Policy Updates Reimbursement PoliciesCommercialJanuary 31, 2019

Reminder Review ICD-10-CM Coding Guidelines - Professional

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

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.