↓ See below for any exclusions, inclusions or special notations. 2). 9, are assigned to a code from category I11, Hypertensive heart disease. ICD-10-CM Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. E10. and more. 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. combination. 9. 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. tracheobronchitis to bronchitis in. the code does not contain additional characters. 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 . 891) tobacco dependence (F17. Etiology/manifestation convention (code first, use additional code and in diseases classified elsewhere notes): Certain conditions have both an underlying etiology and. 89 is a valid billable ICD-10 diagnosis code for Other specified diseases of anus and rectum . 42 is a valid billable ICD-10 diagnosis code for Type 2 diabetes mellitus with diabetic polyneuropathy . #1. This convention instructs you to “Code first” the underlying condition, followed by etiology and/or manifestations. ) • 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. 2 also applies to the following:See” and “See Also” “Code also Note” Default codes Code assignment and Clinical Criteria Points to Remember -When selecting codes, the coder must follow all instructional notes present -Instructional notes, abbreviations, and punctuation provide direction to coders -When cross-references are present in the Index, the additional. They do not assign B96. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. 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. 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. 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 underlying condition" note OC. Category O02 Use additional code note and excludes1 note 10. 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. 5. b. 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. This notation indicates that use of an additional. 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. Used to signify that the conditions listed are not assigned to the category or block of category. b. When a coder encounters a "Use additional code" note, the coder should NOT assign a code from the list unless it is documented in the record. 9. 11 is a valid billable ICD-10 diagnosis code for Chronic respiratory failure with hypoxia . F33. Code First/Use Additional Code notes (etiology/manifestation paired codes) Certain conditions have both an underlying etiology and multiple body system. b. 2. -) •Tobacco use (Z72. There are multiple additional codes for identified influenza virus infections, including novel A types (avian, swine. Use "additional code" note OB. Wherever an etiology and manifestation combination of codes exists, the manifestation code contains an instructional note to: use of an additional code. 891) tobacco dependence (F17. A. C. 80 d. Instructional notes Punctuation marks Abbreviations Symbols. A portion of the body part is being removed. " In the "Index to Diseases," the multiple coding requirement is indicated by the use of the slanted brackets. 3. 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. 1 is a valid billable ICD-10 diagnosis code for Solitary pulmonary nodule . is not used in ICD coding; In ICD coding, the code first is not used. There is an instructional note to code also the type of asthma, if applicable (J45. If coded incorrectly and missing the instructional notations, it could result in a claim denial or medical record review. 15. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Located at the etiology code and directs you to assign a manifestation code. infection. NOS. A. are introduced by the word "includes" when placed at the beginning of a chapter or section. 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. general notes, inclusion and exclusion notes, code first notes, use additional code notes, and code also notes. When an "Includes" note appears after the start of a chapter, the note governs the entire chapter. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. The other instructional note is under category code I85 which says to use an additional code to report alcohol abuse and dependence. Adherence to these guidelines when assigning -10-CM ICD diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). 0 indicates to use additional code to identify the stage of the CKD. The 7 th character must always be the 7 th character in the data field. Therefore, we recommend. Indicates that an additional code should be used, if available. If a patient is documented as having both MRSA colonization and infection during a hospital admission, code Z22. Appears in the Official Guidelines at I. , The instructional note "INCLUDES" ________. 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. Below are just some of the ICD-10-CM guidelines I use and reference on a regular basis: Guideline Section IA:13 – Etiology/Manifestation Convention – Code first and Use additional code notes are sequencing rules in the classification of certain codes that are not part of an. ICD-10-CM: type 2 DM with diabetic CKD (E11. The SEE ALSO instructional note. 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 7th character must always be the 7th character in the data field. 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. Example: Type 2 diabetes with stage three chronic kidney disease combination exists there is a “use additional code” note at the etiology code and a “code first” note at the manifestation code. 22)” applies to All codes in ICD-10-CM Chapter 10. 