Wiki Excludes1 Guidelines

[eharloff]

I'm confused but not confused on these Excludes1 notes, especially when it comes to Z00.00 excludes1 notes. For example, a patient came in today for her CPE and pre-conception counseling was discussed, so the provider coded Z00.00 and z31.69, but I know this is going to get rejected because of the Z00.00 excludes1 stating those cannot be coded together unless unrelated to each other.

There's another one that I always know is going to reject and that's fatigue w/ any depression/anxiety diagnoses.

That being said, how do you guys go about these claims? In the CPE case, do you take the Z31.69 out of the claim since it's "included with Z00.00?" or wait for official denial?

 

[sls314]

I'm confused but not confused on these Excludes1 notes, especially when it comes to Z00.00 excludes1 notes. For example, a patient came in today for her CPE and pre-conception counseling was discussed, so the provider coded Z00.00 and z31.69, but I know this is going to get rejected because of the Z00.00 excludes1 stating those cannot be coded together unless unrelated to each other.

There's another one that I always know is going to reject and that's fatigue w/ any depression/anxiety diagnoses.

That being said, how do you guys go about these claims? In the CPE case, do you take the Z31.69 out of the claim since it's "included with Z00.00?" or wait for official denial?

Where are you seeing an Excludes1 note on Z00.00 for the Z31.69?

I show the following Excludes1 notes for Z00:

encounter for examination for administrative purposes (Z02.-) (Z02-Z02.9)

And then an additional Excludes1 note specific to Z00.0-

	encounter for examination of sign or symptom - code to sign or symptom
	general health check-up of infant or child (Z00.12.-)

 

[eharloff]

I used Codify's real time claim scrubber with the information above and it gave me the results per my attachment. The only exception is if they are unrelated - which, in my opinion they are.

 

[eharloff]

Now, looking in the book, I do not see the excludes1 note for either code. Why would it show up on the claim scrubber as an error if it's not in the book? Am I interpreting the scrubber's results too formally?