contain a use additional code instruction in the ICD-10-CM tabular list. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. ICD-10-CM Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. When using code n52. 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. appears in the Tabular NOS means not otherwise specified. Identify the main term below that has an instructional note indicating another main term may need to be referenced providing an additional index entry to report the diagnostic code. I-8 conventions. 1 Code First note 8. In the following problem, find polar and Cartesian forms for all three cube roots of the complex number. 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). , Instructional notes appear in both the Tabular List and Alphabetic Index of ICD-10-CM. 890. 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. The instructional notes include terms and diagnoses included and excluded for each code. Under code T81. There is no mention of vomiting. These instructional notes indicate the proper sequencing order of the codes, etiology flowed by manifestation if applicable Use additional code, where applicable, to identify: history of tobacco dependence (Z87. 891) tobacco dependence (F17. 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. The "use additional code" note will be found under the associated condition code in the "Tabular List of Diseases. 9. The "Excludes" notes give examples of the content of a section of the code book. locate main term in index. This notation indicates that use of an additional code may provide a more complete picture of the diagnosis or procedure. Use additional Characters (red. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 0 can also apply to. In most cases the manifestation codes will have in the code title, "in diseases. 5. The "use additional code" note is. "See" and "See Also": The "see" instruction following a main term in the Alphabetic Index shows that. antonyms of code titles or "unspecified" terms. R10. 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 additional code *indicates that an additional code should be used, if available *additional code is always listed after the primary code. 2 is a valid billable ICD-10 diagnosis code for Nausea with vomiting, unspecified . These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 01 Conn’s syndrome. Codes mentioned in articles are linked to Code Information pages. 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 Additional Code: Note at the etiology code to alert the coder that a manifestation code is needed. 9. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. A “code also” note is an instruction that two codes may be required to. ( True/False) Question. Otoscopy confirmed acute infection of the canal, with erythema and pus in the canal noted on exam. Code the following diagnosis: Seizure. c. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 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. 0 Rationale: Look in the ICD-10-CM Alphabetic Index for Nausea. Use additional code to identify type of heart failure (I50. use additional code for. ↓ See below for any exclusions, inclusions or special notations. Korsakoff's (Wernicke) disease, psychosis or. For influenza NOS (not otherwise specified), ICD-10 directs you to use J11. Excludes 1: fever and chills. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 850. R50. 22) •History of tobacco use (Z87. 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 . Brackets An instructional note with code N39. ↓ See below for any exclusions, inclusions or special notations. The SEE ALSO instructional note. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. precalculus. Selected Answer : The code should be sequenced first . ICD-10-CM guideline I. Some people are interpreting a "use additional code" note to mean that the secondary code must always appear in the diagnosis field immediately following the. 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). 30. Question 1. The applicable 7 th character is required for all codes within the category, or as the notes in the Tabular List instruct. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. When it applies, codes missing this character are. When it applies, codes missing this character are. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These items provide guidelines for using the code set. However, if the coder also sees the instructional note of "Use an Additional Code" in the ICD 10 CM Code Book in the Tabular List, the coder would then also provide an additional code to provide. Instructional notes indicate the proper sequencing order of these conditions-etiology (underlying condition) followed by manifestation. It is used in the alphabetical Index of ICD-10-CM and instructs the coder that another term should be referenced. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 32 is a valid billable ICD-10 diagnosis code for Chronic kidney disease, stage 3b . 1 states: Hypertension with heart conditions classified to I50. Hypertension With Heart Disease. R13. 6). 0-). followed by the manifestation. ” Verified questions. E86. These instructional note indicate the proper sequencing order of the codes, etiology followed by manifestation, if applicable Underlying condition. Create flashcards for FREE and quiz yourself with an interactive flipper. A) when the note appears under a code, it is acceptable to use both the code and the excluded code together when applicable. 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. Use an additional code to identify the infectious agent. Select one: True False. 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. Code First :In this scenario the patient has a history of alcohol use making K70. 0-). These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Introduction ICD-10 was endorsed by the 43rd World Health Assembly in May 1990 and came into use in WHO Member States in 1994 (including US) The classification is the latest in a series, which has its origins in the 1850s The first edition, known as the International List of Causes of. 1. The patient is alcohol dependent. C. , An additional codes instructional note is listed under code 33881. An instructional note will be found at the infection code advising that an additional organism code is required. 