30. CPC Prep Course Chapter 3 Notes. In most cases the manifestation codes will have in the code title, "in diseases. and more. Correctly use instructional terms and symbols as defined in the ICD-9-CM. 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. 13 (Etiology/Manifestation Convention) "In addition to the notes in the Tabular List, these conditions also have a specific Alphabetic Index entry structure. -). 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 . instructional notes, and may also require coding to a higher degree of specificity than indicated here. 0) is reported as the PDX followed by the code for the heart failure (I50. Diseases of the Eye and Adnexa. Breakdown the ICD-10-CM Guidelines. ↓ See below for any exclusions, inclusions or special notations. 0 (paroxysmal atrial fibrillation) based on the instructional note to use an additional code to specify the. R29. The notes also remind the code to use an additional (secondary) code to show the dialysis status (Z99. followed by the manifestation. It is necessary to go to the main term referenced with the "see" note to locate the correct code. Code N75. Create flashcards for FREE and quiz yourself with an interactive flipper. 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. The patient is alcohol dependent. ↓ See below for any exclusions, inclusions or special notations. ) Assign combination codes when available. The coder must use the main term Infection, bacterial, as cause of disease classified, Klebsiella to locate the additional code of B96. 12. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Found at the etiology code as a clue to identify the manifestations commonly associated with the disease. Diseases of the Digestive System. Verify code selection in the Tabular List. 83)ICD 10 Code Description Notes E08. , specific ear diseases) may be more extensive, contain additional . The underlying disease must be first sequenced, accompanied by the manifestation, according to the ICD-10-CM coding rule. 9 is a valid billable ICD-10 diagnosis code for Acute upper respiratory infection, unspecified . 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. You will also find instructional notes that say code first or use additional code. R11. There is no information of the infectious agent and no additional code is reported. In most cases the manifestation codes will have in the code title, "in diseases. This notation indicates that use of an additional code. Pain in unspecified foot Billable Code. general notes, inclusion and exclusion notes, code first notes, use additional code notes, and code also notes. What is the correct 7th character for single gestation? 0. NOTES 1. According to the instructional notes for the category code, are the codes for use on the maternal or fetal record, or both? Maternal. Adherence to these guidelines when assigning -10-CM ICD diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). Introduction ICD-10 was endorsed by the 43rd World Health Assembly in May 1990 and came into use in WHO Member States in 1994 (including US) The classification is the latest in a series, which has its origins in the 1850s The first edition, known as the International List of Causes of. Verified answer. Instructional notes include. 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 4. 4. b. This note indicates that an additional code should be used, if available. -) Use additional code to identify stage of chronic kidney disease ( 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. d. 850. usually contains a fourth and/or fifth character of 8 and/or 9. 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 Tips Instructional Notes and Common Coding Mistakes . 9 (Diabetes mellitus type 2 without complications) to code this diagnosis. 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. 6. When you look up this code in the Tabular List, you’ll find an instructional note to “Code also” adrenal adenoma (D35. 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. Chronic sinusitis (includes abscess, empyema, infection, suppuration) There are several instructional notes you must consider when applying the sinusitis codes. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Your Answer:false An additional codes instructional note is listed under code 33881. ” 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. There is advice at the beginning of this chapter to use an additional code to identify resistance to antimicrobial drugs using. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. The patient is also a type 1 diabetic with diabetic retinopathy and diabetic neuropathy. These instructional notes indicate that the etiology code should be listed first followed by the manifestation 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 . 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;• Read full code descriptors and instructional notes • see, see also, see category • with or without. 30. 0. These conventions are incorporated within the Alphabetic Index and Tabular List of ICD-10-CM as instructional notes. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 9. -underlying condition should be sequenced first. 3. 0. 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. Which is not an instructional note under Transport Accidents? Use additional code to identify: failure to use seatbelt. -coder can. 1 is a valid billable ICD-10 diagnosis code for Major depressive disorder, recurrent, moderate . additional instruction. These instructional notes indicate the proper. 