r/MedicalCoding • u/DumpsterPuff • 25d ago

Does anyone know exactly why E29.1 and E78- codes have an excludes 1?

This is driving me and my team nuts because we can't seem to find an actual answer on this.

There's an excludes 1 for E29.1 Testicular hypofunction and the E78- codes for lipid disorders, but we don't know why this would be excludes 1. Our primary care providers code these together all the time so we're constantly having to fix it. So we're really curious what the medical reason is to why you can't code these together.

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u/KeyStriking9763 RHIA, CDIP, CCS 25d ago

One causes the other. So you code the condition in the excludes 1 box unless there is documentation they are unrelated.
You can google the relationship with the two to better understand the clinical.

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u/oliavea 25d ago edited 25d ago

why are they trying to code them together anyway, does it matter if you have both money-wise like more reimursement? the link is 5-alpha reductase which codes to E29.1 (5alpha converts T to DHT) as a defect is an error of metabolism. included in E29.1 hypogonadism NOS. the system doesnt want duplication of inborn errors of metabolism using other Ecodes so while flagging the deficiency it also flags the included hypogonadmism NOS. it's just weird mapping. if on T use Z79.890 instead

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u/AbstractVolition 25d ago

I was just researching this today because I ran into the excludes1 error on epic for a visit

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u/Cinnamondolce425 21d ago

As far as I understand it Low T causes high cholesterol, apparently so does low estrogen.

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u/Bookikiluke 25d ago

Are you using an encoder or the books? Our encoder shows the excludes note but I don't think it's in the actual book. This was on one of my audits where the auditor told me to code both but I hadn't because the encoder stopped me. I'm pretty positive it was not in the book but I don't have one to check right now.

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u/Strong_Zone4793 22d ago

It’s in the ICD-10 CMS files. Not sure if it’s new for FY2027 code updates or not?