# DX codes D22.5, D18.1 and D23.22



## jessica1974 (Jan 3, 2018)

I am confused on these codes. I am seeing a lot of denials when these three codes are done together. I know there is an exclusion with D22, D23 and D18 being coded together. Is this because they are inclusive of one another? Also noticing that when we use D22.5 as a primary DX we are receiving denials that it cannot be a primary DX. New to dermatology so any help would be appreciated. Thanks


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## mitchellde (Jan 3, 2018)

jessica1974 said:


> I am confused on these codes. I am seeing a lot of denials when these three codes are done together. I know there is an exclusion with D22, D23 and D18 being coded together. Is this because they are inclusive of one another? Also noticing that when we use D22.5 as a primary DX we are receiving denials that it cannot be a primary DX. New to dermatology so any help would be appreciated. Thanks



Yes D22.5 can be a primary Dx code.  And D22.5 and D23.22 can be used together as they indicate separated areas of the body. So you need to use the exception to the excludes 1 notation, see your coding guidelines. You need to be more specific with the D18 code to be successful. you will need separate procedures to make these work.  You could not use one procedure for both the D22.5 and the D23.22 for example.  Watch how you are linking the diagnosis to the procedure codes.  I suspect the denials have more to do with with the procedure codes and/or the linking than the actual diagnosis codes.


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## jessica1974 (Jan 3, 2018)

It's an established patient visit.


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## mitchellde (Jan 3, 2018)

i would need to see the visit note to advise further.


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## ellzeycoding (Jan 3, 2018)

The D18 and D22 series cannot be coded together for a _procedure _per an *Excludes1* note in the ICD-10 manual.  

Most carriers don't have a problem with these being coded together for E/M encounters and their system edits.  However, there are a few carriers whose systems aren't sophisticated enough to ignore the Excludes1 ICD-10 combination linked to an E/M code. When this happens you can eliminated one of the two DX linked to the E/M, as the E/M isn't tied to the number of ICD-10 codes linked to it.  As long as the E/M encounter is documented properly and meets the criteria for code selection based on the key component, you are fine.


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