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    WebPT EMR | ICD-10 Excludes 1 Edits
    • 08 Aug 2023
    • 3 Minutes to read
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    WebPT EMR | ICD-10 Excludes 1 Edits

    • Updated on 08 Aug 2023
    • 3 Minutes to read
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    Article Summary

    Overview

    This feature is currently in Limited Release to a select group of Members and will be gradually rolled out in the future.

    The ICD-10-CM Official Guidelines for Coding and Reporting is a document that provides guidance for how to use the codes in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM, or simply ICD-10). Some of the guidelines provided in this document include certain codes that cannot be billed together, and are marked with the note Excludes 1.

    Generally speaking, if a provider is treating a patient for a specific condition, the provider uses the ICD-10 code for that specific condition, and does not add additional ICD-10 codes for diagnoses that are consequences of the condition you’re treating for. For instance, if you’re treating a total knee replacement patient, you should not add codes like knee pain, joint effusion, joint contracture, or difficulty walking, as these symptoms are already a given for a patient recovering from a total knee replacement. Similarly, for patients with intervertebral disc disorders, don’t include codes like cervicalgia, low-back pain, neck pain, or any other conditions that are a direct consequence of the disorder.

    ICD-10 Excludes 1 Edits conflicts can occur between diagnosis codes, treatment diagnosis codes, or a mix between the two. The only other ICD-10 codes that should be used in conjunction with the primary diagnosis are any comorbidities that could impact treatment, such as diabetes.

    Click the arrows below to discover more about how the WebPT EMR helps prevent claim denials due to ICD-10 Excludes 1 Edits conflicts.

    Apply the ICD-10 Excludes 1 Edits Setting

    Apply the ICD-10 Excludes 1 Edits Setting

    The Prevent ICD-10 Excludes 1 conflicts from being billed setting is applied to only Primary Insurances, and on an insurance by insurance basis; as such you will need to apply this setting for each individual insurance provider. If a payer you work with denies claims with ICD-10 Excludes 1 Edits conflicts, enable the insurance setting to prevent those codes from being used together.

    If the Prevent ICD-10 Excludes 1 conflicts from being billed setting is turned on, you will not be able to finalize notes until the conflicting codes are removed and/or resolved. Additionally, you will not be able to add a Case or Quick Add a patient with conflicting diagnosis codes when this setting is enabled.

    1. Click Display Insurance in the WebPT EMR.
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    2. Search for the desired Insurance and click Edit Insurance.
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      a. If the Insurance you want to edit has not been added to the WebPT EMR, click Add New Insurance. Visit this article to learn more about adding an insurance payer to the WebPT EMR.

    3. Check the box next to Prevent ICD-10 Excludes 1 conflicts from being billed.
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    4. Click Save Insurance.

    After the Setting is On

    After the Setting is On

    Once the setting is applied, you’ll be notified of ICD-10 Excludes 1 conflicts in several different ways.

    Adding and Editing a Patient

    When adding or editing a case on a patient’s chart, you will be notified of ICD-10 Excludes 1 Edits under the ICD-10 code selector when conflicting codes are chosen.
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    Quick Adding a Patient

    When using the Quick Add form to add a new patient, you will be notified of conflicting ICD-10 codes under the ICD-10 code selector. Remember, the insurance payer must be added before the ICD-10 Excludes1 Edits setting can notify you of conflicts.
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    Documenting in SOAP 1.0

    In SOAP 1.0, ICD-10 Excludes 1 Edits conflicts appear on the Subjective tab, under the ICD-10 code selector.
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    Documenting in SOAP 2.0

    In SOAP 2.0, you will be notified of any ICD-10 Excludes1 Edits conflicts upon signing the note. If any conflicts are selected, providers will receive an error message that prompts them to correct the conflict, with an explanation of which specific codes are not compatible.
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