9 is a valid billable ICD-10 diagnosis code for Male erectile dysfunction, unspecified . These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In the tabular list, code first and use additional code instructional notes indicate the proper sequencing order of what conditions Certain conditions that have both an underlying etiology and multiple body system manifestations due to the underlying etiology instructional notes indicate a proper sequencing order of these conditions etiology. 10. precalculus. Code first any follow-up examination after treatment of malignant neoplasm (Z08). subcategory notations D. Use Additional Code. 96. These instructional notes indicate the proper sequencing order of the codes, etiology followed by 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 . Excludes 1: fever and chills. 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. xxxx Drug or chemical-induced diabetes mellitus Code first a dx from (T36-T65) Use additional code for adverse effect (T36-T50) E10. Some categories of codes (e. 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 . N30. , The "See Also" instructional note refers the coder to another location in the Tabular List. ↓ See below for any exclusions, inclusions or special notations. Notes provide information on code selection. 44 (Sepsis following a procedure). 7 th Characters Certain ICD-10-CM categories have applicable 7 th characters. following previous Cesarean delivery 034. Study with Quizlet and memorize flashcards containing terms like When a code does not exist that accurately describes the procedure/treatement, the coder should report an unlisted code. 6 is assigned. 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. Patient is admitted to the hospital with pneumonia due to bacteriodes fragilis, J15. 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. 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). 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. Use additional Characters (red. 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. 2019. 1 Code First note 8. 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 nausea? R11. In most cases, the manifestation codes will have in the code title “in. 6 is a valid billable ICD-10 diagnosis code for Repeated falls . Question 1. (Schraffenberger, 2018, 439)referenced with the “see” note to locate the correct code. 13. ↓ See below for any exclusions, inclusions or special notations. 01-Use additional code to specify site and severity of ulcer (L97. 83. 8. use additional code for. This indicates the sequencing. Codes with this phrase are never used as a first-listed or principal diagnosis. True B. True The "Excludes 1" note _____. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. All ICD-10-CM Index to Diseases and Injuries subterms associated with an index entry's main term are indented two spaces, with any 2nd and 3rd qualifiers associated with the main term further indented by two and four spaces, respectively. 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. 1 directs to use an additional code to identify pneumonia or other manifestations. ↓ See below for any exclusions, inclusions or special notations. 16. note is not actually needed under the proposed new code at all, since there is already an instructional note regarding the use of additional codes for associated mani festations at the category level, and additional instructional notes are not generally included under existing syndrome codes in this category. 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. 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. Multiple codes are required when two codes, the second in brackets and italics, appear after a main term. It is used in the alphabetical Index of ICD-10-CM and instructs the coder that another term should be referenced. are designated in the ICD-10-CM index by brackets. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. 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. E86. ) Courtesy of the Centers for Medicare & Medicaid Services, 3-1d See Also Instructional Note Another cross-reference note used in ICD-10-CM, the See Also note refers the coder to another location in the Alphabetic Index when the initial listing does not contain all the. Another important instructional note is “Use additional code,” which can lead to querying for clarification of organ dysfunction that may be present, see the. The anemia is documented to be due to end stage renal disease (ESRD) after workup. 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. There is an instructional note that states to "Use additional code to identify the stage of chronic kidney disease (N18. ↓ See below for any exclusions,. 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. What diagnosis code(s) should be reported for acute and chronic cystitis? a. locate main term in index. followed by the manifestation. As with all DM categories, an Excludes 1 note excludes all other DM, including gestational, neonatal, and postprocedural. “Code first” and “Use additional code” notes are also used as sequencing rules in the classification for certain codes that are not part of an etiology/manifestation. You must use the applicable 7th character for all ICD-10-CM codes within the category or as notes in the Tabular List instruct. 22? “Use additional code” to identify stage of chronic kidney disease (N18. 6 also applies to the following: Inclusion term. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Cholecystitis would be reported in the ICD-10-CM chapter entitled _____. 9 ) In the example, we see three distinct conditions listed individually in the Assessment and Plan that are all represented in one combination code. "Code first" notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. 