docDefinitions of Medicare Code Edits Preliminary Software version 30.0 PBL–011 October 2012
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Definitions of Medicare Code Edits Preliminary Software version 30.0 PBL–011 October 2012
Preliminary 07/20/12 Definitions of Medicare Code Edits Software version 30.0 PBL–011 October 2012 07/20/12 Document number October 2012 Preliminary PBL–011 ii Definitions of Medicare Code Edits October 2012 Preliminary 07/20/12 About this document T HE MEDICARE CODE EDITOR (MCE) detects and reports errors in the coding claims data. This manual contains a description of each coding edit with corresponding ICD-9-CM code lists. The coding edit information in this manual is effective from 10/01/2012 to 09/30/2013. October 2012 iii 07/20/12 iv Definitions of Medicare Code Edits Preliminary October 2012 Preliminary 07/20/12 Contents Preface Chapter 1 About this document iii Edit code lists 1.3 1. Invalid diagnosis or procedure code 1.4 2. E-code as principal diagnosis 1.4 3. Duplicate of PDX 1.4 4. Age conflict 1.4 5. Sex conflict 1.20 6. Manifestation code as principal diagnosis 1.39 7. Non-specific principal diagnosis 1.42 8. Questionable admission 1.42 9. Unacceptable principal diagnosis 1.43 10. Non-specific O.R. procedure 1.52 11. Non-covered procedure 1.52 12. Open biopsy check 1.55 13. Bilateral procedure 1.55 14. Invalid age 1.56 15. Invalid sex 1.56 16. Invalid discharge status 1.56 17. Limited coverage 1.57 18. Wrong procedure performed 1.58 19. Procedure inconsistent with length of stay 1.58 1.58 Chapter 2 Code list changes 2.3 Changes to existing edits Octoberl 2012 2.3 Contents v 07/20/12 vi Definitions of Medicare Code Edits Preliminary Octoberl 2012 Chapter 1 Edit code lists 1 Contents 1.2 Definitions of Medicare Code Edits Edit code lists 1.3 1. Invalid diagnosis or procedure code 1.4 2. E-code as principal diagnosis 1.4 3. Duplicate of PDX 1.4 4. Age conflict 1.4 5. Sex conflict 1.20 6. Manifestation code as principal diagnosis 1.39 7. Non-specific principal diagnosis 1.42 8. Questionable admission 1.42 9. Unacceptable principal diagnosis 1.43 10. Non-specific O.R. procedure 1.52 11. Non-covered procedure 1.52 12. Open biopsy check 1.55 13. Bilateral procedure 1.55 14. Invalid age 1.56 15. Invalid sex 1.56 16. Invalid discharge status 1.56 17. Limited coverage 1.57 18. Wrong procedure performed 1.58 19. Procedure inconsistent with length of stay 1.58 October 2012 Chapter 1 Edit code lists BELOW IS A LIST of current edits described in this chapter. October 2012 1. Invalid diagnosis or procedure code 2. E-code as principal diagnosis 3. Duplicate of PDX 4. Age conflict 5. Sex conflict 6. Manifestation code as principal diagnosis 7. Non-specific principal diagnosis (Discontinued as of 10/01/07) 8. Questionable admission 9. Unacceptable principal diagnosis 10. Non-specific O.R. procedure (Discontinued as of 10/01/07) 11. Non-covered procedure 12. Open biopsy check (Discontinued as of 10/01/10) 13. Bilateral procedure 14. Invalid age 15. Invalid sex 16. Invalid discharge status 17. Limited coverage 18. Wrong procedure performed 19. Procedure inconsistent with length of stay Edit code lists 1.3 Invalidordiagnosis or 1. Invalid1.diagnosis procedure code procedure code E-code as principal 2. 2. E-code as principal diagnosis diagnosis The Medicare Code Editor checks each diagnosis including the admitting diagnosis and each procedure against a table of valid ICD-9-CM codes. If an entered code does not agree with any code on the internal list, it is assumed to be invalid or that the 4th or 5th digit of the code is invalid or missing. For a list of all valid ICD-9-CM codes, see volumes 2 (diseases) and 3 (procedures) of the International Classification of Diseases, 9th Revision, Fourth Edition, Clinical Modification (ICD-9-CM). E-codes are ICD-9-CM codes beginning with the letter E. They describe the circumstance causing an injury, not the nature of the injury, and therefore should not be used as a principal diagnosis. For a list of all E-codes, see volume 2 (diseases) of the International Classification of Diseases, 9th Revision, Fourth Edition, Clinical Modification (ICD-9-CM). 