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Icd-9 "excluldes" clarification

  1. #1
    Location
    Spokane, WA
    Posts
    35
    Question Icd-9 "excluldes" clarification
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    I just started working in a Spine center that does pain management. I noticed that the 724 and 723 icd-9 code series has an excludes note for code series 722 and 721. I just want clarification. Does that mean, if I have low back pain (724.2) and cervical DDD (722.4), I only bill one or the other? Am I only to use the 724.2 since it excludes 722.4?

    I also noticed that other chronic pain (338.29) excludes myalgia (729.1). So, if my doctor documents both diagnoses, am I only to use the 338.29?

    My doc's want education on this and I cannot find anything to print out that explains "excludes notes" and how they work other than the ICD-9 book... which doesn't give much clarification. Any help, or hints as to where to get this information, would be very much appreciated.

    Thank you
    T

  2. #2
    Location
    Albany Oregon
    Posts
    21
    Default Exclusions note from official guidelines....
    Hi ttate,

    This is copied from the ICD-9-CM Official Guidelines for Coding and Reporting effective October 1, 2008 regarding Exclusions:

    " Excludes: An excludes note under a code indicates that the terms excluded from the code are to be coded elsewhere. In some cases the codes for the excluded terms should not be used in conjunction with the code from which it is excluded. An example of this is a congenital condition excluded from an acquired form of the same condition. The congenital and acquired codes should not be used together. In other cases, the excluded terms may be used together with an excluded code. An example of this is when fractures of different bones are coded to different codes. Both codes may be used together if both types of fractures are present."
    I understand that to mean that if both types of spinal disorders are present, then both codes are to be used. So if your patient has low back pain (724.2) and cervical DDD (722.4), it is appropriate to use both codes, one for each disorder.

    I will leave the chronic pain question to be answered/explained by another, maybe someone who works in a pain management clinic or practice.



    Terri Powers
    aka truescaper

  3. #3
    Default excludes
    Quote Originally Posted by ttate View Post
    I just started working in a Spine center that does pain management. I noticed that the 724 and 723 icd-9 code series has an excludes note for code series 722 and 721. I just want clarification. Does that mean, if I have low back pain (724.2) and cervical DDD (722.4), I only bill one or the other? Am I only to use the 724.2 since it excludes 722.4?

    I also noticed that other chronic pain (338.29) excludes myalgia (729.1). So, if my doctor documents both diagnoses, am I only to use the 338.29?

    My doc's want education on this and I cannot find anything to print out that explains "excludes notes" and how they work other than the ICD-9 book... which doesn't give much clarification. Any help, or hints as to where to get this information, would be very much appreciated.

    Thank you
    What I consider is the most definitive diagnosis. The 724 codes are for pain in general, the 722 codes are for definitive purposes such as displaced, degenerative etc. These are the disorders that cause the pain. So, if you have one of these, I do not code the pain codes as it's a symptom of the disorder. That's in the coding guidelines also. Will look for the passage so you can look it up.

  4. #4
    Default clarification
    I should also say that sometimes, it is necessary to use both diagnoses to pass medical necessity when the definitive diagnosis will not pass for some reason but the symptom will. Then I add it.

  5. #5
    Location
    Louisville, KY
    Posts
    1,101
    Default
    ICD-9 Guidelines state that if the definitive diagnosis is known and reported, then any associated signs and symptoms are never to be reported along with the definitive diagnosis code.

    I live by that rule, but frequently see outpatient, physician coders breaking it.

    Reference: ICD-9-CM, Official Coding & Reporting Guidelines, Section I, B, #6.

    If the "pain" is separately reportable, it should be with a 338 series code.

  6. Default exclude
    I have a code which is 72.1 and 73.6. I was wanting to know that the patient had and low outlet forceps which required over a midline episiotomy which was subsequently repaired by and episiorrhaphy. now the exclude said that with: high forceps 72.31, low forceps 72.1, mid forceps 72.21, outlet forceps 72.1, and vacuum extraction 72.71. the code I need is 72.1, so what code would I use with this code? this is confusing me.
    Last edited by jean1dc@embarqmail.com; 04-14-2014 at 03:31 PM.

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