Diagnosis Coding Excludes 1 Codes
Question:
Our physicians list their diagnosis codes in the Assessment section of their notes. They link the diagnosis codes to the charges in our EHR. We receive a claims submission edit stating the two diagnosis codes may not be reported together. We review the rules and find the codes have an “Excludes 1” relationship. Our question is, should we remove the diagnosis code that is listed as the “Excludes 1” from the Assessment section of the note when correcting the claim based on the guidelines.
Answer:
No, we should never change anything in the provider documentation or remove information from the provider’s assessment and plan. Great news to hear you are reviewing your claims edit reports timely and it appears your edit is set up correctly in your system. The “Excludes 1” is an ICD-10 coding guideline or a coding rule found in the Conventions for the ICD-10-CM. A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE”. An Excludes 1 indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note. An Excludes 1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. For the complete information and definition of Excludes Notes please refer to Section 1A Conventions for the ICD-10-CM #12.
*This response is based on the best information available as of 3/14/24.
