Can N20.0 and N13.2 be billed on the same CPT line?

When billing for an Assessment/Management (E/M) visit, a patient presents with a left unobstructed kidney stone (N20.0) and a right hydronephrotic ureteral stone (N13.2). In International Classification of Diseases, Tenth Revision, Clinical Modification (CIM-10-CM) under N20, it indicates EXCLUDED 1: the one with hydronephrosis (N13.2). Can I charge N20.0 and N13.2 on the same Current Procedural Terminology line (E/M line)? I’ve encountered denied claims in the past, and I’m not sure if I should charge only 1 CIM-10-CM or 2.

We are seeing an increase in payer changes that reference CIM-10-CM guidelines such as “Excludes 1” notes. As you mentioned, the code N20.

includes the remark:

Excludes 1:

• nephrocalcinosis (E83.5)

• those with hydronephrosis (N13.2)

Note applies to all N20 codes, including N20.0, N20.1 and N20.2. the CIM-10-CM the guidelines state that if the code(s) notes include an Excludes 1 list, the CIM-10-CM the codes listed below the note should not be reported in conjunction with the codes for which the note is listed. Interestingly, if you look under code N13.2, you won’t see a reciprocal reference. In short, it is not correct coding to list both N20.0 and N13.2 codes for the same patient encounter.

It is correct coding to list a single diagnosis if the code accurately describes the patient’s condition. Therefore, you should not receive a denial if only 1 CIM-10-CM code is listed for the claim. If the patient has other conditions that are not listed in the notes as “Excludes 1” or “Includes codes”, more than 1 should be listed CIM-10-CM code, with a few exceptions.

Send coding and refund questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology time®, to [email protected]

Questions of general interest will be selected for publication. The information in this column is designed to be authoritative and every effort has been made to ensure its accuracy at the time of writing. However, readers are encouraged to check with their carrier or private payers for updates and confirm that this information complies with their specific rules.

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