Excludes 1 clarification from WHO

mitchellde

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This just cam e in from the WHO regarding the confusion on the excludes 1 confusion. Now who is going to tell the payers? That would be us when we write our appeals!

We have received several questions regarding the interpretation of Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another.
Answer:
If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note. 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. 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 bipolar disorder.
In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.
 

CodingKing

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Thank you. Is there a link to the source? I just passed on this info so it can get to the proper people at the insurance company i work for. So they can see what kind of issues this will cause. I also sent it to my people in appeals although they are so far behind they likley wont be getting to any I10 appeals for 4-6 months.
 

ollielooya

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Debra and to all who follow her posts and replies...I think it can be agreed that this information should be be in the forum as a shout out! I wish there was some way that posts such as this could be highlighted or in the form of a pop-up box. I was actually searching today for add'l answers regarding the "excludes notes" and behold, who came to my rescue again? Thank you to the Coding Queen of All Topics, Debra!
 

lsethier

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Excludes 1 note for category Z00.0

"If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes 1 note".

I wonder if this clarification will allow us to bill a routine exam with the Z00.0 code and a significant separately identifiable "illness" E/M (-25) with a problem diagnosis code.

The two conditions are not related....
 

mitchellde

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I don't think that is what this means. I think they have some of the edits in the wrong place and this is a work around until it can be fixed. They titled it an interim clarification. i expect they are working on a permanent fix. Until then be cautious and be ready to appeal with really good logic such as I should be able to treat a contracture of a joint of the ankle and a contracture of a muscle of the shoulder in the same encounter. They are completely different areas. Or you should be able to code an ankle fracture with a traumatic amputation of the opposit limb. Along those lines is the reasoning.
I TRUELY do not think a sick patientient presenting for a well visit is what they had in mind.
 
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lorenc00

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Our organization wrote to Coding Clinic Support yesterday about the Excludes1 interim advice.

They reiterated the question and answer as quoted in the release and then added this:
"The reason this guidance was developed is that circumstances 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. However, due to the partial code freeze, no changes to Excludes notes or revisions to the official coding guidelines can be made until next October. The new guidance concerning Excludes1 notes is intended to allow conditions to be reported together when appropriate even though they may currently be subject to an Excludes1 note."

Until they can fix next year we will have to use our best judgment and appeal as necessary
 
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