Alert 10011 (Excludes)

Owned by Roman Konovalov
Last updated: Aug 11, 2020Version comment
1 min read

Description: Errors in this edit are generated if a particular ICD-10-CM code is included in Excludes 1 note list for another diagnosis. One error is generated for every code in the Excludes 1 note list.

Edit ID: 10011

Error type: ERROR

Error message example 1:

This example is provided for the following scenario: 

  1. The claim has principal ICD-10-CM code = O03.34.
  2. The claim has secondary ICD-10-CM code = Z34.80.
  3. Greenrain MNC generates one error for diagnosis code Z34.80.

Diagnosis code Z34.80 is on the Excludes 1 note list for diagnosis code O03.34.

DESCRIPTION

Principal diagnosis code O03.34 = Damage to pelvic organs following incomplete spontaneous abortion

Secondary diagnosis code Z34.80 = Encounter for supervision of other normal pregnancy, unspecified trimester

Error message example 2:

This example is provided for the following scenario: 

  1. The claim has principal ICD-10-CM code = P37.0.
  2. The claim has secondary ICD-10-CM codes = A18.5, R76.11, J65 and A02.21.
  3. Greenrain MNC generates errors for diagnosis codes P37.0, R76.11 and J65 because all three of them are included in Excludes 1 note list for code A18.5.

Error for code P37.0

Diagnosis code P37.0 is on the Excludes 1 note list for diagnosis code A18.5.

DESCRIPTION

Principal diagnosis code P37.0 = Congenital tuberculosis

Secondary diagnosis code A18.5 = Tuberculosis of eye

Error for code R76.11

Diagnosis code R76.11 is on the Excludes 1 note list for diagnosis code A18.5.

DESCRIPTION

Secondary diagnosis code A18.5 = Tuberculosis of eye

Secondary diagnosis code R76.11 = Nonspecific reaction to tuberculin skin test without active tuberculosis

Error for code J65

Diagnosis code J65 is on the Excludes 1 note list for diagnosis code A18.5.

DESCRIPTION

Secondary diagnosis code A18.5 = Tuberculosis of eye

Secondary diagnosis code J65 = Pneumoconiosis associated with tuberculosis

Owner object: Diagnosis

Owner object property name: Code

Owner object property value: Value of Diagnosis.Code

Reference object: Claim

Reference object property name: ID

Reference object property value: Value of Claim.ID