AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Issue 1; Clarifications

Code First Instructional Note

Some payers are denying claims when heart failure or sepsis codes are sequenced as the principal diagnosis because they are misinterpreting the “code first” note at categories I50, Heart failure, and A41, Other sepsis. They are denying the claim based on the belief that the conditions listed in the note are always sequenced first, even though the patient may not have any of the conditions listed. Could you please clarify the intent of the instructional note? ...

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