Wiki Excludes codes and auditing

KFLYNN70

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I am wondering when auditing a note and you have excludes 1 notes. Example H50 billed with H53 dx codes. When auditing the note, do you give credit for both dx codes H50 AND H53 on the audit tool or would you not since they both cannot be coded together.
 
I am wondering when auditing a note and you have excludes 1 notes. Example H50 billed with H53 dx codes. When auditing the note, do you give credit for both dx codes H50 AND H53 on the audit tool or would you not since they both cannot be coded together.

When you say 'give credit', I'm assuming here you mean credit toward MDM for an E&M level? If so, I would not use ICD-10 codes for auditing E&M levels, I would only use the information that has been documented by the provider. The MDM elements that based on number of diagnoses should be credited from the conditions being managed, not the number of ICD-10 codes that are generated in the process of coding the condition.

As for the excludes 1 note, I'd refer you to the ICD-10 guidelines regarding this. Depending on documentation, it may be appropriate in some cases to code both conditions together, but you would need to review the record to determine whether or not both codes are supported.
 
I am referring to the MDM for subsequent inpatient visits. The provider is documenting H53 amblyopia along with H50 exotropia which hits an excludes code. they are inclusive on one another. In auditing, should I give credit for both dx codes? which amblyopia he is listing may develop in the future, so he is only listed amblyopia suspect along with H50.15 exotropia which is common in babies. Should I give him both dx codes on the audit tool?
 
I am referring to the MDM for subsequent inpatient visits. The provider is documenting H53 amblyopia along with H50 exotropia which hits an excludes code. they are inclusive on one another. In auditing, should I give credit for both dx codes? which amblyopia he is listing may develop in the future, so he is only listed amblyopia suspect along with H50.15 exotropia which is common in babies. Should I give him both dx codes on the audit tool?

I am not seeing the excludes note you are talking about here, but in any case, excludes notes are not relevant to MDM. Excludes notes are an ICD-10 coding guideline, not a measure for MDM.

As mentioned above, if the provider is documenting the work of evaluating, managing or treating two separate diagnoses, then I would give credit for both toward the MDM for that visit. If they are two aspects or symptoms of the same disease, and there is a single plan of care that encompasses both, then I would treat is as a single problem.
 
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