There have been many offices recently receiving denials for improper use of diagnosis. This is stemming not that the codes are incorrect but that they cannot be coded together on the same claim. This type of denial is due to âType 1 Excludesâ which is a diagnosis rule that does not allow the certain codes to be combined and if they are the claim will be denied. Note the codes below on the left cannot be coded with any of the codes. For instance spine pain codes M54.2, M54.6 and M54.5 cannot be coded with the respective disc codes for the same region. Muscle spasm of back M62.830 cannot be coded with myalgia M79.10 to M79.18. Please verify if any of these codes are on our common code lists and that you make some notation of the excludes to avoid the combination that will need to a denial.
| M54.2 | Type 1 exclude do not code together – cervicalgia due to intervertebral cervical disc disorder (M50.-) |
| M54.5 | Type 1 exclude do not code together – low back strain (S39.012) lumbago due to intervertebral disc displacement (M51.2-) lumbago with sciatica (M54.4-) |
| M54.6 | Type 1 exclude do not code together – pain in thoracic spine due to intervertebral disc disorder (M51.-) M54.3, M54.5, M79.2 |
| M54.4- | Type 1 exclude do not code together – lumbago with sciatica due to intervertebral disc disorder (M51.1-) M54.3, M54.5, M79.2 |
| M54.81 | Type 1 exclude do not code together – dorsalgia in thoracic region (M54.6) low back pain (M54.5) |
| M54.89 | Type 1 exclude do not code together – dorsalgia in thoracic region (M54.6) low back pain (M54.5) |
| M54.1- | Type 1 exclude do not code together – neuralgia and neuritis NOS (M79.2) radiculopathy with cervical disc disorder (M50.1) radiculopathy with lumbar and other intervertebral disc disorder (M51.1) radiculopathy with spondylosis (M47.2) |
| M50. – | Type 1 exclude do not code together – cervicalgia (M54.2), traumatic rupture of cervical intervertebral disc (S13.0-) |
| M51.- | Type 1 exclude do not code together – lumbar dislocation and sprain (S33.-), traumatic rupture of lumbar intevertebral disc (S33.0-), thoracic pain (M54.6), dislocation and sprain of thoracic S23.-) |
| M53.- | Type 1 exclude do not code together – nerve root plexus compressions in diseases classified elsewhere (G55.) |
| S33.- | Type 1 exclude do not code together – nontraumatic rupture or displacement of lumbar intervertebral disc NOS (M51) obstetric damage to pelvic joints and ligaments (O71.6) |
| S39.012- | Type 1 exclude do not code together – low back pain (M54.5) |
| S23.- | Type 1 exclude do not code together – rupture or displacement (nontraumatic) of thoracic intervertebral disc NOS (M51) |
| M79.1- | Type 1 exclude do not code together – fibromyalgia (M79.7) myositis (M60.-) disorders of muscles (spasm, cramp) (M62.-) |
| M79.7 | Type 1 exclude do not code together – myalgia (M79.1-) |
| M62- | Type 1 exclude do not code together – myalgia (M79.1-), cramp spasm (R25.82) stiff man syndrome (G25.82) |
| M47.- | Type 1 exclude do not code together – nerve root plexus disorders (G54.-) |
| G54.- | Type 1 exclude do not code together – intervertebral disc disorders (M50, M51), neuralgia or neuritis NOS (M79.2), neuritis or radiculitis brachial NOS (M54.13), neuritis or radiculitis lumbar NOS (M54.16), neuritis or radiculitis lumbosacral NOS (M54.17), neuritis or radiculitis thoracic NOS (M54.14), radiculitis NOS, radiculopahty (M54.10), spondylosis (M47.-) |
| G55.- | Type 1 exclude do not code together- ankylosing spondylitis (F45.-), dorsopathies (M53.- M54.-)., disc disorders (M50.1- M51.1-), spondylosis (M47.0- M47.2-), spondylopathies M46.-, M48.-) |
| M40.- | Type 1 exclude do not code together- congenital kyphosis and lordosis (Q76.4), kyphoscoliosis (M41), postprocedural kyphosis and lordosis (M96.) |
| M41.- | Type 1 exclude do not code together-congenital scoliosis NOS (Q67.5), congenital scoliosis due to bony malformation (Q76.3), postural congenital scoliosis (Q67.5), kyphoscoliotic heart disease (I27.1), postprocedural scoliosis (M96.) |
| M43.- | Type 1 exclude do not code together- congenital spondylolysis and spondylolisthesis (Q76.2), hemivertebra (Q76.3, Q76.4-), Klippel-Feil syndrome (Q76.1), lumbarization and sacralization (Q76.4), spina bifida occulta (Q76.0), spinal curvature in osteoporosis (M80.), spinal curvature in Paget’s disease of bone [osteitis deformans] (M88.) |
| M46.- | Type 1 exclude do not code together-nerve root and plexus compressions in diseases not classified elsewhere (G55.-) |
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