MSCALLIE79
Networker
I am having trouble explaining the reason for excludes 1 rule to a physician for a patient that has strabismus (esotropia H50.011) and strabismic amblyopia (H53.031).
His response "Those are two related but separate diagnoses that require separate assessments and treatments. Many patients with strabismus do not have strabismic amblyopia, so the second diagnosis is a necessary addition that clearly adds more information. It's like a patient with hypertension and coronary disease. The hypertension might have caused the heart disease, but you still document and address the two problems separately. Can you please clarify the reasoning why I cannot document both of these diagnoses in the same patient?"
Can anyone give me a clinical explanation for these 2 codes?
His response "Those are two related but separate diagnoses that require separate assessments and treatments. Many patients with strabismus do not have strabismic amblyopia, so the second diagnosis is a necessary addition that clearly adds more information. It's like a patient with hypertension and coronary disease. The hypertension might have caused the heart disease, but you still document and address the two problems separately. Can you please clarify the reasoning why I cannot document both of these diagnoses in the same patient?"
Can anyone give me a clinical explanation for these 2 codes?