Includes Notes, Inclusion Terms, Parentheses, Brackets, and “And”: How to Read a Tabular Entry

Includes notes (I.A.10): “This note appears immediately under a three-character code title to further define, or give examples of, the content of the category.” Category E11’s Includes note lists “diabetes NOS” and “insulin resistant diabetes (mellitus)” — the category’s scope, stated once at the top.

Inclusion terms (I.A.11): “List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of ‘other specified’ codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.” I50.9 lists “Congestive heart failure NOS” and “Cardiac, heart or myocardial failure NOS” — the words in the record that land there. Absence of a term from the list is not exclusion; the Index may still route a term to the code.

Parentheses and brackets (I.A.7): “Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers.” I34.0, Nonrheumatic mitral (valve) insufficiency, is the same code whether the record says “mitral insufficiency” or “mitral valve insufficiency.” In the Index, a nonessential modifier applies to the subterms “except when a nonessential modifier and a subentry are mutually exclusive, the subentry takes precedence” — the Guidelines’ example is Enteritis, where “acute” is a nonessential modifier and “chronic” a subentry. Brackets “enclose synonyms, alternative wording or explanatory phrases” in the Tabular and “identify manifestation codes” in the Index.

“And” (I.A.14): “The word ‘and’ should be interpreted to mean either ‘and’ or ‘or’ when it appears in a title. For example, cases of ‘tuberculosis of bones’, ‘tuberculosis of joints’ and ‘tuberculosis of bones and joints’ are classified to subcategory A18.0, Tuberculosis of bones and joints.” A title reading “X and Y” does not require both.

1. Start at the category and read its Includes note for scope, then its Excludes notes (the Excludes guide).
2. At the code, read the inclusion terms as “this belongs here” — and remember the list is not closed; a term the Index routes to the code belongs there too.
3. Ignore words in parentheses when matching the record to the title; they neither add nor remove.
4. Read “and” in a title as “and/or.”A18.0 covers bone alone, joint alone, or both.
5. In the Index, a bracketed code is a manifestation code and goes second — the manifestation guide covers the sequencing.

1. “CHF” in the record. I50.9 — “Congestive heart failure NOS” is an inclusion term there.
2. “Tuberculosis of the hip joint.” A18.0, whose title says “bones and joints” — “and” means either.
3. “Mitral regurgitation,” nonrheumatic. I34.0 — “Nonrheumatic mitral (valve) regurgitation NOS” is an inclusion term; the parenthetical “(valve)” is nonessential.

• Treating an inclusion-term list as exhaustive — the Guidelines say it is not, and Index-only terms also assign.
• Refusing a code because the record lacks a parenthetical word — nonessential modifiers do not affect assignment.
• Reading “and” as requiring both conditions — it means and/or.
• Reading an Includes note as a complete list — it defines or exemplifies the category.

• The exact term in the record — matched against inclusion terms and, failing that, the Index.
• Words that are nonessential modifiers, which neither add nor remove.
• Whether one or both conditions in an “and” title are present — either suffices.