Wiki Reporting Excludes 1 diagnosis codes

[mfournier]

Hello Everyone:

I'm hoping can clarify this ICD-10 question.

I have a patient where a provider reported E55.9 and E83.110 on the same claim. E83.110 states excludes 1 rule with diagnosis E55.9. If the provider documented both diagnosis can they be reported together even though there is an exclude 1 rule?? How would one select which diagnosis to report??

Just looking for guidance and better understanding.

Thanks in advance
MF

 

[LisaAlonso23]

Hello Everyone:

I'm hoping can clarify this ICD-10 question.

I have a patient where a provider reported E55.9 and E83.110 on the same claim. E83.110 states excludes 1 rule with diagnosis E55.9. If the provider documented both diagnosis can they be reported together even though there is an exclude 1 rule?? How would one select which diagnosis to report??

Just looking for guidance and better understanding.

Thanks in advance
MF

The provider documents what happened (the procedure) and why it occurred (diagnosis). They should not be providing you with codes, but verbiage describing the encounter. They don't often know coding conventions or guidelines. As the coder, it is your responsibility to utilize the guidelines to accurately code the case. That said, code from the documentation not the provider's codes.

 

[miriambroyles]

According to the guidelines for Excludes1 (Section I.A.12.a.), if the Vitamin D deficiency is related to the hereditary hemochromatosis, don't code E55.9. The only exception is if the two conditions are unrelated to each other. The provider needs to be queried to confirm and document that the two conditions are unrelated. Only then can both codes be coded.

 

[mfournier]

Thank you for the clarification