Policy Updates Reimbursement PoliciesCommercialFebruary 1, 2019

Reminder: Review ICD-10-CM Coding Guidelines (Professional)

To help ensure the accurate processing of submitted claims, keep in mind ICD-10-CM Coding Guidelines when selecting the most appropriate diagnosis for patient encounters.  Remember, ICD-10-CM has two different types of excludes notes and each type has a different definition.  In particular, one of the unique attributes of the ICD-10 code set and coding conventions is the concept of Excludes 1 Notes.  An Excludes 1 Note is used to indicate when two conditions cannot occur together (Congenital form versus an acquired form of the same condition). An Excludes 1 Note indicates that the excluded code identified in the note should not be used at the same time as the code or code range listed above the Excludes 1 Note. These notes are located under the applicable section heading or specific ICD-10-CM code to which the note is applicable. When the note is located following a section heading, then the note applies to all codes in the section.