DEC 11, 2019
Excludes1 Edits Now Being Applied
Question: There is an Excludes1 edit that states H50. strabismus codes cannot be submitted with H53. amblyopia codes for the same service. We are now seeing denials where previously payers were allowing us to bill both diagnoses. How should we go forward?
Answer: The payer may have just implemented the Excludes1 edit. Consider appealing or submit the diagnosis code that carries the most weight in the exam documentation.
Learn more about Excludes1 in the ICD-10-CM for Ophthalmology.