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.

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.

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.

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 .

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.

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 .

Insurance agent who works for one insurance company and is not permitted to sell products of other companies. He or she may be salaried or work on a commission basis. Also known as captive agent .

Type of managed health care plan that combines features of HMOs and PPOs. It is referred to as exclusive because it is offered to large employers who agree not to contract with any other plan. EPOs are regulated under state health insurance laws. Such plans are for large clinics to participate in and combine fee-for-service PPO and HMO benefits.
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A plan that requires some or all services to be provided by a very limited number of medical care providers. It is similar to but more restrictive in its provider network than the HMO.