01608
OCE Edit Code
2011-03-06
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.
LengthNot specified
43 values
... | - | 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) |
22 components
| 1 | O | - | Identifier | |
| 2 | O | - | Text | |
| 3 | C | Name of Coding System | ||
| 4 | O | - | Alternate Identifier | |
| 5 | O | - | Alternate Text | |
| 6 | C | Name of Alternate Coding System | ||
| 7 | C | - | Coding System Version ID | |
| 8 | O | - | Alternate Coding System Version ID | |
| 9 | O | - | Original Text | |
| 10 | O | - | Second Alternate Identifier | |
| 11 | O | - | Second Alternate Text | |
| 12 | C | Name of Second Alternate Coding System | ||
| 13 | O | - | Second Alternate Coding System Version ID | |
| 14 | C | - | Coding System OID | |
| 15 | O | - | Value Set OID | |
| 16 | C | - | Value Set Version ID | |
| 17 | C | - | Alternate Coding System OID | |
| 18 | O | - | Alternate Value Set OID | |
| 19 | C | - | Alternate Value Set Version ID | |
| 20 | C | - | Second Alternate Coding System OID | |
| 21 | O | - | Second Alternate Value Set OID | |
| 22 | C | - | Second Alternate Value Set Version ID |