Medicare AdvantageBilling CodesHigh impact
[New York] Telehealth claims update: ICD-10-CM Excludes1 editing
Anthem BCBS·NY·Coding
Effective date
Sep 1, 2026
We identified it
Jul 21, 2026
Summary
Beginning September 1, 2026, telehealth claims billed with Place of Service (POS) 02 or POS 10 will be subject to ICD-10-CM Excludes1 editing rules, the same as in-person claims. Claims submitted with diagnosis code combinations prohibited by Excludes1 notes may be denied for reimbursement. Providers must verify diagnosis codes do not violate Excludes1 conventions before submitting telehealth claims.
Action Required
By August 31, 2026: Billing team and clinical staff must implement verification procedures for all telehealth claims (POS 02 and POS 10) to ensure diagnosis code combinations comply with ICD-10-CM Excludes1 notes. Actions required: (1) Update billing system to apply Excludes1 editing rules to telehealth claims; (2) Train providers and coders on Excludes1 conventions, using the example Z01.419 and Z12.4 as reference; (3) Review current telehealth coding practices and identify common Excludes1 violations; (4) Add Excludes1 compliance check to claim submission workflow in billing software; (5) Document supporting medical records to justify selected diagnosis codes. Consequences: Claims with prohibited diagnosis code combinations will be denied for reimbursement. For disputed denials, submit appeals through Availity.com using the Provider Dispute Resolution Form with supporting documentation.