3. Duplicate of PDX 4. Age conflict Whenever a secondary diagnosis is coded the same as the principal diagnosis, the secondary diagnosis is identified as a duplicate of the principal diagnosis. The Medicare Code Editor detects inconsistencies between a patient’s age and any diagnosis on the patient’s record. For example, a five-year-old patient with benign prostatic hypertrophy or a 78-year-old patient coded with a delivery. In the above cases, the diagnosis is clinically and virtually impossible in a patient of the stated age. Therefore, either the diagnosis or the age is presumed to be incorrect. There are four age categories for diagnoses in the program: ◆ Newborn. Age of 0 years; a subset of diagnoses intended only for newborns and neonates (e.g., fetal distress, perinatal jaundice). ◆ Pediatric. Age range is 0–17 years inclusive (e.g., Reye’s syndrome, routine child health exam). ◆ Maternity. Age range is 12–55 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication). ◆ Adult. Age range is 15–124 years inclusive (e.g., senile delirium, mature cataract). The following pages contain lists of ICD-10-CM diagnosis codes with corresponding English descriptions for each of the age categories described above. 1.4 Definitions of Medicare Code Edits October 2012 Newborn diagnoses 27701 74783 76077 76078 7620 7621 7622 7623 7624 7625 7626 7627 7628 7629 7630 7631 7632 7633 7634 7635 7636 7637 76381 76382 76383 76384 76389 7639 76400 76401 76402 76403 76404 76405 76406 76407 76408 76409 76410 76411 76412 76413 76414 76415 76416 76417 76418 76419 76420 76421 76422 76423 76424 76425 76426 76427 76428 76429 76490 76491 76492 76493 76494 76495 76496 Cystic fibrosis w ileus Persistent fetal circ Mat anticonv aff NB/fet Mat antimetabol aff NB Placenta previa aff NB Placenta hem NEC aff NB Abn plac NEC/NOS aff NB Placent transfusion syn Prolapsed cord aff NB Oth umbil cord compress Umbil cond NEC aff NB Chorioamnionitis aff NB Abn amnion NEC aff NB Abn amnion NOS aff NB Breech del/extrac aff NB Malpos/dispro NEC aff NB Forceps delivery aff NB Vacuum extrac del aff NB Cesarean delivery aff NB Mat anesth/analg aff NB Precipitate del aff NB Abn uterine contr aff NB Ab ftl hrt rt/rh b/f lab Ab ftl hrt rt/rh dur lab Ab ftl hrt rt/rhy NOS Meconium dur del aff NB Compl del NEC aff NB Compl deliv NOS aff NB Light-for-dates wtNOS Light-for-dates <500g Lt-for-dates 500-749g Lt-for-dates 750-999g Lt-for-dates 1000-1249g Lt-for-dates 1250-1499g Lt-for-dates 1500-1749g Lt-for-dates 1750-1999g Lt-for-dates 2000-2499g Lt-for-dates 2500+g Lt-for-date w/mal wtNOS Lt-for-date w/mal <500g Lt-date w/mal 500-749g Lt-date w/mal 750-999g Lt-date w/mal 1000-1249g Lt-date w/mal 1250-1499g Lt-date w/mal 1500-1749g Lt-date w/mal 1750-1999g Lt-date w/mal 2000-2499g Lt-for-date w/mal 2500+g Fetal malnutrition wtNOS Fetal malnutrition <500g Fetal malnutr 500-749g Fetal mal 750-999g Fetal mal 1000-1249g Fetal mal 1250-1499g Fetal mal 1500-1749g Fetal malnutr 1750-1999g Fetal malnutr 2000-2499g Fetal malnutr 2500+g Fet growth retard wtNOS Fet growth retard <500g Fet growth ret 500-749g Fet growth ret 750-999g Fet grwth ret 1000-1249g Fet grwth ret 1250-1499g Fet grwth ret 1500-1749g October 2012 76497 76498 76499 76500 76501 76502 76503 76504 76505 76506 76507 76508 76509 76510 76511 76512 76513 76514 76515 76516 