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 OB. 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. Code First. Table of Neoplasms. When there is a “code first” note and an underlying condition is present, the underlying condition is sequenced first. The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In this example, assigning. followed by the manifestation. These are sequencing instructions that must be followed. The additions for FY 2021 presently pushing the number of codes to over 70,000. 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 . These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. exists there is a 'use additional code' note at the etiology code, and a 'code first' note at the. Patient has type 2 DM with diabetes-related CKD stage 3. Basically stated, ICD-10-CM requires you to sequence the underlying condition first “if applicable, followed by the manifestation. 7 th Characters Certain ICD-10-CM categories have applicable 7 th characters. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07. 850 is a valid billable ICD-10 diagnosis code for Homicidal ideations . 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. R91. FIGURE 18-5 Example of. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. -). 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. 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. d. that it is a pure excludes note. Instructional notes appear in the Alphabetical Index and Tabular List • INCLUDES: This. The ICD-10-CM Index does have instructional notes to code first the underlying infection. Assign code V12. When a code does not exist that accurately describes the procedure/treatement, the coder should report an unlisted code. A list of abbreviations, punctuation, symbols, typefaces, and instructional notes appears at the beginning of the ICD-9-CM. There is an instructional note to code also the type of asthma, if applicable (J45. 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. 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. use additional code for any associated physical or developmental disorders. 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. ) Assign multiple codes when required (usually coder will be guided to do this by additional instructional notes in the ICD-9. In the Alphabetic Index look for Dependence/alcohol referring you to code F10. 0) CONVENTIONS 12 • Instructional Notes •“Code also” ‐alerts coder that more than one code may be required to describe the condition ‐does not provide sequencing directions manifestation. Use Additional Code. In addition, if an index entry requires more than one line. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 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. 0 Cerebrospinal fluid leak from spinal puncture Code also any associated diagnoses or complications, such as:There is an instructional note to code also the type of asthma, if applicable (J45. The note, however, does not provide sequencing. Verify code selection in the Tabular List. 00Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. Not necessary Use Additional. 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. Largo, FL. Examples of these notes include: Use additional code to identify the infectious agent; Use additional code to identify the virus; Code first any associated lung abscess Code First/Use additional code These instructional notes provide sequencing instruction. In most cases the manifestation codes will have in the code title, "in diseases. You should never use the exculde1 code at the same time as the code above Excludes1 notes. 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. 890 is exempt from POA reporting ( Present On Admission). 2). 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. Multiple Codes. 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. 9 is a valid billable ICD-10 diagnosis code for Acute upper respiratory infection, unspecified . contains the code that is to be. 8- directing to “Code first underlying disease when associated fever is present such as with: neutropenia (D70. ↓ See below for any exclusions, inclusions or special notations. a list of abbreviations, punctuation, symbols, typefaces and instructional notes appearing int he beginning of ICD-9. 23 is a valid billable ICD-10 diagnosis code for Adjustment disorder with mixed anxiety and depressed mood . 0. 2x-3y=-2. 6 is assigned. contain a use additional code instruction in the ICD-10-CM tabular list. 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 . Selected Answer: is not used in ICD coding. A 3-year-old patient was brought in to the physician's office by her mother because of fever, fussiness, and tugging at the right ear. ” (See Reference 1) For instance, if a patient has a diabetes, the coder may use the code E11. The ICD-10-CM code assigned to this case is:Instructional notes are an important resource for medical coders, as they provide additional guidance and clarification when the code descriptions in the Tabular section of the coding book are not clear or specific enough. 07 is a valid billable ICD-10 diagnosis code for Spinal stenosis, lumbosacral region . 7th Character Certain ICD-10-CM categories have applicable 7th characters. Instructional Notes. 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. Verified answer. A combination code is used to classify? Two diagnosis, a diagnosis w/ an associated secondary process ( manifestation) , a diagnosis w/ an associated complication. 0 indicates to use additional code to identify the stage of the CKD. which may or may not be followed by the ICD-9-CM code number, nonessential modifiers, or followed by Instructional Notes. References 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. 