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. It is necessary to go to the main term referenced with the "see" note to locate the correct code. However, if the coder also sees the instructional note of "Use an Additional Code" in the ICD 10 CM Code Book in the Tabular List, the coder would then also provide an additional code to provide. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. These instructional notes indicate the proper. , Modifiers are used to identify when no procedure is done. b. 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. This notation indicates that use of an additional 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 . 0 would be reported in chapter ____ of ICD-10-CM. ↓ See below for any exclusions, inclusions or special notations. 00, N30. If coded incorrectly and missing the instructional notations, it could result in a claim denial or medical record review. Category J05 Use Additional code note and Code Also 9. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. urinary tract infectious organism of Klebsiella identified, the coder must follow the instructional note under N39. “Code first” and “Use additional code” notes are also used as sequencing rules in the classification for certain codes that are not part of an etiology/manifestation. This note is used to provide additional information or clarification on the coding of a specific condition or diagnosis. instructional notes. when the note appears under a code, it is acceptable. 0 is a valid billable ICD-10 diagnosis code for Abdominal distension (gaseous) . is used in the Tabular The note "Includes" _____. 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. At the beginning of Chapter 15 there is a note to use an additional code from Category Z3A Weeks of gestation, to identify the weeks of gestation for codes O00-O9A. Select one: True False. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. False T/F - NEC means not elsewhere coded. ICD 10 CM ___________ include the following: Instructional notes, Abbreviations, Cross-reference notes, Punctuation marks, and Relational terms. Abbreviations The "Use additional code" _____. . 0 Acute cystitis . Verified answer. i. E26. R13. Correctly use instructional terms and symbols as defined in the ICD-9-CM. followed by the manifestation. In most cases the manifestation codes will have in the code title, "in diseases. This indicates the sequencing. True. 0 is a valid billable ICD-10 diagnosis code for Celiac disease . 9. The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings. 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. Often, instructions appear in one place, but aren’t repeated by each code,” said. 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 . An instructional note in the Tabular List instructs us to use an additional code to identify alcohol and/or tobacco use and/or dependence, history of tobacco dependence, and/or exposure to tobacco smoke. instructional notes. , specific ear diseases) may be more extensive, contain additional. a. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. The “Use additional” code note is found below the underlying condition code. c. Instructional notes appear in both the Tabular List and Alphabetic Index of ICD-10-CM. 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 also indicate when additional codes are required to fully describe the condition you are coding. In addition,. In most cases the manifestation codes will have in the code title, "in diseases. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Your Answer:false An additional codes instructional note is listed under code 33881. is not used in ICD coding; In ICD coding, the code first is not used. 07 is a valid billable ICD-10 diagnosis code for Spinal stenosis, lumbosacral region . In most cases the manifestation codes will have in the code title, "in diseases. b. 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. Square brackets are used in the Tabular List of Diseases to: To enclose alternative wordings, abbreviations, and explanatory phrases. Instructional notes, like Inclusion and Excludes notes, are located in the. The additions for FY 2021 presently pushing the number of codes to over 70,000. ICD-10-CM: type 2 DM with diabetic CKD (E11. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 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. Learn Test Match Q-Chat Created by chubut Chapter 3 Terms in this set (20) Conventions include: Instructional notes, Abbreviations, Cross-reference notes, Punctuation marks,. 0. In most cases the manifestation codes will have in the code title, "in diseases. The "use additional code" note is. The see also instruction in the ICD-10-CM index follows a subterm and refers the coder to another main term that: a. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 96 is a valid billable ICD-10 diagnosis code for Alcohol use, unspecified with alcohol-induced persisting amnestic disorder . exists there is a 'use additional code' note at the etiology code, and a 'code first' note at the. There are also instructional notes to use additional code to identify specific organ dysfunction. F33. A list of abbreviations, punctuation, symbols, typefaces, and instructional notes appears at the beginning of the ICD-9-CM. detail to ensure the code assignment is not affected. This is step number __ when coding: Assign the code to the highest level of specificity. 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, inclusions or special notations. ” 1. ) Assign codes to the highest possible level of detail. ” The draft guidelines for ICD-10-CM do not require the additional code for this condition, but may require it when final guidelines are implemented. assign an additional code only if the “additional” condition is documented in the health record as being present. 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 . 4-)Study with Quizlet and memorize flashcards containing terms like These _____ are incorporated within the Alphabetic Index and Tabular List of the ICD--CM as instructional notes, The conventions and instructions of the classification take precedence over _____, The _____ _____ is an alphabetical list of terms and their corresponding code. 5. general notes, inclusion and exclusion notes, code first notes, use additional code notes, and code also notes. Your Answer:true Appendix C contains coding examples to assist in. provide general information on usage in a specific section. true false An additional codes instructional note is listed under code 33881. N30. 