76517 76518 76519 76520 76521 76522 76523 76524 76525 76526 76527 76528 76529 7660 7661 76621 76622 7670 76711 76719 7672 7673 7674 7675 7676 7677 7678 7679 7680 7681 7682 7683 7684 7685 7686 76870 76871 76872 76873 7689 769 7700 77010 77011 77012 Fet grwth ret 1750-1999g Fet grwth ret 2000-2499g Fet growth ret 2500+g Extreme immatur wtNOS Extreme immatur <500g Extreme immatur 500-749g Extreme immatur 750-999g Extreme immat 1000-1249g Extreme immat 1250-1499g Extreme immat 1500-1749g Extreme immat 1750-1999g Extreme immat 2000-2499g Extreme immat 2500+g Preterm infant NEC wtNOS Preterm NEC <500g Preterm NEC 500-749g Preterm NEC 750-999g Preterm NEC 1000-1249g Preterm NEC 1250-1499g Preterm NEC 1500-1749g Preterm NEC 1750-1999g Preterm NEC 2000-2499g Preterm NEC 2500+g Weeks of gestation NOS <24 comp wks gestation 24 comp weeks gestation 25-26 comp wks gestation 27-28 comp wks gestation 29-30 comp wks gestation 31-32 comp wks gestation 33-34 comp wks gestation 35-36 comp wks gestation 37+ comp wks gestation Exceptionally large baby Heavy-for-date infan NEC Post-term infant Prolong gestation-infant Cerebral hem at birth Epicranial subapo hemorr Injuries to scalp NEC Clavicle fx at birth Bone injury NEC at birth Spinal cord inj at birth Facial nerve inj-birth Brach plexus inj-birth Nerve inj NEC at birth Birth trauma NEC Birth trauma NOS Fetal death-anoxia NOS Fet death-anoxia dur lab Fet distress befor labor Fetal distrs dur lab/del Fetal distress NOS Severe birth asphyxia Mild/mod birth asphyxia Hypoxc-ischem enceph NOS Mild hypox-ischem enceph Mod hypox-ischem enceph Sev hypox-ischem enceph Birth asphyxia NOS Respiratory distress syn Congenital pneumonia Fetal & newborn asp NOS Meconium asp wo resp sym Meconium asp w resp symp Edit code lists 1.5 Newborn diagnoses 77013 77014 77015 77016 77017 77018 7702 7703 7704 7705 7706 77081 77082 77083 77084 77085 77086 77087 77088 77089 7709 7710 7711 7712 7713 7714 7715 7716 7717 77181 77182 77183 77189 7720 77210 77211 77212 77213 77214 7722 7723 7724 7725 7726 7728 7729 7730 7731 7732 7733 7734 7735 7740 7741 7742 77430 77431 77439 7744 7745 7746 7747 7750 7751 7752 7753 7754 7755 Amniotc asp w/o resp sym Amniotic asp w resp sym Blood asp w/o resp sympt Blood asp w resp sympt NB asp w/o resp symp NEC NB asp w resp symp NEC NB interstit emphysema NB pulmonary hemorrhage Primary atelectasis NB atelectasis NEC/NOS NB transitory tachypnea Primary apnea of newborn Other apnea of newborn Cyanotic attack, newborn Resp failure of newborn Stomch cont asp w/o resp Stomach cont asp w resp NB respiratory arrest NB hypoxia Resp prob after brth NEC NB respiratory cond NOS Congenital rubella Cong cytomegalovirus inf Congenital infec NEC Tetanus neonatorum Omphalitis of newborn Neonatal infec mastitis Neonatal conjunctivitis Neonatal candida infect NB septicemia [sepsis] NB urinary tract infectn Bacteremia of newborn Perinatal infection NEC NB fetal blood loss NEC NB intraven hem NOS NB intraven hem,grade i NB intraven hem,grade ii NB intravn hem,grade iii NB intraven hem,grade iv NB subarachnoid hemorr Post-birth umbil hemorr NB GI hemorrhage NB adrenal hemorrhage NB cutaneous hemorrhage Neonatal hemorrhage NEC Neonatal hemorrhage NOS NB hemolyt dis:rh isoimm NB hemolyt dis-abo isoim NB hemolyt dis-isoim NEC Hydrops fetalis:isoimm NB kernicterus:isoimmun NB late anemia:isoimmun Perinat jaund-hered anem Perinat jaund:hemolysis Neonat jaund preterm del Delay conjugat jaund NOS Neonat jaund in oth dis Delay conjugat jaund NEC Fetal/neonatal hepatitis Perinatal jaundice NEC Fetal/neonatal jaund NOS NB kernicterus Infant diabet mother syn Neonat diabetes mellitus Neonat myasthenia gravis Neonatal thyrotoxicosis Hypocalcem/hypomagnes NB Neonatal dehydration 1.6 Definitions