Excludes 1 nightmare

[navila0508]

Does anyone know of the link for cms.gov for the list of all exclude 1's?

Running into denials and i cant keep up with all the excludes for gastro. Wondering if there is such a list of excludes 1's

tia

 

[mitchellde]

There is no list, and it will change from update to update. You need a code book, and you need to look each time. It would be exhaustive to try and construct a list. Any excludes notes at the chapter apply to all codes in the chapter, any at the subchapter apply to all codes in the sub section, any excludes at the category apply to all codes in the category and any excludes notes in the subcategory apply to all codes in the subcategory. So any one code can have excludes notes found listed with the code, or under its sub category, catergory, sub section, and chapter.

 

[navila0508]

Ok...

I received a denial for exclude reasons and when i called for dispute she asked if i had looked at the list on cms.gov website. She said it was a list containing all the excludes. I said no i looked in the actual icd 10 book. Ugh!! Thank you again. I wish someone would make a list though... It would be very helpful!

 

[mitchellde]

Were you able to locate the excludes notes in the code book?

 

[RebeccaC]

I check in the books every time as well. One rule of thumb I always use when speaking with an insurance company rep is that when they refer to something that can be found online, I ask them to direct me there while on the phone. This way you have a clear, written explanation documented. If they cannot bring you through the site to find it, they need to provide a link or a hardcopy showing clearly the guidelines they are following. If they are denying a claim, they must provide the documentation to back it up, either in writing or electronically.

Rebecca C, CPC, CPMA