0458

OCE Edit Code

Introduced in v2.4· user· Steward: FM· 43 values

OID & Vocabulary Information

Table OID
2.16.840.1.113883.12.458
Codesystem OID (v1)
2.16.840.1.113883.6.301.9
Expansion
All codes from codesystem
Where Used
GP1-3
UTG Code Table
domain only(with example values)
2
43
...
Modified: deleted
Deprecated
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)