of Medicare Code Edits 7756 7757 77581 77589 7759 7760 7761 7762 7763 7764 7765 7766 7767 7768 7769 7771 7772 7773 7774 77750 77751 77752 77753 7776 7778 7779 7780 7781 7782 7783 7784 7785 7787 7788 7789 7790 7791 7792 77931 77932 77933 77934 7794 7795 7796 77981 77982 77983 77984 77985 77989 7799 78092 7966 V2031 V2032 V290 V291 V292 V293 V298 V299 V3000 V3001 V301 V3100 V3101 V311 Neonatal hypoglycemia Late metab acidosis NB NB acidosis NEC Neonat endo/met dis NEC Transient met dis NB NOS NB hemorrhagic disease Neonatal thrombocytopen Dissem intravasc coag NB Oth neonatal coag dis Polycythemia neonatorum Congenital anemia Anemia of prematurity Neonatal neutropenia Transient hemat dis NEC NB hematological dis NOS Meconium obstruction Intest obst-inspiss milk Swallowed blood syndrome Transitory ileus of NB Nec enterocoltis NB NOS Stg I nec enterocol NB Stg II nec enterocol NB Stg III nec enterocol NB Perinatal intest perfor Perinat GI sys dis NEC Perinat GI sys dis NOS Hydrops fetalis no isoim Sclerema neonatorum NB cold injury syndrome NB hypothermia NEC NB temp regulat dis NEC Edema of newborn NEC/NOS NB breast engorgement NB integument cond NEC NB integument cond NOS Convulsions in newborn NB cereb irrit NEC/NOS Cns dysfunction syn NB NB feeding problems NB bilious vomiting NB other vomiting NB failure to thrive NB drug reaction/intoxic NB drug withdrawal syndr Termination of pregnancy Neonatal bradycardia Neonatal tachycardia Delay separate umbl cord Meconium staining NB cardiac arrest Perinatal condition NEC Perinatal condition NOS Excess cry infant/baby Abnorm neonate screening Health supvsn nb <8 days Health supv nb 8-28 days NB obsrv suspct infect NB obsrv suspct neurlgcl Obsrv NB suspc resp cond NB obs genetc/metabl cnd NB obsrv oth suspct cond NB obsrv unsp suspct cnd Single lb in-hosp w/o cs Single lb in-hosp w cs Singl livebrn-before adm Twin-mate lb-hosp w/o cs Twin-mate lb-in hos w cs Twin, mate lb-before adm October 2012 Newborn diagnoses V3200 V3201 V321 V3300 V3301 V331 V3400 V3401 V341 V3500 V3501 V351 V3600 V3601 V361 V3700 V3701 V371 V3900 V3901 V391 Twin-mate sb-hosp w/o cs Twin-mate sb-hosp w cs Twin, mate sb-before adm Twin-NOS-in hosp w/o cs Twin-NOS-in hosp w cs Twin NOS-before admissn Oth mult lb-hosp w/o cs Oth mult lb-in hosp w cs Oth mult nb-before adm Oth mult sb-hosp w/o cs Oth mult sb-in hosp w cs Oth mult sb-before adm Mult lb/sb-in hos w/o cs Mult lb/sb-in hosp w cs Mult nb/sb-before adm Mult brth NOS-hos w/o cs Mult birth NOS-hosp w cs Mult brth NOS-before adm Liveborn NOS-hosp w/o cs Liveborn NOS-hosp w cs Liveborn NOS-before adm October 2012 Edit code lists 1.7 Pediatric diagnoses (age 0 through 17) 04041 05810 05811 05812 2591 31389 3139 33181 69011 69012 7511 7512 75161 78091 78341 78342 78631 7897 7980 79982 99550 99551 99552 99553 99554 99555 99559 V200 V201 V202 V695 V8551 V8552 V8553 V8554 Infant botulism Roseola infantum NOS Roseola infant d/t HHV-6 Roseola infant d/t HHV-7 Sexual precocity NEC Emotional dis child NEC Emotional dis child NOS Reye's syndrome Seborrhea capitis Sbrheic infantl drmtitis Atresia small intestine Atresia large intestine Biliary atresia Fussy infant/baby Failure to thrive-child Delayed milestones Ac idio pul hemrg infant Colic Sudden infant death synd Appar life threat-infant Child abuse NOS Child emotnl/psych abuse Child neglect-nutrition Child sexual abuse Child physical abuse Shaken infant syndrome Child abuse/neglect NEC Foundling health care Care of healthy chld NEC Routin child health exam Behav insomnia-childhood BMI,pediatric <5% BMI,pediatric 5% - <85% BMI,pediatric 85% - <95% BMI,pediatric >= 95% 1.8 Definitions of Medicare Code Edits October 2012 Maternity diagnoses (age 12 through 55) 630 6310 6318 632 63300 63301 