Word with number that is one of the conventions used in the diagnostic code book titled International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) . This indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note. An Excludes 1 is when two conditions cannot occur together (e.g., congenital form versus acquired form of a condition). A note instructs the reader to go to another code for the excluded condition. This convention does not appear in the former ICD-9-CM code books.
Insurance Encyclopedia
Excludes 2
Word with number that is one of the conventions used in the diagnostic code book titled International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) . This note represents “Not included here” and indicates 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. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together. This convention does not appear in the former ICD-9-CM code books.
Excludes notes
Term (excludes) used in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Tabular List, Volume 1, that refers to terms or conditions that are not included within the diagnostic code. These notes may further direct the coder to the correct diagnostic code assignment.
Exclusion
A clause in the contract denying coverage for specific hazards, people, or property.
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A contractual provision that denies coverage for certain perils, persons, property or locations.
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UK: a peril or contingency specifically excluded from the cover afforded by a policy.
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A term in an insurance or reinsurance contract that excludes the insurer or reinsurer from liability for specified types of loss. An exclusion may apply throughout a policy or it may be limited to specific sections of it. In certain circumstances an exclusion may be limited or removed altogether following the payment of an additional premium.
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An exclusion is a provision in an insurance policy that eliminates coverage for certain risks, people, property classes, or location. Often excluded risks can be covered with additional insurance. For example, the personal automobile policy normally excludes coverage if the automobile is being used for business purposes, but a commercial automobile policy is available. In a commercial general liability policy, discrimination in employment is excluded, but the firm can buy Employment Practices Liability coverage separately.Related to an exclusion is the “conditions” portion of the insurance policy. A condition is language in the policy that qualifies or put limits on the insurance company’s promise to pay a claim. If the policy conditions are not met, the insurer can refuse coverage. Common conditions include giving timely notice of a loss, protecting property from further damage, and cooperating with the company during the investigation of a loss or the defense of a lawsuit.
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Certain causes and conditions, listed in the policy, which are not covered.
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The part of a policy that removes or restricts coverage. Common exclusions to most policies include war, intentional loss, governmental action, etc. All policies contain exclusions, as policies cannot provide coverage for everything in many situations the premiums for coverage would be prohibitively expensive, and some events are rare enough that there is no way to determine the odds of the occurrence happening or how to develop sound rates.
Exclusion Absolute
Type of exclusions such as war, nuclear risk etc which cannot be deleted even upon payment of additional premium.
Exclusion endorsement
See: waiver .
Exclusion list
Office of the Inspector General (OIG) record of providers, individuals, and entities that are excluded from Medicare reimbursement. It includes identifying information about the sanctioned party, specialty, notice date, sanction period, and sections of the Social Security Act used in arriving at the determination to impose a sanction. It is titled List of Excluded Individuals/Entities (LEIE) and may be found at http://oig.hhs.gov/fraud/exclusions.asp . Also called sanctioned provider list .
Exclusion note
Excludes notation that lists a disease or condition with a diagnostic code that indicates it cannot be used when assigning a code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) , Tabular List, Volume 1.
Exclusion rider
See: impairment rider .
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An attachment to a policy that eliminates coverage for certain hazards.
Exclusion(s)
1. Provisions written into the insurance contract denying coverage or limiting the scope of coverage. They may be specific hazards, perils, or conditions. In connection with a preexisting condition, it means that the policy will not pay benefits arising from that condition. 2. Department of Health and Human Services (DHHS) and Office of the Inspector General (OIG) penalty imposed on a provider that prohibits the individual from billing Medicare or other government programs. 3. In the Medicare program, services not covered such as eye examinations, foot care, eyeglasses, hearing aids, cosmetic surgery, custodial care, and personal comfort items. Medical practices are required to make patients aware of their financial responsibility for noncovered services through waiver of liability statements. Also called exceptions .