Wiki Excludes 1 Denials Z01.419/Z30.41

[Aimee Ramadan]

We currently have a diagnosis edit tool that is flagging GYN preventative visits billed with DX Z01.419 and Z30.41 as having an excludes 1 relationship. We're also receiving denials from some commercial plans for this same reason. ICD-10 lists Z01.4 as excludes 2 with Z30.4 , meaning they can be billed together if supported by documentation. Anyone else experiencing this, and have you had success with appealing the denials?

 

[mitchellde]

There is an excludes 1 note at the category heading for Z00-Z13
Type 1 excludes:
Examinations related to pregnancy and reproduction(Z30-Z36, Z39-)

 

[pspears]

Yes, some of the payers are denying claims when contraception codes such in the Z30.4 series when they are billed with Z01.411/Z01.419. The guidelines clearly say they can be billed together which is why the excludes 2 note is listed under the Z01.411 section. But the payers make their own guidelines as well. So, yes you are not alone.

 

[RajashekarB]

Can we code Z11.3 with Z30.432, do we have any edits regarding these ICDs, it was denied for invalid diagnosis.

 

[Cmama12]

There are not any excludes notes for this pair. See section 5 in the Chapter 21 guidelines for info on screening codes - Z11.3 is acceptable but some insurers don't like the Z codes.