Multiple codes are required when two codes, the second in brackets and italics, appear after a main term. Use additional Characters (red. Graph the system and estimate the solution. - or I51. Indicates that an additional code should be used, if available. 0. Location. Tabular List. In most cases the manifestation codes will have in the code title, 'in diseases. ) Assign codes to the highest possible level of detail. Hint: Locate the instructional notes before CPT 11102. In the following problem, find polar and Cartesian forms for all three cube roots of the complex number. 96 is a valid billable ICD-10 diagnosis code for Alcohol use, unspecified with alcohol-induced persisting amnestic disorder . In Diseases Classified Elsewhere. 4 , N18. , The "See Also" instructional note refers the coder to another location in the Tabular List. The "use additional code" note will be found under the associated condition code in the "Tabular List of Diseases. 07 is a valid billable ICD-10 diagnosis code for Spinal stenosis, lumbosacral region . Located at the etiology code and directs you to assign a manifestation code. 7. ↓ See below for any exclusions, inclusions or special notations. ( True/False) Question 2. e. 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. 1R29. the use of ICD 9 codes is mandated by HIPAA for. 2 is a valid billable ICD-10 diagnosis code for Pelvic and perineal pain . What is the instruction provided in the note below code E10. 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 . Manifestation. K90. These items provide guidelines for using the code set. An instructional note for Chapter 1 where B95. subcategory notations D. You are directed to R11. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 4-I51. 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. are introduced by the word "includes" when placed at the beginning of a chapter or section. 5. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a morbidity classification published by the Centers for Medicare and Medicaid Services. "Code first". A. A commonly missed instructional note under N18. 1-N18. It instructs you to code first underlying disease, which in this case, is the cirrhosis of the liver from the alcohol. 9. instructional notes. The SEE instructional 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. Answer: The Use Additional Code note instructs the coder to use an additional code to identify the manifestation that is present. Instructional notes Punctuation marks Abbreviations Symbols. 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 . An instructional note with category Z16 says to code first the infection. -) Use additional code to identify stage of chronic kidney disease ( N18. 011, Postthrombotic syndrome with ulcer of right lower extremity, and L97. 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. 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 . 8. Square brackets are used: In the Alphabetic Index to enclose the manifestation of a disease. 0. Not necessary Use Additional. The additional code referenced with the “see” note to locate the correct 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. " In the "Index to Diseases," the multiple coding requirement is. defines and or gives examples of the content of a particular category. the code does not contain additional characters. b. The Includes note is used to define, give examples, or both, of the content of a category. 890. ICD-10-CM;The "See Also" instructional note is a coding guideline that refers the coder to another code or group of codes in the Tabular List of the International Classification of Diseases (ICD). 30 the correct code. instructs the coder to use an additional code to identify the manifestation that is present. 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. E26. When it applies, codes missing this character are. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When an Excludes _____ note appears under a code, it is acceptable to use both the code and the excluded code together. 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. 22) and CKD, stage 3 (N18. 0 says to use additional code (B95-B97), to identify infectious agent. Z98. general notes, inclusion and exclusion notes, code first notes, use additional code notes, and code also notes. Learn your Medical Coding Conventions and Guidelines. F10. 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. 32 is a valid billable ICD-10 diagnosis code for Chronic kidney disease, stage 3b . is used in the Tabular The note "Includes" _____. ICD-10-CM Official Guidelines for Coding and Reporting FY 2024 Page 8 of 120 5. ↓ See below for any exclusions,. If coded incorrectly and missing the instructional notations, it could result in a claim denial or medical record review. In this case, the PDX of hypertensive heart disease with CHF (I11. N30. Similar to ICD-9-CM, "Code first" and "Use additional code" notes are present for some of the diabetes mellitus categories and subcategories that require the underlying condition be sequenced first, followed by the manifestation. 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 . following previous Cesarean delivery 034. J30. K62. In most cases the manifestation codes will have in the code title, "in diseases. ) Assign multiple codes when required (usually coder will be guided to do this by additional instructional notes in the ICD-9. Some people are interpreting a "use additional code" note to mean that the secondary code must always appear in the diagnosis field immediately following the. Thromboarteritis - see arteritis. You will also find instructional notes that say code first or use additional code. Selected Answer: is not used in ICD coding. Alphabetic Index. Code First/Use Additional Code notes (etiology/manifestation paired codes) Certain conditions have both an underlying etiology and multiple body system. True B. -) •Tobacco use (Z72. 