• Denials regarding certain ICD-10 codes

    I have been getting denials from payers regarding certain ICD-10 codes that cannot be billed together. Example: H16.223 Keratoconjunctivitis sicca, not specified as Sjogren’s bilateral and M35.01 Sjogrens’s syndrome.

    From the ICD-10-CMS Complete Reference for Ophthalmology, these are called Excludes1 edits and represent codes that can’t be billed together. Your charge sheet or electronic health record may not have the full ICD-10 code description that includes not specified as Sjogren’s Submit one or the other. Not both.