63310 63311 63320 63321 63380 63381 63390 63391 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 63500 63501 63502 63510 63511 63512 63520 63521 63522 63530 63531 63532 63540 63541 63542 63550 63551 63552 63560 63561 63562 Hydatidiform mole Inapp chg hCG early preg Oth abn prod conception Missed abortion Abd preg w/o intrau preg Abd preg w intraut preg Tubal preg w/o intra prg Tubal preg w intra preg Ovarn preg w/o intra prg Ovarian preg w intra prg Ect preg NEC w/o int prg Ectpc prg NEC w int preg Ect preg NOS w/o int prg Ectp preg NOS w int preg Spon abor w pel inf-unsp Spon abor w pelv inf-inc Spon abor w pel inf-comp Spon abort w hemorr-unsp Spon abort w hemorr-inc Spon abort w hemorr-comp Spon ab w pel damag-unsp Spon ab w pelv damag-inc Spon ab w pel damag-comp Spon ab w ren fail-unsp Spon ab w ren fail-inc Spon ab w ren fail-comp Spon ab w metab dis-unsp Spon ab w metab dis-inc Spon ab w metab dis-comp Spon abort w shock-unsp Spon abort w shock-inc Spon abort w shock-comp Spon abort w embol-unsp Spon abort w embol-inc Spon abort w embol-comp Spon ab w compl NEC-unsp Spon ab w compl NEC-inc Spon ab w compl NEC-comp Spon ab w compl NOS-unsp Spon ab w compl NOS-inc Spon ab w compl NOS-comp Spon abort uncompl-unsp Spon abort uncompl-inc Spon abort uncompl-comp Leg abor w pelv inf-unsp Leg abor w pelv inf-inc Leg abor w pelv inf-comp Legal abor w hemorr-unsp Legal abort w hemorr-inc Legal abor w hemorr-comp Leg ab w pelv damag-unsp Leg ab w pelv damag-inc Leg ab w pelv damag-comp Leg abor w ren fail-unsp Leg abor w ren fail-inc Leg abor w ren fail-comp Leg ab w metab dis-unsp Leg ab w metab dis-inc Leg ab w metab dis-comp Legal abort w shock-unsp Legal abort w shock-inc Legal abort w shock-comp Legal abort w embol-unsp Legal abort w embol-inc Legal abort w embol-comp October 2012 63570 63571 63572 63580 63581 63582 63590 63591 63592 63600 63601 63602 63610 63611 63612 63620 63621 63622 63630 63631 63632 63640 63641 63642 63650 63651 63652 63660 63661 63662 63670 63671 63672 63680 63681 63682 63690 63691 63692 63700 63701 63702 63710 63711 63712 63720 63721 63722 63730 63731 63732 63740 63741 63742 63750 63751 63752 63760 63761 63762 63770 63771 63772 63780 63781 Leg ab w compl NEC-unsp Leg ab w compl NEC-inc Leg ab w compl NEC-comp Leg ab w compl NOS-unsp Leg ab w compl NOS-inc Leg ab w compl NOS-comp Legal abort uncompl-unsp Legal abort uncompl-inc Legal abort uncompl-comp Illeg ab w pelv inf-unsp Illeg ab w pelv inf-inc Illeg ab w pelv inf-comp Illeg ab w hemorr-unspec Illeg ab w hemorr-inc Illeg ab w hemorr-comp Illeg ab w pel damg-unsp Illeg ab w pel damag-inc Illeg ab w pel damg-comp Illeg ab w ren fail-unsp Illeg ab w ren fail-inc Illeg ab w ren fail-comp Illeg ab w met dis-unsp Illeg ab w metab dis-inc Illeg ab w met dis-comp Illeg abort w shock-unsp Illeg abort w shock-inc Illeg abort w shock-comp Illeg ab w embolism-unsp Illeg ab w embolism-inc Illeg ab w embolism-comp Illg ab w compl NEC-unsp Illeg ab w compl NEC-inc Illg ab w compl NEC-comp Illg ab w compl NOS-unsp Illeg ab w compl NOS-inc Illg ab w compl NOS-comp Illeg abort uncompl-unsp Illeg abort uncompl-inc Illeg abort uncompl-comp Abort NOS w pel inf-unsp Abort NOS w pel inf-inc Abort NOS w pel inf-comp Abort NOS w hemorr-unsp Abort NOS w hemorr-inc Abort NOS w hemorr-comp Ab NOS w pelv damag-unsp Ab NOS w pelv damag-inc Ab NOS w pelv damag-comp Ab NOS w renal fail-unsp Ab NOS w renal fail-inc Ab NOS w renal fail-comp Ab NOS w metab dis-unsp Ab NOS w metab dis-inc Ab NOS w metab dis-comp Abort NOS w shock-unsp Abort NOS w shock-inc Abort NOS w shock-comp Ab NOS w embolism-unsp Ab NOS w embolism-inc Ab NOS w embolism-comp Ab NOS w compl NEC-unsp Ab NOS w compl NEC-inc Ab NOS w compl NEC-comp Ab NOS w compl NOS-unsp Ab