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)” applies to. J30. 2 is classified says to use additional code to identify resistance to antimicrobial drugs (Z16. N30. ) 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. In most cases the manifestation codes will have in the code title, "in diseases. Read and be guided by the instructional notes in both indexes The Alphabetical Index does not always provide the full 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. #1. 12. In most cases the manifestation codes will have in the code title, "in diseases. – Indicates that code identified in the note and code where the note appears cannot be reported together because the 2 conditions cannot occur together Example:. 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. Check the solution algebraically . " ICD-10-CM Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. In most cases the manifestation codes will have in the code title, "in diseases. These instructional notes indicate the proper sequencing order of the codes, etiology flowed by. -)It is important to use both the Alphabetic Index and the Tabular list when assigning ICD-10-CM codes because we do not code from the Alphabetic Index, the alphabetic index doesn’t provide the full code and you must refer to the Tabular List to get the full code 2 how instructional notes in both the Alphabetic Index and the Tabular List guide. C. In ICD-10-CM there are no supplementary classifications. algebra2. 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 . With: The words "with" or "in" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, either under a main term or subterm, or an instructional note in the Tabular List. The official AHA publication for ICD-10-CM and ICD-10-PCS coding guidelines and advice. NEC means not elsewhere classifiable 2. In most cases the manifestation codes will have in the code title, "in diseases. 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 the ICD-10-CM tabular, the coder will see notes under the Category J91. Cholecystitis would be reported in the ICD-10-CM chapter entitled _____. 13. Added instructional notes and inclusion terms Code Description G97. 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. ICD-10-CM codes would be I97. Adherence to these guidelines when assigning -10-CM ICD diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). %PDF-1. The other instructional note is under category code I85 which says to use an additional code to report alcohol abuse and dependence. The “Use additional” code. instructional notes, and may also require coding to a higher degree of. Notice the instructional notes tell the coder to assign a code for diabetes first (code first any associated diabetic chronic kidney disease). Laterality and 7 thfollowed by the manifestation. Code the following diagnosis: Fever. A. 1. In most cases the manifestation codes will have in the code title, 'in diseases. followed by the manifestation. The instructional note “Use additional code, where applicable, to identify exposure to environmental tobacco smoke (Z77. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07. A. 5 Chronic kidney disease, stage 5 states that this code excludes “chronic kidney disease, stage 5 requiring chronic dialysis (N18. Excludes1: irradiation cystitis (N30. The 7th character must always be the 7th character in the data field. The 7th character must always be the 7th character in the data field. (See Appendix A, Section I. In most cases, the manifestation codes will have in the code title “in diseases classified elsewhere. The principal diagnosis for this case is reported with code _____. Use the code(s) in brackets in addition to the disease or condition to identity an associated manifestation. View Feedback 1 / 1 point If this were a subsequent encounter for treatment, would the place of injury be reported? Question options: 1 / 1 point What additional code(s) are we advised to use? Question options: e additional code to indicate other abnormalities of forces of labor 062. ” Excludes 1 Notes: Indicates that an excluded code should never be used at the same time as the code listed above the Exclude1 note used. When using code E66. An instructional note with category Z16 says to code first the infection. Use additional code for any associated fecal incontinence ( R15 . Graph the system and estimate the solution. 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. 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. Your Answer:true Modifiers are used to identify when no procedure is done. are introduced by the word "includes" when placed at the beginning of a chapter or section. 1R29. In most cases the manifestation codes will have in the code title, "in diseases. The Instructional Note under code U07. Pay attention to the instructional notes in the tabular list (see yellow highlighted areas). 12. 44 (Sepsis following a procedure). 5 is a valid billable ICD-10 diagnosis code for Hyperlipidemia, unspecified . The two codes are to be sequenced as listed in the "Index to Diseases. It is used in the alphabetical Index of ICD-10-CM and instructs the coder that another term should be referenced. A commonly missed instructional note under N18. In most cases the manifestation codes will have in the code title, "in diseases. Chapter 3: (PASSWORD: NOS) ICD-10-CM Coding Conventions Coding conventions are instructional notes, punctuation marks, abbreviations, and symbols that are used throughout ICD-10-CM and ICD-10-PCS to provide direction when selecting codes. Correct Answer: Add an additional character to the code. Similar to ICD-9-CM, "Code first" and "Use additional code" notes are present for some of the diabetes mellitus categories and subcategories that require the underlying condition be sequenced first, followed by the manifestation. J06. 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. 