include notes indicating that an additional code should be assigned or an associated condition should be sequenced first. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Look for Cirrhosis/liver/alcoholic and you are directed to K70. 2). 10. Without further description you are directed to R53. A postcoordination instructional note labeled “Has manifestation (use additional code, if desired)” is a reminder to the user that, depending on the case being coded, it is allowable to post-coordinate any manifestations with the underlying condition. There are multiple additional codes for identified influenza virus infections, including novel A types (avian, swine. Good morning, I am wanting to clarify some red instructional notes in the code book. The two codes are to be sequenced as listed in the "Index to Diseases. combination exists there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code. The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. 2 is a valid billable ICD-10 diagnosis code for Pelvic and perineal pain . This is where you may see a “Use additional” note, or a note that states “Code first”. Manifestations are listed as additional codes. Group of answer choices. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These are sequencing instructions that must be followed. This notation indicates that use of an additional. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. R50. 0 Cerebrospinal fluid leak from spinal puncture Code also any associated diagnoses or complications, such as:There is an instructional note to code also the type of asthma, if applicable (J45. assign an additional code only if the “additional” condition is documented in the health record as being present. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. ”Verified questions. The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings. • Read and follow instructions • Includes & Exclude notes • Use additional code • Code first underlying disease • Code also • Character requirements – 4th, 5th, 6th, & 7th • Age and gender 6 . These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. The instructional note “Use additional code, where applicable, to identify exposure to environmental tobacco smoke (Z77. Indicates that an additional code should be used, if available. Excludes2 means that the condition is not a part of the condition that is being represented by the code, but the patient can have both conditions at the same time. Thromboarteritis - see arteritis. In most cases the manifestation codes will have in the code title, "in diseases. In most cases the manifestation codes will have in the code title, "in diseases. Take note of the tabular instructions for code M31. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . When there is a "code first" note and an underlying. There are several organ dysfunctions listed it the ICD-10-CM Index, but this list is not an exhaustive. Category P00 Code first note and excludes2 note 1. ” (See Reference 1) For instance, if a patient has a diabetes, the coder may use the code E11. There is no information of the infectious agent and no additional code is reported. What is the ICD-10-CM code for nausea? R11. true false Appendix C contains coding examples to assist in the selection of. Wherever such a combination exists there is a 'use additional code' note at the etiology code, and a 'code first' note at the manifestation code. This note indicates that an additional code should be used, if available. Best answers. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 2. (See Appendix A, Section I. Use additional Characters (red. They do not assign B96. In the Tabular List, the 6th character 2 is selected to specify the left ovary. R56. 850 in processing claims, check the following: — See additional coding rules. The ICD-10-CM Index does have instructional notes to code first the underlying infection. is used in the Tabular The note "Includes" _____. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . Verified answer. ” A corresponding instructional note is present at subcategory R50. provide general information on usage in a specific section. R29. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. When you look up this code in the Tabular List, you’ll find an instructional note to “Code also” adrenal adenoma (D35. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 22) history of tobacco use (Z87. , The "See Also" instructional note refers the coder to another location in the Tabular List. The Instructional Note under code U07. 88 Other and unspecified bacterial agents as the cause of diseases classified to other chapters. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These notes are used to signal that, when there is an underlying etiology and multiple body system manifestation due to the underlying etiology, two codes are needed. g. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. a. 9. Your Answer:true Appendix C contains coding examples to assist in. [Brackets] are an ICD-10-CM convention indicating the enclosed code is. As with all DM categories, an Excludes 1 note excludes all other DM, including gestational, neonatal, and postprocedural. Whenever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. A) when the note appears under a code, it is acceptable to use both the code and the excluded code together when applicable. For instance, if a patient has a diabetes, the coder may use the code E11. 