# Hyperlipidemia (E78.5) and Hyperglycemia (R73.9)



## amoskovich (Oct 9, 2015)

I am having a problem reporting these two diagnosis together on the same claim. 
ICD-10 lists exclusions that can not be reported together with a code from R70-R79. Included is any lipid code E78.-
I used to code these together often in ICD-9 without a problem.
How can I now report hyperlipidemia and hyperglycemia on a claim?
Is there a combination code or do I need to drop one of these diagnosis from the claim?
Thank you in advance


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## bonzaibex (Oct 9, 2015)

I have that very same question.  I'm really hoping someone will have an answer for you soon....

Rebecca Hardin, CPC


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## jesfriday (Oct 12, 2015)

I am having the same problem!  I can't find anything in our mounds of education that mentioned this.  I was thinking that maybe I missed something.


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## mitchellde (Oct 12, 2015)

Your education on ICD-10 CM should have included the excludes 1.  You cannot code the codes together.  There is no way to override an exclude 1 exclusion.  You will be able to use only one.


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## bonzaibex (Oct 13, 2015)

Hi Debra,

You have been answering a lot of these ICD10 questions.  Thank you very much.  I truly appreciate your answers.  

I do understand the Excludes 1 notes, and the fact that you cannot code these 2 together because of the Excludes 1 rule.  What I personally was looking for was to see if anyone understood WHY these 2 codes have an Excludes 1 rule.  

Most of the time I understand the reason behind an Excludes 1.  On this pair I don't.  My physician has multiple patients with the 2 conditions.  I don't understand why ICD10 is not letting us report the 2 conditions together.  Is there perhaps a combination code that I'm missing somewhere?  My physician as well as myself are wanting to figure out why ICD10 wants us to choose one diagnosis over the other in this coding scenario.  That's the part that doesn't make sense to me, and I'm hoping somebody else might have some insight.

Again, thank you very much for all the time you have spent answering our ICD10 questions, Debra.    Do you have any other insight on this coding exclusion?

Rebecca Hardin, CPC


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## mitchellde (Oct 13, 2015)

I have many hours spent researching this code set and honestly there is no reasoning given for many things.  Now we have to look at this two different ways.. Either they made a mistake and we will need to accept it for now and hope it will be corrected in future updates OR the WHO when creating this code set had absolute reasons they did things like this and we will have to be accepting that these conditions cannot be managed at the same encounter.  There is no way we can override the excludes 1 edit and no payer is allowed to let us override it.
It could be that the R codes are symptoms, or ill defined issues while the E code is a defined disorder of the endocrine system both dealing with the same system and organ.


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## bonzaibex (Oct 13, 2015)

The reasons you have listed above were pretty much all I could think of, too.  It's nice to at least know I wasn't missing something somewhere.  

You're the best, Debra!  Thank you for taking the time to expand.


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## jesfriday (Oct 14, 2015)

My comment above was specifically related to this combination, and not excludes 1 in general.  We were educated on excludes 1, but not this combination in general.  Its really hard to get the providers to understand this one.  

Thanks


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## msrenee (Oct 26, 2015)

*E78.5** & r73.9*

There are no exludes for this combination


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## mitchellde (Oct 26, 2015)

Yes there is.  You need to look at the subchapter for R70-R79.  There is an exclude 1 note for the E78 codes.


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## TheStephCode (Oct 27, 2015)

This explains everything,.. they can be coded together.


https://www.aapc.com/memberarea/forums/showthread.php?t=128780


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## mitchellde (Oct 27, 2015)

They can be as long as you can prove by documentation that they are not related.  This is only for the interim.  So after this is "fixed" then it will go back to you cannot code codes together with an excludes 1.


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