BC Advantage - 2022 Issue 4

Are Excludes1 Edits Causing Problems?

We've heard some comments about payer edits that are citing Excludes1 instructional notations as the reason for denials. Excludes1 notations have been around since the beginning of the implementation of ICD-10-CM, but only recently have these types of edits become more common. One example of this change is an announcement by Anthem BC/BS on April 1, 2021, which states:"Beginning with dates of service on or after April 1, 2021, Anthem will be implementing revised claims editing logic tied to Excludes1 notes from ICD-10-CM 2020 coding guidelines. To help ensure the accurate processing of claims, use ICD-10-CM coding guidelines when...

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