Many years ago, problem lists started appearing at the beginning of an Evaluation and Management note, the notes were dictated and transcribed, and the list was recreated for each new visit.
Coders that have been around before the switch from ICD-9 to ICD-10 know the concept of Excludes1 did not exist in ICD-10, so there was noting stopping a coder from submitting contradictory codes together. The came Excludes1 notes in ICD-10-CM to assist in guiding coders to not code mutually exclusive medical conditions together at the same time.
Reminding codes of the Excludes1 notes and potential conflicts can help a practice catch them before submitting the claim in order to avoid costly denials and unnecessary work.
Now it is the industry standard to use an Electronic Health Record (EHR) with check boxes, templates, and auto-populated fields, but it is important for coders to know they have to review this information and not just trust the EHR.
Up until very recently, payers were not denying claims that included mutually exclusive ICD-10 codes that should not be coded together. This is changing now and denials are beginning to happen. It is important to have tools or a procedure in place to alert coders about ICD-10 coding conflicts, as this will be the key to avoid these potential costly denials and rework of the claim.
It is very important to be diligent about coding with these Excludes1 notes involved. As a responsible coder, you should look up all of the applicable codes to ensure you are not in violation of the ICD-10 coding conventions. Also be sure you are checking the Excludes1 notes in each category. Electronic tools will speed up the process of coding, but you have to check that these tools are accurate with each visit note.
ICD-10 coding accuracy and compliance are becoming more important to the bottom line. As a responsible coder, it is important to take the time to check coding tools to have proper alerts set, have procedure in place to self-check if coding tools are not used, ensure all books are current and up-to-date, and educate any team members who are responsible for selecting diagnosis codes for claims.
If you’d like to stay up-to-date with the 2020 updates, attend the 2020 ICD-10 Updates Live Webinar with Rhonda Granja. The webinar will be held Thursday, October 3, 2019 at 1 pm EST. The webinar is worth 3 MMI and AAPC approved CEUs. For more information on what will be covered in the webinar and to save your seat, please visit: https://mmiclasses.com/2020-icd-10-updates-webinar/