5, N18. In most cases the manifestation codes will have in the code title, "in diseases. The additional code is always listed after the primary code. Look for Cirrhosis/liver/alcoholic and you are directed to K70. Two “use additional code” notes appear to remind the coder to use an additional code to identify the infectious agent. K90. Code First. The patient is also a type 1 diabetic with diabetic retinopathy and diabetic neuropathy. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Instructional notes indicate the proper sequencing order of these conditions-etiology (underlying condition) followed by manifestation. They may appear independently of each other or to designate certain etiology/manifestation paired codes. –In the index both conditions are listed together with the. 9. but provide additional instruction. What is the ICD-10-CM code for fatigue? R53. ↓ See below for any exclusions, inclusions or special notations. ICD-10-CM code I25. 6. Which is not an instructional note under Transport Accidents? Use additional code to identify: failure to use seatbelt. R14. CODING CONVENTIONS. 0 is a valid billable ICD-10 diagnosis code for Dehydration . 9 is a valid billable ICD-10 diagnosis code for Acute upper respiratory infection, unspecified . (Schraffenberger, 2018, 439)referenced with the “see” note to locate the correct code. It's in Section I. Make sure to review pairs of ‘Use additional code’ notes at the etiology code, and ‘Code first’ notes at the manifestation code to ensure proper sequencing order in the guidance,” Blanchard adds. CPC Prep Course Chapter 3 Notes. 0 (paroxysmal atrial fibrillation) based on the instructional note to use an additional code to specify the. Patient present with anemia and is admitted for transfusion. if instructional phrase or condition is found after main term or anatomical site has been mistakenly referenced instead of disorder or disease documented in diagnostic statement. 2019. 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. 6). Additional terms found only in the Alphabetic Index may also be assigned to a 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. 8. code set based on a system maintained by the World Health Organization. A use additional code note is present at category D70 which instructs to “Use additional code for any associated: fever (R50. ‐) tobacco use (Z72. 890 is exempt from POA reporting ( Present On Admission). 891) •Occupational exposure to environmental tobacco smoke (Z57. Explain two (2) methods you will use to build good coding habits. 1 indicates if the documentation does not have a causal relationship between the hypertension and heart disease the conditions are coded separately. These instructions signal the coder that an additional code should be reported to provide a more complete picture of that diagnosis. There are times when a single condition may require multiple coding. K90. ↓ See below for any exclusions, inclusions or special notations. 2. 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 . ” (See Reference 1) For instance, if a patient has a diabetes, the coder may use the code E11. Appears in the Official Guidelines at I. You will also find instructional notes that say code first or use additional code. 20 b. The implementation of ICD-10-CM coding brought about significant changes to the world of coding. 22) and CKD, stage 3 (N18. Z71. 0. The use additional note may need revision to identify the “type” of sepsis (as is seen in the note. 3. 6 also applies to the following: Inclusion term. Code First/Use Additional Code notes (etiology/manifestation paired codes) Certain conditions have both an underlying etiology and multiple body system. 2. In most cases the manifestation codes will have in the code title, "in diseases. the etiology/ manifestation guideline B. ” 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. ICD-10-CM assumes a causal relationship and this is coded as hypertensive heart disease with CHF and an additional code for the specific type of heart failure. Instructional notes in the Alphabetic Index and the Tabular List guide coders when selecting ICD-10-CM codes by providing additional instructions. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In addition, if an index entry requires more than one line. 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. 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). 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. . R91. the mainifestaion code will have a "code first" instructional note, and the eitiology code will have a " use additonal code" note in the tabular list. Code N75. The “use additional code” note appears with the code for toxic shock syndrome because it is an infectious disease code that does not identify the specific bacterial or viral organism that caused it,. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Assign code V12. 22) •History of tobacco use (Z87. Correct Answer : Add an additional character to the 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 . true false Appendix C contains coding examples to assist in the selection of. provide general information on usage in a specific section. The instructional note “Use additional code, where applicable, to identify exposure to environmental tobacco smoke (Z77. 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. False In the ICD-10-CM Index to Diseases and Injuries, with or directly under the main term Pregnancy, there are several notes or instructions. Select one: a. Sam was admitted due to a loss of consciousness. The Instructional Note under code U07. 3 is a valid billable ICD-10 diagnosis code for Dietary counseling and surveillance . 0 says to use additional code (B95-B97), to identify infectious agent. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. -)R45. 3. Basically stated, ICD-10-CM requires you to sequence the underlying condition first “if applicable, followed by the manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. When you look up this code in the Tabular List, you’ll find an instructional note to “Code also” adrenal adenoma (D35. When an Excludes _____ note appears under a code, it is acceptable to use both the code and the excluded code together. 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 7 th character must always be the 7 th character in the data field. 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.