Part B Insider (Multispecialty) Coding Alert

Physician Notes:

New 'Excludes1' Guideline Could Change Your Diagnosis Coding

Published on Mon Jan 11, 2016

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Plus: House of Representatives votes to repeal the ACA.

You’ve been using ICD-10 for nearly four months now, so it’s likely that you’ve run into a few hiccups along the way—particularly involving the “Excludes1” notations in your diagnosis coding manual. Fortunately, the Centers for Disease Control (CDC) has addressed that issue, creating a new temporary guideline that will help you report multiple diagnoses together.

“There are circumstances that have been identified where some conditions included in Excludes1 notes should be allowed to both be coded, and thus might be more appropriate for an Excludes2 note,” the CDC said in an Oct. 26 memorandum. “However, due to the partial code freeze, no changes to Excludes notes or revisions to the official coding guidelines can be made until October 1, 2016.”

In the interim, the CDC advises practices to use its temporary guidance, advising that if two conditions are unrelated to each other, you can report them both, even if an Excludes1 note exists. “For example, the Excludes1 note at code range R40-R46 states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes,” the CDC says in its memo. “However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and the mental health condition.”

Resource: To read more from the CDC on this topic, visit www.cdc.gov/nchs/data/icd/Interim_advice_updated_final.pdf.

In other news…

Just when you started memorizing the regulations within the Affordable Care Act (ACA), the House of Representatives has voted to dismantle the system, known as “Obamacare.” But don’t pull your ACA protocols off of your desk just yet—President Obama has reportedly vowed to veto the House’s attempt to eliminate the ACA.

On Jan. 6, the House voted 240 to 181 to repeal the ACA, and the bill will head to the president’s desk where he is expected to veto it. Just as fervently as the House majority wants the ACA dismantled, CMS wants it to stay in place. That’s the takeaway from HHS Secretary Sylvia Burwell’s Jan. 6 statement on the issue.

“As I travel the country, I consistently hear Americans say that they want Washington to build on the progress we have made to increase access to coverage, drive down the growth of health costs and improve the quality of care,” Burwell said. “Unfortunately, today’s partisan effort in the House of Representatives to repeal key parts of the ACA, along with its effective defunding of Planned Parenthood, does the opposite. It would roll back historic reductions in the uninsured rate, eliminate reforms that are helping slow health care cost growth and improve quality, reduce access to health care for women and families across the country, and deprive all Americans of the ACA’s improved consumer protections no matter where they buy health insurance.”