Excludes 2 for H16.011 and H16.223

tlwhlw

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We have several DOS's denied for MA63 Missing/Invalid Principal Diagnosis. The CPT is 92012 w/DX H16.001 and H16.223. After reviewing the chart notes, there is also B20 (HIV) listed in the DX list. ICD-10-CM has a note to use an external cause code for the eye condition....and is also indicating an excludes 2 for these DX codes. Can someone please clarify what this means? Do we need to include the B20 DX code? Thank you for your help!

I am new to the ophthalmology coding world, so any help is appreciated. If there is a good eye website to use, please let me know.
 
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Hello there,
I have looked at these two dx and I don't see why you should be getting denied.
I have worked in ophthalmology for many years. I have been using these dx's frequently. I have not
see any problems.
I would suggest calling on a couple and make sure that the dx's went over as you have them entered.
 

tlwhlw

Networker
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Phoenix, AZ
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Thank you for your answer....everything going through correctly, so will have someone else in our auditing department look into this further. :)
 
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