Why can't hyperlipidemia and prediabetes be coded together?

TheStephCode

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Does anyone have a technical explanation or even a guesstimate as to why ICD-10-CM guidelines prohibit hyperlipidemia (E78.5) and prediabetes (R73.09) to be coded together?

Abnormal findings on exam of blood, without diagnosis (R70-R79)
EXCLUDES1 lipids (E78.-)

Our physicians are asking why this guideline exists and I would like an answer more savvy than "I don't know, I didn't write the guidelines"! :)
 
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mitchellde

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I am not certain anyone has a definitive answer for this. Perhaps it is because the abnormal lab section and the lipids E code are all in the same system and the E code is a diagnosis and the R70-79 states without diagnosis. I am reaching but really I have no idea, and no physican I have spoke to has any idea. So we can say the WHO made a mistake, or possibly they didn't and they have reasons why thus edit is there, which does make it not possible for the provider to address both in the same encounter. Maybe that was the intent?
 

TheStephCode

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Thank you. I was really hoping you would be amongst those to read and reply. I've been all over my books and google this morning trying to figure out some reasoning behind this guideline.

I'm glad to learn we're not the only ones confused by this!
 

TheStephCode

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For reference:


This just came in from the WHO regarding the confusion on the excludes 1 confusion. Now who is going to tell the payers? That would be us when we write our appeals!

We have received several questions regarding the interpretation of Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another.
Answer:
If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note.
For example, the Excludes1 note at code range R40-R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46
codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder.
In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.
 
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