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  • Denials Based on Excludes1 Notes

    We have received several rejected claims from a commercial carrier when reporting both H59.811 and Z96.1 on the same date of service. The carrier representative told us we could not bill both codes per their policy. When asked where we could find the policy, they replied that they follow CMS guidelines. Is it correct that we cannot bill both these codes?


    There is an Excludes1 note in ICD-10-CM for pseudophakia (Z96.1) with all codes in the H59.- Intraoperative and post-procedural complications and disorders of eye and adnexa, not otherwise classified subchapter. An Excludes1 note indicates that the ICD-10 code noted should never be reported at the same time as the other ICD-10 code.

    Learn more by reviewing ICD-10-CM for Ophthalmology: The Complete Reference