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). Appears in the Official Guidelines at I. (See Appendix A, Section I. I-8 conventions. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 30. 1 should be reported as the principal or first diagnosis, regardless of whether the patient's most recent COVID-19. Codee F10. 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. They may appear independently of each other or to designate certain etiology/manifestation paired codes. N52. Another important instructional note is “Use additional code,” which can lead to querying for clarification of organ dysfunction that may be present, see the. ICD-10-CM Tabular Instructional Notes . Etiology/manifestation convention (code first, use additional code and in diseases classified elsewhere notes): Certain conditions have both an underlying etiology and. These instructional notes indicate the proper sequencing order of the codes, etiology flowed by manifestation if applicable Use additional code, where applicable, to identify: history of tobacco dependence (Z87. 9 in processing claims, check the following: — See additional. instructs the coder to select a code to represent the etiology that caused the manifestation. R13. 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. Your Answer:true Appendix C contains coding examples to assist in. 0 to code first the underlying neoplasm. Verify code selection in the Tabular List. 2. combination. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. F43. C. 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. Code N18. -). ” Excludes 1 Notes: Indicates that an excluded code should never be used at the same time as the code listed above the Exclude1 note used. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. "code first" and "use additional code" are examples of A. -). E11. The SEE ALSO instructional note. Is used to define, give examples, or both, of the content of the category of ICD 10 CM or of a block of category codes. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. The instructional notation "USE ADDITIONAL CODE" instructs the coder to: Add a second code to fully code the diagnosis. b. ) Assign multiple codes when required (usually coder will be guided to do this by additional instructional notes in the ICD-9. True. a. CODING CONVENTIONS. Pain in unspecified foot Billable Code. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. the etiology/ manifestation guideline B. In this case the patient has end stage renal disease so 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. Code first any follow-up examination after treatment of malignant neoplasm (Z08). 4. Some codes in chapter 10 have been expanded to include notes indicating that an additional code should be assigned or an associated condition should be sequenced first. instructional notes, and may also require coding to a higher degree of. A component of. In the Alphabetic Index both conditions are listed together with the etiology code first followed by the manifestation codes in brackets. which may or may not be followed by the ICD-9-CM code number, nonessential modifiers, or followed by Instructional Notes. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 1 states to not assign codes from category Z34 with Chapter 15 codes. 1 - N18. 10. 102. 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. 10. There is an instructional note use additional code to identify organism. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. This is addressed in guideline 1. 2. A note under category J01 Acute sinusitis states that an additional code (B95-B97) is used to identify the infectious agent, if known. E10. 0. Otoscopy confirmed acute infection of the canal, with erythema and pus in the canal noted on exam. ICD-10-CM;• Read full code descriptors and instructional notes • see, see also, see category • with or without. Relating to Use Additional Code and Code First Instructional Notes: The CODE FIRST note _____. In most cases the manifestation codes will have in the. The see also instruction in the ICD-10-CM index follows a subterm and refers the coder to another main term that: a. 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. E78. In this example, assigning. R56. In most cases the manifestation codes will have in the code title, "in diseases. 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. c. Sam was admitted due to a loss of consciousness. 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 . 22)” applies to. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. FIGURE 18-5 Example of. 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. Instructional notes appear in the Alphabetical Index and Tabular List • INCLUDES: This. 5. In most cases the manifestation codes will include “in diseases classified elsewhere” in the. In most cases the manifestation codes will have in the code title, "in diseases. followed by the manifestation. Without further description you are directed to R53. -). These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. If a code. detail to ensure the code assignment is not affected. It consists 1. the mainifestaion code will have a "code first" instructional note, and the eitiology code will have a " use additonal code" note in the tabular list. 6 is assigned. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. The Instructional Note under code U07. ”Verified questions. 1. Includes Note. ↓ See below for any exclusions, inclusions or special notations. 96. 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 . is not used in ICD coding; In ICD coding, the code first is not used. Parallel ICD-9-CM Code Guidelines Increased Instruction Notes (Code first; Use Additional Code) Enhanced Combination Codes Updated Terminology to Reflect Current Medical Practices COPD (J44-J45) Acute exacerbation is a worsening or decompensation of a chronic condition An acute exacerbation is NOT equivalent to an infectionin ICD-10-CM/PCS uses an indented arrangement. 0 would be reported in chapter ____ of ICD-10-CM. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. usually contains a fourth and/or fifth character of 8 and/or 9. 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. Diseases of the Eye and Adnexa. The underlying disease must be first sequenced, accompanied by the manifestation, according to the ICD-10-CM coding rule. 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. Coding Guidelines and Instructional Notes for ICD-10-CM Chapter 1 0 Instructional note appears at beginning of chapter, "when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site" Use additional codes, where applicable, to identify o Exposure. ”. R11. The "Use additional code" _____. 9, C37) explicitly indicate the use of additional codes to identify exposures and histories. Brackets enclose all but which one of the following? essential modifiers. 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. 3. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. “Code first” and “Use additional code” notes are also used in. In addition to coding the respiratory system condition in ICD-10-CM, there is an instructional note in many of the subclassifications in chapter 10, as shown here: Diseases of the respiratory system (J00–J99) Use additional code, where applicable, to identify: exposure to environmental tobacco smoke (Z58. General notes. Selected Answer : The code should be sequenced first . These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Adherence to these guidelines when assigning -10-CM ICD diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 891) •Occupational exposure to environmental tobacco smoke (Z57. N18. 9 (Diabetes mellitus type 2 without complications) to code this diagnosis. The Use additional code note appears at the etiology code and a Code. Use "additional code" note OB. R10. However, in general, audiology related. 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. b. Look at code E10. ↓ See below for any exclusions, inclusions or special notations. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. K86. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Some codes in chapter 10 have been expanded to include notes indicating that an additional code should be assigned or an associated condition should be sequenced first. when the note appears under a code, it is acceptable. Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). If a coder sees the instructional note of "Use an Additional Code" in the ICD 10 CM Code Book in the Tabular List it is indicating to the coder the following instruction: Q&A. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. There is an instructional note under category code K70 to use additional code to identify alcohol abuse and dependence. Social phobia, unspecified Billable Code. appearing. 9 is a valid billable ICD-10 diagnosis code for Male erectile dysfunction, unspecified . 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. [Brackets] are an ICD-10-CM convention indicating the enclosed code is. For such codes, a "use additional code" note will still be present and the rules for sequencing still apply. [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. 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 the following diagnosis: Seizure. Z71. underlying disease, such as: amyloidosis E85Question options: 1 / 1 point What additional code(s) are we advised to use?. 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. R91. 15. ” (See Reference 1) For instance, if a patient has a diabetes, the coder may use the code E11. c. such a combination exists there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. 20. N30. 2). 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. Chronic sinusitis (includes abscess, empyema, infection, suppuration) There are several instructional notes you must consider when applying the sinusitis codes. Use additional code for adverse effect, if applicable, to identify adverse effect of drug (T36-T50 with fifth or six. 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. = cause of disease. 891)The ICD-10-CM is divided into the Alphabetic Index, an alphabetical list of terms and their corresponding code, and the Tabular list, a chronological list of codes divided into chapters based on body system or 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. Appears in the Official Guidelines at I. Read and be guided by the instructional notes in both indexes The Alphabetical Index does not always provide the full code. For such codes, there is a "use additional code" note at the etiology code and a "code first" note at the manifestation code. Code First. Under the Main Term Diabetes in the Index, first-level subterms identify: The specific complication (s) with each type. True. ICD 10 CM ___________ include the following: Instructional notes, Abbreviations, Cross-reference notes, Punctuation marks, and Relational terms. 