Reminder: Reinstatement of edits for Excludes1 and Excludes2 notes

October 24, 2018

As a reminder, Independence 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, Independence 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 Independence.

Mutually exclusive combination per ICD-10 Excludes1 NotesDescription
Q66.51 ? M21.41 ? Congenital pes planus, right footFlat foot (pes planus) (acquired), right foot
K92.2 ? K29.70 ? Gastro intestinal hemorrhage, unspecifiedGastritis, unspecified, without bleeding
K51.00 ? K58.0 ? Ulcerative (chronic) pancolitis without complicationsIrritable bowel syndrome with diarrhea
K01.1 ? M26.34 ? Impacted teethVertical displacement of fully erupted tooth or teeth
I49.5 ? R00.1 ? Sick sinus syndromeBradycardia, unspecified
D61.818 ? D70.9 ? Other pancytopeniaNeutropenia, unspecified
Z01.419 ? Z12.4 ? Encounter for gynecological examination (general) (routine) without abnormal findingsEncounter for screening for malignant neoplasm of cervix
R06.02 ? J96.01 ? Shortness of breathAcute repository failure with hypoxia
K63.0 ? K57.80 ? Abscess of intestineDiverticulitis of intestine, part unspecified, with perforation and abscess without bleeding
P29.3 ? Q25.0 ? Persistent fetal circulationPatent ductus arteriosus
K56.600 ? P76.0 ? Partial intestinal obstruction, unspecified as to causeMeconium 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 215-640-7410.

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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