Excludes 1 Note

How do you decide which code to use when both conditions have excludes 1 notes for each other?

I know there is this coding clinic advice but sometimes they both exclude each other..... Example Respiratory distress of newborn and resp failure of newborn.  


We understand that the Official Guidelines for Coding and Reporting provide that "an Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note." However, we have not been able to locate official guidance as to which code should be assigned out of the two codes. Can you help?


Assign only the code referenced in the Excludes1 note. For example, when peripheral vascular disease and gangrene are documented, the Alphabetical Index will provide the following references:



vascular NOS I73.9

Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer) (see also Necrosis) I96

Referencing the corresponding Tabular List, code I96, Gangrene, not elsewhere classified, has an Excludes1 note below that excludes "gangrene in other peripheral vascular diseases (I73.-)." This note should be interpreted to mean "not coded here" and that code I73.- should be assigned for gangrene in other peripheral vascular disease.


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