3. When a code does not exist that accurately describes the procedure/treatement, the coder should report an unlisted code. instructional notes. Chapter 1 of the ICD-10-CM guidelines provides incredibly detailed instruction on coding for sepsis, severe sepsis, and septic shock infections. Wherever such a combination exists, a Use additional code note is found with the etiology code, and a Code first note is found with the manifestation code. The applicable 7 th character is required for all codes within the category, or as the notes in the Tabular List instruct. but provide additional instruction. Dysphagia, unspecified Billable Code. At the beginning of Chapter 10, Diseases of the Respiratory System (J00-J99) there is an instructional note to Use additional code, where applicable, to identify tobacco dependence (F17. If the coder sees a "see" note, they should follow the cross-reference to where it tells you to go to review extra entries in the index. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. 22 ? Type 1 diabetes mellitus with chronic kidney disease due to conditions. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. ICD-10-CM Official Guidelines for Coding and Reporting FY 2024 Page 8 of 120 5. Instructional notes in the Alphabetic Index and the Tabular List guide coders when selecting ICD-10-CM codes by providing additional instructions. False When an "Includes" note appears after. Breakdown the ICD-10-CM Guidelines. These conventions are. %PDF-1. In most cases, the manifestation codes will have in the code title “in diseases classified elsewhere. It is necessary to go to the main term referenced with the "see" note to locate the correct code. Instructional notes Punctuation marks Abbreviations Symbols. 83) Use additional code to identify: chronic total occlusion of coronary artery (I25. Wherever such a combination exists, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code. following previous Cesarean delivery 034. A. The additions for FY 2021 presently pushing the number of codes to over 70,000. Whenever such a combination exists, there is a use an additional code note at the etiology code, and a code first note at the manifestation code. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07. Learn your Medical Coding Conventions and Guidelines. There is advice at the beginning of this chapter to use an additional code to identify resistance to antimicrobial drugs using. It is necessary to go to the main term referenced with the "see" note to locate the correct code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. E66. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. True B. 2. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. 6). All codes in ICD-10-CM Chapter 10. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . appears in the Tabular NOS means not otherwise specified. FIGURE 18-5 Example of. R91. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 0 would be reported in chapter ____ of ICD-10-CM. Often, instructions appear in one place, but aren’t repeated by each code,” said. 001. ICD-10-CM Coding Tips Instructional Notes and Common Coding Mistakes . When an Excludes _____ note appears under a code, it is acceptable to use both the code and the excluded code together. code first any associated physical or developmental disorders. Brackets enclose all but which one of the following? essential modifiers. ICD-10-CM guideline I. A component of. Whenever such a combination exists, there is a use an additional code note at the etiology code, and a code first note at the manifestation code. These conventions are incorporated within the Index and Tabular List of the ICD-10-CM as instructional notes. These instructional notes indicate the proper. The additional code is always listed after the primary code. These instructional note indicate the proper sequencing order of the codes, etiology followed by manifestation, if applicable Underlying condition. A) a combination code. 6 End stage renal disease, you will notice a “use additional code” instructional note to identify dialysis status. Use additional code, where applicable, to identify: history of tobacco dependence (Z87. 20 c. ( True/False) Question 2. Category J05 Use Additional code note and Code Also 9. -). 9 in processing claims, check the following: — See additional. When you look up this code in the Tabular List, you’ll find the instructional note to “Use additional code” to identify any functional activity (this determines the order). instructs the coder to select a code to represent the etiology that caused the manifestation. An ICD-10-CM "other specified" code: a. C. which may or may not be followed by the ICD-9-CM code number, nonessential modifiers, or followed by Instructional Notes. An instructional note for Chapter 1 where B95. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. It is found in the 2024 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2023 - Sep 30, 2024 . In Diseases Classified Elsewhere. infection. In disease classified else. Expert tip: “Tab your copy of ICD-10 with reminders. A note under category J01 Acute sinusitis states that an additional code (B95-B97) is used to identify the infectious agent, if known. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. ↓ See below for any exclusions,. The instructional notation "USE ADDITIONAL CODE" instructs the coder to: Add a second code to fully code the diagnosis. precalculus. 621 Type 1 diabetes mellitus with foot ulcerConventions of ICD-10: The general rules for use of the classification independent of guidelines. It consists 1. The SEE ALSO instructional note. 65 is a valid billable ICD-10 diagnosis code for Type 1 diabetes mellitus with hyperglycemia . 1 - N18. b. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. A list of abbreviations, punctuation, symbols, typefaces, and instructional notes appears at the beginning of the ICD-9. that it is a pure excludes note. What diagnosis code(s) should be reported for acute and chronic cystitis? a. BracketsCode Also Instructional Note The Code Also note is used in ICD-10-CM to instruct the coder that two codes may be needed to fully code a diagnostic phrase. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. Use the primary code and change the number of units to match the number of biopsies taken Use the appropriate add-on code for a different technique Use the appropriate add-on code for the appropriate technique Use the primary code and only bill one unitE66. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. 44 (Sepsis following a procedure). , Instructional notes appear in both the Tabular List and Alphabetic Index of ICD-10-CM. g. These instructions signal the coder that an additional code should be reported to provide a more complete picture of that diagnosis. This would code: Fibrillation > atrial > postoperative complication > paroxysmal. includes general notes, inclusion and exclusion notes, "code first" notes, "use additional code" notes and "code also" notes. The patient is also a type 1 diabetic with diabetic retinopathy and diabetic neuropathy. 12. Wherever such a combination exists, there is a use additional code¨ note at the etiology code, and a, ¨code first¨note at the manifestation code. additional instruction. Introduction to ICD-10-CM. Z98. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07. 82) exposure to environmental tobacco smoke (Z77. A "use additional code" note will normally be found at the infectious disease code, indicating a need for the organism code to be added as a secondary code. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. 3) Rationale: A note under the code for type 2 DM with diabetic CKD instructs to use an additional code to identify the stage of CKD (N18. are introduced by the word "includes" when placed at the beginning of a chapter or section. 9 (Diabetes mellitus type 2 without complications) to code this diagnosis. 13. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Study with Quizlet and memorize flashcards containing terms like combination codes for. As a result, it is crucial to follow the symbols, conventions, instructional notes, and guidelines mentioned throughout the book. Study with Quizlet and memorize flashcards containing terms like When a code does not exist that accurately describes the procedure/treatement, the coder should report an unlisted code. 891) tobacco dependence (F17. ) Only use NEC/NOS codes when no further detail is possible. 0 also applies to the following: Inclusion term. Code N75. The "use additional code" note is. the use of ICD 9 codes is mandated by HIPAA for. 00 is found in the ICD-10-CM chapter entitled _____. Neither of these two codes are acceptable as the PDX. 1 also applies to the following:R94. You will also find instructional notes that say code first or use additional code. ” Per the coding guidelines, this instructional note is found in the Tabular List with codes that are not part of an etiology/manifestation pair where a secondary code is useful to fully describe a condition. Mar 5, 2021. 3 is a valid billable ICD-10 diagnosis code for Pseudocyst of pancreas . Verify the codes in the tabular list and assign codes in this order: I87. 0) CONVENTIONS 12 • Instructional Notes •“Code also” ‐alerts coder that more than one code may be required to describe the condition ‐does not provide sequencing directions manifestation. 89 (other post-procedural complications and disorders of the circulatory system, not elsewhere classified) and I48. Adherence to these guidelines when assigning -10-CM ICD diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). 01 Conn’s syndrome. Two “use additional code” notes appear to remind the coder to use an additional code to identify the infectious agent. ICD-10-CM guideline, I. general notes, inclusion and exclusion notes, code first notes, use additional code notes, and code also notes. The Includes note is used to define, give examples, or both, of the content of a category. See Note: an instruction following the main term in the Alphabetic Index that indicates that another term should be referenced - for correct coding it is necessary to go to the main term referenced with this note. The 7th character must always be the 7th character in the data field. These instructional notes indicate the proper sequencing order of the codes: etiology, followed by manifestation. NOS. -). 8. Select one: a. 2. Coding Notes for Chapter 10 Chapter Notes: When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e. You are directed to R11. 7th Character Certain ICD-10-CM categories have applicable 7th characters. -) •Tobacco use (Z72. In most cases the manifestation codes will have in the code title, "in diseases. Examples of these notes include: Use additional code to identify the infectious agent; Use additional code to identify the virus; Code first any associated lung abscessCode First/Use additional code These instructional notes provide sequencing instruction. 10. exists, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code. The notes also remind the code to use an additional (secondary) code to show the dialysis status (Z99. " In the "Index to Diseases," the multiple coding requirement is. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. The 7 th character must always be the 7 th character in the data field. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.