NOS w compl NOS-inc Edit code lists 1.9 Maternity diagnoses (age 12 through 55) 63782 63790 63791 63792 6380 6381 6382 6383 6384 6385 6386 6387 6388 6389 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64120 64121 64123 64130 64131 64133 64180 64181 64183 64190 64191 64193 64200 64201 64202 64203 64204 64210 64211 64212 64213 64214 64220 64221 64222 64223 64224 64230 64231 64232 Ab NOS w compl NOS-comp Ab NOS uncomplicat-unsp Ab NOS uncomplicat-inc Ab NOS uncomplicat-comp Attem abort w pelvic inf Attem abort w hemorrhage Attem abort w pelv damag Attem abort w renal fail Attem abor w metabol dis Attem abortion w shock Attemp abort w embolism Attemp abort w compl NEC Attemp abort w compl NOS Attempted abort uncompl Postabortion gu infect Postabortion hemorrhage Postabort pelvic damage Postabort kidney failure Postabort metabolic dis Postabortion shock Postabortion embolism Postabortion compl NEC Postabortion compl NOS Threatened abort-unspec Threatened abort-deliver Threaten abort-antepart Hem early preg NEC-unsp Hem early preg NEC-deliv Hem early pg NEC-antepar Hemorr early preg-unspec Hem early preg-delivered Hem early preg-antepart Placenta previa-unspec Placenta previa-deliver Placenta previa-antepart Placenta prev hem-unspec Placenta prev hem-deliv Placen prev hem-antepart Prem separ placen-unspec Prem separ placen-deliv Prem separ plac-antepart Coag def hemorr-unspec Coag def hemorr-deliver Coag def hemorr-antepart Antepart hem NEC-unspec Antepartum hem NEC-deliv Antepart hem NEC-antepar Antepart hem NOS-unspec Antepartum hem NOS-deliv Antepart hem NOS-antepar Essen hyperten preg-unsp Essen hyperten-delivered Essen hyperten-del w p/p Essen hyperten-antepart Essen hyperten-postpart Renal hyperten preg-unsp Renal hyperten pg-deliv Renal hyperten-del p/p Renal hyperten-antepart Renal hyperten-postpart Old hyperten preg-unspec Old hyperten NEC-deliver Old hyperten-deliv w p/p Old hyperten NEC-antepar Old hyperten NEC-postpar Trans hyperten preg-unsp Trans hyperten-delivered Trans hyperten-del w p/p 1.10 Definitions of Medicare Code Edits 64233 64234 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64290 64291 64292 64293 64294 64300 64301 64303 64310 64311 64313 64320 64321 64323 64380 64381 64383 64390 64391 64393 64400 64403 64410 64413 64420 64421 64510 64511 64513 64520 64521 64523 64600 64601 64603 64610 64611 64612 64613 64614 64620 64621 64622 64623 64624 64630 Trans hyperten-antepart Trans hyperten-postpart Mild/NOS preeclamp-unsp Mild/NOS preeclamp-deliv Mild preeclamp-del w p/p Mild/NOS preeclamp-antep Mild/NOS preeclamp-p/p Severe preeclamp-unspec Severe preeclamp-deliver Sev preeclamp-del w p/p Sev preeclamp-antepartum Sev preeclamp-postpartum Eclampsia-unspecified Eclampsia-delivered Eclampsia-deliv w p/p Eclampsia-antepartum Eclampsia-postpartum Tox w old hyperten-unsp Tox w old hyperten-deliv Tox w old hyp-del w p/p Tox w old hyper-antepart Tox w old hyper-postpart Hyperten preg NOS-unspec Hypertens NOS-delivered Hypertens NOS-del w p/p Hypertens NOS-antepartum Hypertens NOS-postpartum Mild hyperem grav-unspec Mild hyperem grav-deliv Mild hyperemesis-antepar Hyperem w metab dis-unsp Hyperem w metab dis-del Hyperem w metab-antepart Late vomit of preg-unsp Late vomit of preg-deliv Late vomit preg-antepart Vomit compl preg-unspec Vomit compl preg-deliver Vomit compl preg-antepar Vomit of preg NOS-unspec Vomit of preg NOS-deliv Vomit of pg NOS-antepart Threat prem labor-unspec Thrt prem labor-antepart Threat labor NEC-unspec Threat labor NEC-antepar Early onset deliv-unspec Early onset delivery-del Post term preg-unsp Post term preg-del Post term preg-antepar Prolonged preg-unsp Prolonged preg-del Prolonged preg-antepar Papyraceous fetus-unspec Papyraceous fetus-deliv Papyraceous