Wiki Diagnoses when they are exclude 1

KaylaRieken

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My physicians will list 1. Urge Incontinence 2. Nocturia 3. Urgency as their diagnoses. According to the ICD 10 book urge incontinence and urgency have an exclude 1 and you can't use them together. Can you still count them as separate problems or does this mean that they are basically the same thing? My physicians will argue that they are separate problems.
 
I think you will need to look at the note as a whole to be able to decide whether or not these can be considered separate problems, and also whether or not the Excludes1 notes should apply or not (see the ICD-10 guidelines for when codes that carry the Excludes1 note may both be reported). If the physicians believe they are separate problems, then their note should reflect this, for example by having different treatment plans directed at the different symptoms.

If you have doubts, I would have an open discussion with the physicians and ask them to explain why these would constitute separately problems. After all, if there is an audit or a question of medical necessity arises with a payer, the physicians will need to be able to justify this from a clinical perspective so that you will be able to support any appeals that may need to be made.
 
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