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. In most cases the manifestation codes will have in the code title, "in diseases. K90. These conventions are incorporated within the Alphabetic Index and Tabular List of ICD-10-CM as instructional notes. This notation indicates that use of an additional code. Use additional code. - Use additional code notes appear throughout chapter 9 to direct the coder to identify exposure to, history of current use, and dependence of _____. What is the correct 7th character for single gestation? 0. Hypertension With Heart Disease. Which is not an instructional note under Transport Accidents? Use additional code to identify: failure to use seatbelt. Manifestation code = “code 1st” These instructional notes indicate the proper sequencing order of the codes 3. CODING CONVENTIONS. 20 is assigned a tthe direction of the "use additional code to identify alcohol use and dependence (F10. 00, N30. First notes indicate that this code may be assigned as first-listed diagnosis when the casual condition is? Un known/ Not Applicable. The includes note is used to define, give examples, or both, of the content of a category of ICD-10-CM or of a block of category codes. ↓ See below for any exclusions, inclusions or special notations. 8. 31) •Tobacco dependence (F17. In most cases the manifestation codes will have in the code title, "in diseases. CMS. There are also instructional notes to use additional code to identify specific organ dysfunction. An instructional note will be found at the infection code advising that an additional organism code is required. In the Tabular List, the 6th character 2 is selected to specify the left ovary. There is no mention of vomiting. Appears in the Official Guidelines at I. F40. 00, C31. 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 most cases the manifestation codes will have in the code title, "in diseases. Look for Cirrhosis/liver/alcoholic and you are directed to K70. Therefore, when a patient presents with an acute manifestation of COVID-19, such as pneumonia, code U07. *Instructional note in ICD-10-CM indicates to use additional code, if applicable, to identify coronary atherosclerosis due to lipid rich plaque (I25. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. – 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:. A “code also” note is an instruction that two codes may be required to. . 15. For such codes, there is a "use additional code" note at the etiology code and a "code first" note at the manifestation code. 3 is a valid billable ICD-10 diagnosis code for Pseudocyst of pancreas . 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 for. 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. true false Appendix C contains coding examples to assist in the selection of. ” A corresponding instructional note is present at subcategory R50. Learn your Medical Coding Conventions and Guidelines. ICD 10 CM ___________ include the following: Instructional notes, Abbreviations, Cross-reference notes, Punctuation marks, and Relational terms. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. instructional notes. 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 . Fully searchable through Find-A-Code's Comprehensive Search. In most cases, the manifestation codes will have in the code title “in diseases classified elsewhere. F33. E11. The Use additional code note appears at the etiology code and a Code. In this case the patient has end stage renal disease so N18. In Diseases Classified Elsewhere. Code First/Use Additional Code notes (etiology/manifestation paired codes) Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. 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. 10. Excludes1: irradiation cystitis (N30. Explain two (2) methods you will use to build good coding habits. They may appear independently of each other or to designate certain etiology/manifestation paired codes. R50. 12. J30. In most cases the manifestation codes will have in the code title, "in diseases. Adherence to these guidelines when assigning -10-CM ICD diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). ↓ See below for any exclusions, inclusions or special notations. 6. [Brackets] are an ICD-10-CM convention indicating the enclosed code is a manifestation code INSTRUCTIONAL NOTES Excludes1&2 Tip: Excludes1: Only 1 code can be used Excludes2: 2 codes can be use if both are appropriate and there is proper documentation for both 11/19/2015 17 INSTRUCTIONAL NOTES • “Code First” & “Use Additional Code” • Used for Sequencing Priority – Found in Tabular Use of "Code also" or "Use Additional code" Instructions in ICD 10 coding for medical coders. a. R13. Coders will see the same “code first” instruction when looking at malignant ascites. 3) Rationale: A note under the code for type 2 DM with diabetic CKD instructs to use an additional code to identify the stage of CKD (N18. 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. The SEE instructional note. " Discuss whether or not it is correct to follow the instructional note below as written and assign A41. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. A component of. View all the articles associated with any code, right from the code page! Study with Quizlet and memorize flashcards containing terms like Four types of conventions: instructional notes, punctuation marks, abbreviations, symbols. code first underlying disease. use both the code and the excluded code together. Instructional notes also indicate when additional codes are required to fully describe the condition you are coding. 