fet-antepar Edema in preg-unspec Edema in preg-delivered Edema in preg-del w p/p Edema in preg-antepartum Edema in preg-postpartum Renal dis preg NOS-unsp Renal dis NOS-delivered Renal dis NOS-del w p/p Renal dis NOS-antepartum Renal dis NOS-postpartum Recur preg loss-unspec October 2012 Maternity diagnoses (age 12 through 55) 64631 64633 64640 64641 64642 64643 64644 64650 64651 64652 64653 64654 64660 64661 64662 64663 64664 64670 64671 64673 64680 64681 64682 64683 64684 64690 64691 64693 64700 64701 64702 64703 64704 64710 64711 64712 64713 64714 64720 64721 64722 64723 64724 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64750 64751 64752 64753 64754 64760 64761 64762 64763 64764 64780 64781 64782 64783 64784 Recurnt preg loss-deliv Recurnt preg loss-antep Neuritis of preg-unspec Neuritis-delivered Neuritis-delivered w p/p Neuritis of preg-antepar Neuritis of preg-postpar Bacteriuria preg-unspec Asym bacteriuria-deliver Asy bacteruria-del w p/p Asy bacteriuria-antepart Asy bacteriuria-postpart Gu infect in preg-unspec Gu infection-delivered Gu infection-deliv w p/p Gu infection-antepartum Gu infection-postpartum Liver/bil trct disr-unsp Liver/bil trct disr-del Liver/bil trct disr-ante Preg compl NEC-unspec Preg compl NEC-delivered Preg compl NEC-del w p/p Preg compl NEC-antepart Preg compl NEC-postpart Preg compl NOS-unspec Preg compl NOS-delivered Preg compl NOS-antepart Syphilis in preg-unspec Syphilis-delivered Syphilis-delivered w p/p Syphilis-antepartum Syphilis-postpartum Gonorrhea in preg-unspec Gonorrhea-delivered Gonorrhea-deliver w p/p Gonorrhea-antepartum Gonorrhea-postpartum Other VD in preg-unspec Other vd-delivered Other vd-delivered w p/p Other vd-antepartum Other vd-postpartum TB in preg-unspecified Tuberculosis-delivered Tuberculosis-deliv w p/p Tuberculosis-antepartum Tuberculosis-postpartum Malaria in preg-unspec Malaria-delivered Malaria-delivered w p/p Malaria-antepartum Malaria-postpartum Rubella in preg-unspec Rubella-delivered Rubella-delivered w p/p Rubella-antepartum Rubella-postpartum Oth virus in preg-unspec Oth viral dis-delivered Oth viral dis-del w p/p Oth viral dis-antepartum Oth viral dis-postpartum Inf dis in preg NEC-unsp Infect dis NEC-delivered Infect dis NEC-del w p/p Infect dis NEC-antepart Infect dis NEC-postpart October 2012 64790 64791 64792 64793 64794 64800 64801 64802 64803 64804 64810 64811 64812 64813 64814 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64840 64841 64842 64843 64844 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 64870 64871 64872 64873 64874 64880 64881 64882 64883 64884 64890 64891 64892 64893 64894 64900 64901 64902 64903 64904 64910 64911 64912 64913 64914 64920 64921 64922 Infect in preg NOS-unsp Infect NOS-delivered Infect NOS-deliver w p/p Infect NOS-antepartum Infect NOS-postpartum Diabetes in preg-unspec Diabetes-delivered Diabetes-delivered w p/p Diabetes-antepartum Diabetes-postpartum Thyroid dysfun preg-unsp Thyroid dysfunc-deliver Thyroid dysfun-del w p/p Thyroid dysfunc-antepart Thyroid dysfunc-postpart Anemia in preg-unspec Anemia-delivered Anemia-delivered w p/p Anemia-antepartum Anemia-postpartum Drug depend preg-unspec Drug dependence-deliver Drug dependen-del w p/p Drug dependence-antepart Drug dependence-postpart Mental dis preg-unspec Mental disorder-deliver Mental dis-deliv w p/p Mental disorder-antepart Mental disorder-postpart Congen CV dis preg-unsp Congen CV dis-delivered Congen CV dis-del w p/p Congen CV dis-antepartum Congen CV dis-postpartum CV dis NEC preg-unspec CV dis NEC preg-deliver CV dis NEC-deliver w p/p CV dis NEC-antepartum CV dis NEC-postpartum Bone disord in preg-unsp Bone disorder-delivered Bone disorder-del w p/p Bone disorder-antepartum Bone disorder-postpartum