111. The instructional note “Use additional code, where applicable, to identify exposure to environmental tobacco smoke (Z77. When you look up this code in the Tabular List, you’ll find the instructional note to “Use additional code” to identify any functional activity (this determines the order). true false An additional codes instructional note is listed under code 33881. 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 Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. but provide additional instruction. In most cases the manifestation codes will have in the code title, "in diseases. 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. More Coding Conventions. precalculus. Codes with this phrase are never used as a first-listed or principal diagnosis. listed below certain codes in the index. In most cases the manifestation codes will have in the code title, 'in diseases. 5 is a valid billable ICD-10 diagnosis code for Hyperlipidemia, unspecified . Standard Coding Process (4)A benign neoplasm is a (n): H66. 891) •Occupational exposure to environmental tobacco smoke (Z57. Manifestation code = “code 1st” These instructional notes indicate the proper sequencing order of the codes 3. -). Chapter 1 of the ICD-10-CM guidelines provides incredibly detailed instruction on coding for sepsis, severe sepsis, and septic shock infections. g. It is necessary to go to the main term referenced with the "see" note to locate the correct code. In most cases the manifestation codes will have in the code title, "in diseases. 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. The additional code is always listed after the primary code. c. 10. are designated in the ICD-10-CM index by brackets. 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. B) the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. 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. 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. Look for Cirrhosis/liver/alcoholic and you are directed to K70. ↓ See below for any exclusions, inclusions or special notations. 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. Instructional notes indicate the proper sequencing order of these conditions-etiology (underlying condition) followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases. For influenza NOS (not otherwise specified), ICD-10 directs you to use J11. Volume 3 procedure codes have been adopted for inpatient. In most cases the manifestation codes will have in the code title, "in diseases. ICD-10-CM guideline I. 12. Assign code V12. The other instructional note is under category code I85 which says to use an additional code to report alcohol abuse and dependence. A “code first underlying disease” instructional note will appear with the. In ICD coding, the code first is not used. 4 , N18. 5 Chronic kidney disease, stage 5 states that this code excludes “chronic kidney disease, stage 5 requiring chronic dialysis (N18. 7th Character Certain ICD-10-CM categories have applicable 7th characters. There is advice at the beginning of this chapter to use an additional code to identify resistance to antimicrobial drugs using. There is a. ) • Use additional code to identify resistance to antimicrobial drugs (Z16) • New section called infections with a predominantly sexual mode of transmission (A50–A64) • When coding sepsis or AIDS, it is important to review the Coding Guidelines and the notes at the category level of ICD-10-CMThe “use additional code” note appears at the etiology and a “code first” note at the manifestation code. 7, I51. ICD-10-CM Instructional Notes, Chapter 3 Two instructional notes appear with a code if the type of anemia is produced by either a poisoning or an adverse effect of a drug, such as-Code first _____ due to drug or toxin, if applicable (T36-T65), with fifth or sixth character 1-4 or 6-Use additional code for adverse effect, if applicable, to. Instructional note under I12. ) Only use NEC/NOS codes when no further detail is possible. 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 . 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. What is the ICD-10-CM code for fatigue? R53. The principal diagnosis for this case is reported with code _____. There is no mention of vomiting. 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. 890 is a valid billable ICD-10 diagnosis code for Other specified postprocedural states . ” Verified questions. These instructional notes indicate the proper. F33. M48. This convention instructs you to “Code first” the underlying condition, followed by etiology and/or manifestations. When there is a “code first” note and an underlying condition is present, the underlying condition is sequenced first. 3. 414, Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone. BracketsCode Also Instructional Note 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. . 890 is exempt from POA reporting ( Present On Admission). Use additional code to identify type of heart failure (I50. conventions. general notes, inclusion and exclusion notes, code first notes, use additional code notes, and code also notes. These are sequencing instructions that must be followed. These conventions are incorporated within the Alphabetic Index and Tabular List of ICD-10-CM as instructional notes. When a code does not exist that accurately describes the procedure/treatement, the coder should report an unlisted code. ICD-9-CM Conventions NOS . 6). If this is not the case and coder feels more detail is needed - ask supervisior) 5 very basic (beginning. 8, B96. exists there is a 'use additional code' note at the etiology code, and a 'code first' note at the.