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Question Excludes 1 diagnosis code issue

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ymajestic04@gmail.com

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I am a biller in a small Family Practice and we have no coder. We have a rejected claim due to an Excludes 1 diagnosis issue. The diagnoses used were E03.9, R53.83, F43.0, R73.9, E78.5, R68.82 and Z79.899. I've looked each of these up but I don't see where any of them show an Excludes 1 issue with any of the others. I could really use some help, please.
 
Without seeing the documentation, it's hard to be sure, but I suspect it's due to your symptom codes. For example, E03.9 (Hypothyroidism, unsp) has a common symptom of "fatigue." When a condition has "common" symptoms, coding those symptoms is inappropriate according to Section I.B.5, "Conditions that are an Integral Part of a Disease Process," once a diagnosis is confirmed, you should not code the symptom separately. Technically this is not an "EXCLUDES1" but - it kind of is. It's just guideline based. I hope that helps.
 
LeeJager said:
Without seeing the documentation, it's hard to be sure, but I suspect it's due to your symptom codes. For example, E03.9 (Hypothyroidism, unsp) has a common symptom of "fatigue." When a condition has "common" symptoms, coding those symptoms is inappropriate according to Section I.B.5, "Conditions that are an Integral Part of a Disease Process," once a diagnosis is confirmed, you should not code the symptom separately. Technically this is not an "EXCLUDES1" but - it kind of is. It's just guideline based. I hope that helps.T
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LeeJager said:
Without seeing the documentation, it's hard to be sure, but I suspect it's due to your symptom codes. For example, E03.9 (Hypothyroidism, unsp) has a common symptom of "fatigue." When a condition has "common" symptoms, coding those symptoms is inappropriate according to Section I.B.5, "Conditions that are an Integral Part of a Disease Process," once a diagnosis is confirmed, you should not code the symptom separately. Technically this is not an "EXCLUDES1" but - it kind of is. It's just guideline based. I hope that helps.
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Thank you. I did wonder about that exact thing but could find nothing to confirm it. I appreciate your assistance.
 
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