01608
OCE Edit Code
2007-05-08
Definition: This field contains the edit that results from the processing of HCPCS/CPT procedures for a line item HCPCS/CPT, after evaluating all the codes, revenue codes, and modifiers. Refer to User-defined table 0458 - OCE Edit Code for suggested values.
Length≤3
42 values
1 | Invalid diagnosis code |
2 | Diagnosis and age conflict |
3 | Diagnosis and sex conflict |
4 | Medicare secondary payer alert |
5 | E-code as reason for visit |
6 | Invalid procedure code |
7 | Procedure and age conflict |
8 | Procedure and sex conflict |
9 | Nov-covered service |
10 | Non-covered service submitted for verification of denial (condition code 21 from header information on claim) |
11 | Non-covered service submitted for FI review (condition code 20 from header information on claim) |
12 | Questionable covered service |
13 | Additional payment for service not provided by Medicare |
14 | Code indicates a site of service not included in OPPS |
15 | Service unit out of range for procedure |
16 | Multiple bilateral procedures without modifier 50 (see Appendix A) |
17 | Multiple bilateral procedures with modifier 50 (see Appendix A) |
18 | Inpatient procedure |
19 | Mutually exclusive procedure that is not allowed even if appropriate modifier present |
20 | Component of a comprehensive procedure that is not allowed even if appropriate modifier present |
21 | Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B) |
22 | Invalid modifier |
23 | Invalid date |
24 | Date out of OCE range |
25 | Invalid age |
26 | Invalid sex |
27 | Only incidental services reported |
28 | Code not recognized by Medicare; alternate code for same service available |
29 | Partial hospitalization service for non-mental health diagnosis |
30 | Insufficient services on day of partial hospitalization |
31 | Partial hospitalization on same day as ECT or type "T" procedure |
32 | Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days |
33 | Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services |
34 | Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria |
35 | Only activity therapy and/or occupational therapy services provided |
36 | Extensive mental health services provided on day of ECT or significant procedure |
37 | Terminated bilateral procedure or terminated procedure with units greater than one |
38 | Inconsistency between implanted device and implantation procedure |
39 | Mutually exclusive procedure that would be allowed if appropriate modifier were present |
40 | Component of a comprehensive procedure that would be allowed if appropriate modifier were present |
41 | Invalid revenue code |
42 | Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B) |