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 . d. " ICD-10-CM Coding Conventions The conventions for ICD-10-CM are the general rules for using the classification independent of the guidelines. 12. Selected Answer: is not used in ICD coding. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. Pay attention to the instructional notes in the tabular list (see yellow highlighted areas). instructional notes. After looking up a code in the Alphabetic Index it should be verified by checking the __. What is the instruction provided in the note below code E10. and more. Select one: True False. - Codes also specify the _____ of vessels to identify the specific location of disease. ( True/False) Question. ICD-10-CM guideline I. When the term “and” is used in a statement, it may be interpreted as, “and/or”. 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. In the tabular, code G31. A commonly missed instructional note under N18. i. -) and a note to use an additional code to identify: •Exposure to environmental tobacco smoke (Z77. The Includes note is used to define, give examples, or both, of the content of a category. R91. When there is a "code first" note and an underlying. a list of abbreviations, punctuation, symbols, typefaces and instructional notes appearing int he beginning of ICD-9. Fully searchable through Find-A-Code's Comprehensive Search. ↓ See below for any exclusions, inclusions or special notations. 6. Excludes2 means that the condition is not a part of the condition that is being represented by the code, but the patient can have both conditions at the same time. Use additional code to identify type of heart failure (I50. These instructional note indicate the proper sequencing order of the codes, etiology followed by manifestation, if applicable Underlying condition. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. C. 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. Adherence to these guidelines when assigning ICD-9-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). C. R10. 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. precalculus. 5. 6 End stage renal disease, you will notice a “use additional code” instructional note to identify dialysis status. instructional notes. The additional code is always listed after the primary code. 211 itional code to indicate precipitate labor 062. Your Answer:true Modifiers are used to identify when no procedure is done. F10. includes general notes, inclusion and exclusion notes, "code first" notes, "use additional code" notes and "code also" notes. The International Classification of Diseases (ICD) is published by the World Health Organization (WHO) and is used to classify:In the Tabular List at the beginning of Chapter 1, Certain Infectious and Parasitic Diseases (A00-B99) there is a note to use an additional code. The abbreviation NEC appears with main terms for which no specific code exists. In most cases, the manifestation codes will have in the code title, “in. Brackets An instructional note with code N39. Best answers. In the Tabular List, the 6th character 2 is selected to specify the left ovary. " Discuss whether or not it is correct to follow the instructional note below as written and assign A41. If this is not the case and coder feels more detail is needed - ask supervisior) 5 very basic (beginning. -)R45. Dysphagia, unspecified Billable Code. 1. 3 According to the instructional notes for the category code, are the codes for use on the maternal or fetal record,. 22) and CKD, stage 3 (N18. Make sure to review pairs of ‘Use additional code’ notes at the etiology code, and ‘Code first’ notes at the manifestation code to ensure proper sequencing order in the guidance,” Blanchard adds. ICD-10-CM Code. Use an additional code to identify the infectious agent. but provide additional instruction. ↓ See below for any exclusions, inclusions or special notations. The principal diagnosis for this case is reported with 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. Code First. 83 Rationale: Look in the ICD-10-CM Alphabetic Index for Fatigue. In most cases the manifestation codes will have in the code title, "in diseases. 30 the correct 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 . 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 H27. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. ↓ See below for any exclusions, inclusions or special notations. R50. requires the reporting of multiple codes for a case. 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. 8. ) Assign codes to the highest possible level of detail. False T/F - NEC means not elsewhere coded. 81). 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. 5 is a valid billable ICD-10 diagnosis code for Hyperlipidemia, unspecified . 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 . , Modifiers are used to identify when no procedure is done. –In the index both conditions are listed together with the. 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 that the etiology code should be listed first followed by 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. -) •Tobacco use (Z72. 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. In disease classified else. 10. CMS. 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. Basically stated, ICD-10-CM requires you to sequence the underlying condition first “if applicable, followed by the manifestation. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. includes notation C. and more.