Effective January 21, 2021, when processing claims, PacificSource will follow ICD-10-CM guidelines on inappropriate diagnosis combinations.
The current guideline states, “'An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.” PacificSource will deny claims when billed with diagnosis codes that are mutually exclusive and cannot be reported together. Please review your ICD-10 code book for detailed related to Excludes1 notes. If the two conditions are unrelated to each other, chart notes will need to be submitted.