Medi-Cal Claims Editing Update for ICD-10-CM Excludes 1 Notes
November 10, 2021Nov 1, 2021 • State & Federal / Medi-Cal Managed Care
Beginning with dates of service on or after December 1, 2021, Anthem Blue Cross will implement revised claims editing logic tied to Excludes1 notes from ICD-10-CM 2020 coding guidelines. To ensure the accurate processing of claims, use ICD-10-CM coding guidelines when selecting the most appropriate diagnosis for member encounters. Please remember to code to the highest level of specificity. For example, if there is an indication at the category level that a code can be billed with another range of codes, it is imperative to look for Excludes1 notes that may prohibit billing a specific code combination.
If you need assistance in determining proper coding guidance, the following site should be helpful: https://www.cdc.gov/nchs/icd/icd10cm.htm.