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 guideline, I. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Wherever an etiology and manifestation combination of codes exists, the manifestation code contains an instructional note to: use of an additional code. The definition can be found under number 12A, pg. -)" instructional note under category K70. Codes B95-B97 are secondary codes to. 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 . 5 is a valid billable ICD-10 diagnosis code for Hyperlipidemia, unspecified . Expert tip: “Tab your copy of ICD-10 with reminders. 9 (Diabetes mellitus type 2 without complications) to code this diagnosis. the code does not contain additional characters. 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. 4-I51. 9 in processing claims, check the following: — See additional coding rules. Alphabetic Index. false. Otoscopy confirmed acute infection of the canal, with erythema and pus in the canal noted on exam. Watch the instructional notes carefully. If this is not the case and coder feels more detail is needed - ask supervisior) 5 very basic (beginning. 0 is a valid billable ICD-10 diagnosis code for Celiac disease . defines and or gives examples of the content of a particular category. These notes are used to signal that, when there is an underlying etiology and multiple body system manifestation due to the underlying etiology, two codes are needed. g. In most cases the manifestation codes will have in the code title, "in diseases. R11. Wherever an etiology and manifestation combination of codes exists, the manifestation code contains an instructional note to: use of an additional code The International Classification of Diseases (ICD) is published by the World Health Organization (WHO) and is used to classify: 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. 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. 83. List the instructional. When an Excludes _____ note appears under a code, it is acceptable to use both the code and the excluded code together. In most cases the manifestation codes will include “in diseases classified elsewhere” in the. 32 is a valid billable ICD-10 diagnosis code for Chronic kidney disease, stage 3b . d. 0 Acute cystitis . These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 30. J96. Correctly use instructional terms and symbols as defined in the ICD-9-CM. 5. In the following problem, find polar and Cartesian forms for all three cube roots of the complex number. Category J05 Use Additional code note and Code Also 9. These instructional notes indicate the proper. 1 states to not assign codes from category Z34 with Chapter 15 codes. 88 Other and unspecified bacterial agents as the cause of diseases classified to other chapters. d. 4. 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. 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,. 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. Look at code E10. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. The "Excludes 2" note represents all of the following except that _____. It is necessary to go to the main term referenced with the "see" note to locate the correct code. – The manifestation codes usually have the phrase “ in diseases classified elsewhere” as part of the code title. There is an instructional note that states to "Use additional code to identify the stage of chronic kidney disease (N18. In most cases the manifestation codes will have in the code title, "in diseases. Z98. In most cases the manifestation codes will have in the code title, "in diseases. Added instructional notes and inclusion terms Code Description G97. includes general notes, inclusion and exclusion notes, "code first" notes, "use additional code" notes and "code also" notes. When there is a "code first" note and an underlying. For influenza NOS (not otherwise specified), ICD-10 directs you to use J11. 2. Therefore, we recommend. 3. 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. 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). In most cases the manifestation codes will have in the code title, "in diseases. In most cases the manifestation codes will have in the code title, "in diseases. 9) Under the Category I50 in the ICD-10-CM. The "use additional code" note will be found under the associated condition code in the "Tabular List of Diseases. 9 (Diabetes mellitus type 2 without complications) to code this diagnosis. The Code First note instructs the coder to select a code to represent the etiology that caused the _____. See cross-references lead the coder to another main term; see also suggest additional possible key terms. ” 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. Use additional code to identify type of heart failure (I50. Code the following diagnosis: Fever. In most cases the manifestation codes will have in the. 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. E86. Instructional notes indicate the proper sequencing order of these conditions-etiology (underlying condition) followed by manifestation. The additional code is always listed after the primary code. Graph the system and estimate the solution. The additional code is always listed after the primary code. c. 0. Whenever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. Verified answer. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. precalculus. QUESTION 1 4 points Sa In the ICD 10 CM manual which type of instructional note is used in the Tabular List of Diseases to identify a code for a condition that is a manifestation of an underlying disease? O 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. -)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. 