MAR 04, 2016
Excludes1 Edits for Strabismic Amblyopia
Updated June 2018
Question: An Excludes1 edit in ICD-10 implies H53.03- Strabismic amblyopia can’t be billed to the same patient, same exam as any H50.-Strabismus diagnosis. Is that truly the case?
Answer: Most payers do not follow every aspect of ICD-10 requirements. We have not heard from practices receiving denials. Language regarding Excludes1 notes provided by CMS states: An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider.
Learn more about ICD-10 codes in ICD-10-CM for Ophthalmology: The Complete Reference.