Wiki Excludes 1 and 2

[Cynthia A]

I have three codes E01.0, E03.9, and E04.0

This is my question

Under E04.0 exclude 1 says ( E00.-E02.)

So since exclude 1 means you CANNOT code this here, which diagnosis code do I code the E01.0 or the E04.0?
This has been my question many times as to which code do you then code.

Thank you!

 

[dmcvinney]

I would look at the documentation/talk to your doc about whether the patient really has these 2 conditions, or just one of them.
Also, in case you were not aware, this was added to the guidelines this year regarding Excludes1:
"An exception to the Excludes 1 definition is the circumstance when the two conditions are unrelated to one another. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)", because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However, psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together."

 

[Cynthia A]

Thank you for your response, If I could do what you had suggested I most definitely would have. The charts I get are for HCC coding so we do not have contact with the providers. It is as is coding.