16. Z98. Manifestation. Abbreviations The "Use additional 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. There is a. These instructional notes indicate the proper sequencing order of the codes: etiology, followed by manifestation. 0. 89 (other post-procedural complications and disorders of the circulatory system, not elsewhere classified) and I48. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 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. 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. When using code R45. QUESTION 1 4 points Sa In the ICD 10 CM manual which type of instructional note is used in the Tabular List of Diseases to identify a. If a code. 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 additions. 1 Code First note 8. 20 b. 0) CONVENTIONS 12 • Instructional Notes •“Code also” ‐alerts coder that more than one code may be required to describe the condition ‐does not provide sequencing directionsmanifestation. 2 is classified says to use additional code to identify resistance to antimicrobial drugs (Z16. Pseudocyst of pancreas Billable Code. ‐) tobacco use (Z72. ICD-10-CM Coding Tips Instructional Notes and Common Coding Mistakes . This note signals that an additional code is necessary to fully. The diagnosis codes (Volumes 1-2) have been adopted under HIPAA for all healthcare settings. is used in the Tabular The note "Includes" _____. 81). These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 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 for adverse effect, if applicable, to identify adverse effect of drug (T36-T50 with fifth or six. Take note of the tabular instructions for code M31. Group of answer choices. 673 is a valid billable ICD-10 diagnosis code for Pain in unspecified foot . Instructional notes indicate the proper sequencing order of these conditions-etiology (underlying condition) followed by manifestation. the use of ICD 9 codes is mandated by HIPAA for. Instructional note under I12. 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). instructs the coder to select a code to represent the etiology that caused the manifestation. 1. 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 . Subcategory M10. The instructional note “Use additional code” (B95–B97) is found in the Tabular List of ICD- 10-CM under Code N39. No additional code is necessary. 0 to code first the underlying neoplasm. 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. The patient is alcohol dependent. Use additional Characters (red. In most cases the manifestation codes will have in the code specific eye involved). infection. assign an additional code only if the “additional” condition is documented in the health record as being present. 6). In most cases the manifestation codes will include “in diseases classified elsewhere” in the. detail to ensure the code assignment is not affected. instructional notes. Table of Drugs and Chemicals. 0 would be reported in chapter ____ of ICD-10-CM. Introduction to ICD-10-CM. In most cases the manifestation codes will have in the code title, “in. In most cases the manifestation codes will have in the code title, "in diseases. (See Appendix A, Section I. Verify the codes in the tabular list and assign codes in this order: I87. The 7th character must always be the 7th character in the data field. 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. 011, Postthrombotic syndrome with ulcer of right lower extremity, and L97. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 3. When using code n52. 22) and CKD, stage 3 (N18. In most cases the manifestation codes will have in the code title, “inWherever 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. 0 can also apply to. ICD-10-CM Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. False When an "Includes" note appears after. INSTRUCTIONAL NOTES Excludes1&2 Tip: Excludes1: Only 1 code can be used Excludes2: 2 codes can be use if both are appropriate and there is proper documentation for both 11/19/2015 17 INSTRUCTIONAL NOTES • “Code First” & “Use Additional Code” • Used for Sequencing Priority – Found in TabularUse of "Code also" or "Use Additional code" Instructions in ICD 10 coding for medical coders. appears in the Tabular NOS means not otherwise specified. b. The 7th character must always be the 7th character in the data field. 0 is a valid billable ICD-10 diagnosis code for Abdominal distension (gaseous) . Your Answer:false An additional codes instructional note is listed under code 33881. ) Assign combination codes when available. Explain the use of V and E codes. but provide additional instruction. 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). 0) 11 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. For such codes, there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code and the rules for sequencing apply 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. See Note: an instruction following the main term in the Alphabetic Index that indicates that another term should be referenced - for correct coding it is necessary to go to the main term referenced with this note. 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. Inclusion notes. The guidelines in ICD-9-CM include an additional instructional note to “Use an additional code to identify the stage of chronic kidney disease. You must use the applicable 7th character for all ICD-10-CM codes within the category or as notes in the Tabular List instruct. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. When there is a "code first" note and an underlying. 12.