AmeriHealth will reinstate Excludes1 and Excludes2 notes edits as part of our claim editing process during prepayment review for claims received on or after October 30, 2018.
As previously communicated in Partners in Health UpdateSM on August 7, 2018, Temporary edit suspension for Excludes1 and Excludes2 notes, AmeriHealth temporarily suspended Excludes1 and Excludes2 notes edits beginning July 13, 2018, due to a significant number of billing errors. This edit suspension allowed providers time to make their billing systems compliant with the ICD-10 Excludes1 and Excludes2 notes billing rule.
Common coding errors
If your claims are not billed in compliance with the ICD-10 Excludes1 and Excludes2 notes billing rule as of October 30, 2018, they will be rejected.
The below chart contains common coding errors received by AmeriHealth.
| Mutually exclusive combination per ICD-10 Excludes1 Notes | Description |
|---|
| Q66.51 ? M21.41 ? Congenital pes planus, right foot | Flat foot (pes planus) (acquired), right foot |
| K92.2 ? K29.70 ? Gastro intestinal hemorrhage, unspecified | Gastritis, unspecified, without bleeding |
| K51.00 ? K58.0 ? Ulcerative (chronic) pancolitis without complications | Irritable bowel syndrome with diarrhea |
| K01.1 ? M26.34 ? Impacted teeth | Vertical displacement of fully erupted tooth or teeth |
| I49.5 ? R00.1 ? Sick sinus syndrome | Bradycardia, unspecified |
| D61.818 ? D70.9 ? Other pancytopenia | Neutropenia, unspecified |
| Z01.419 ? Z12.4 ? Encounter for gynecological examination (general) (routine) without abnormal findings | Encounter for screening for malignant neoplasm of cervix |
| R06.02 ? J96.01 ? Shortness of breath | Acute repository failure with hypoxia |
| K63.0 ? K57.80 ? Abscess of intestine | Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding |
| P29.3 ? Q25.0 ? Persistent fetal circulation | Patent ductus arteriosus |
| K56.600 ? P76.0 ? Partial intestinal obstruction, unspecified as to cause | Meconium plug syndrome |
Claim rejections
When claims are rejected as a result of the claim editing process, additional details can be viewed via a new Claim Editor link available within the Claim Status Inquiry transaction on the NaviNet? web portal. Note: The Claim Editor link will only display when one or more service lines are rejected with a code message beginning with E8.
The new Claim Editor link can be found on the Claim Status Details screen under Claim and Service Line Details:
We have updated the Claim Status Inquiry Guide to include this new link, which can be found in the NaviNet Resources section. If you have additional questions on the Claim Status Inquiry transaction, please call the eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for AmeriHealth Pennsylvania.
For more information
For more information on the claim editing process, please read, Enhanced claim edits to support correct coding principles.
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