Abn glucose in preg-unsp Abn glucose toler-deliv Abn glucose-deliv w p/p Abn glucose-antepartum Abn glucose-postpartum Oth curr cond preg-unsp Oth curr cond-delivered Oth curr cond-del w p/p Oth curr cond-antepartum Oth curr cond-postpartum Tobacco use disord-unsp Tobacco use disor-delliv Tobacco use dis-del-p/p Tobacco use dis-antepart Tobacco use dis-postpart Obesity-unspecified Obesity-delivered Obesity-delivered w p/p Obesity-antepartum Obesity-postpartum Bariatric surg stat-unsp Bariatric surg stat-del Bariatric surg-del w p/p Edit code lists 1.11 Maternity diagnoses (age 12 through 55) 64923 64924 64930 64931 64932 64933 64934 64940 64941 64942 64943 64944 64950 64951 64953 64960 64961 64962 64963 64964 64970 64971 64973 64981 64982 650 65100 65101 65103 65110 65111 65113 65120 65121 65123 65130 65131 65133 65140 65141 65143 65150 65151 65153 65160 65161 65163 65170 65171 65173 65180 65181 65183 65190 65191 65193 65200 65201 65203 65210 65211 65213 65220 65221 65223 65230 65231 65233 Bariatrc surg stat-antep Bariatrc surg stat w p/p Coagulation def-unspec Coagulation def-deliv Coagulatn def-del w p/p Coagulation def-antepart Coagulation def-postpart Epilepsy-unspecified Epilepsy-delivered Epilepsy-delivered w p/p Epilepsy-antepartum Epilepsy-postpartum Spotting-unspecified Spotting-delivered Spotting-antepartum Uterine size descrp-unsp Uterine size descrep-del Uterine size-del w p/p Uterine size des-antepar Uterine size descrep-p/p Cervical shortening-unsp Cervical shortening-del Cervical shortening-ante Spon labr w plan C/S-del Lbr w plan C/S-del w p/p Normal delivery Twin pregnancy-unspec Twin pregnancy-delivered Twin pregnancy-antepart Triplet pregnancy-unspec Triplet pregnancy-deliv Triplet preg-antepartum Quadruplet preg-unspec Quadruplet preg-deliver Quadruplet preg-antepart Twins w fetal loss-unsp Twins w fetal loss-del Twins w fetal loss-ante Triplets w fet loss-unsp Triplets w fet loss-del Triplets w fet loss-ante Quads w fetal loss-unsp Quads w fetal loss-del Quads w fetal loss-ante Mult ges w fet loss-unsp Mult ges w fet loss-del Mult ges w fet loss-ante Mul gest-fet reduct unsp Mult gest-fet reduct del Mul gest-fet reduct ante Multi gestat NEC-unspec Multi gestat NEC-deliver Multi gest NEC-antepart Multi gestat NOS-unspec Mult gestation NOS-deliv Multi gest NOS-antepart Unstable lie-unspecified Unstable lie-delivered Unstable lie-antepartum Cephalic vers NOS-unspec Cephalic vers NOS-deliv Cephal vers NOS-antepart Breech presentat-unspec Breech presentat-deliver Breech present-antepart Transv/obliq lie-unspec Transver/obliq lie-deliv Transv/obliq lie-antepar 1.12 Definitions of Medicare Code Edits 65240 65241 65243 65250 65251 65253 65260 65261 65263 65270 65271 65273 65280 65281 65283 65290 65291 65293 65300 65301 65303 65310 65311 65313 65320 65321 65323 65330 65331 65333 65340 65341 65343 65350 65351 65353 65360 65361 65363 65370 65371 65373 65380 65381 65383 65390 65391 65393 65400 65401 65402 65403 65404 65410 65411 65412 65413 65414 65420 65421 65423 65430 65431 65432 65433 65434 65440 65441 Face/brow present-unspec Face/brow present-deliv Face/brow pres-antepart High head at term-unspec High head at term-deliv High head term-antepart Mult gest malpresen-unsp Mult gest malpres-deliv Mult ges malpres-antepar Prolapsed arm-unspec Prolapsed arm-delivered Prolapsed arm-antepart Malposition NEC-unspec Malposition NEC-deliver Malposition NEC-antepart Malposition NOS-unspec Malposition NOS-deliver Malposition NOS-antepart Pelvic deform NOS-unspec Pelvic deform NOS-deliv Pelv deform NOS-antepart Contract pelv NOS-unspec Contract pelv NOS-deliv Contrac pelv NOS-antepar Inlet contraction-unspec Inlet contraction-deliv Inlet contract-antepart Outlet contraction-unsp Outlet contraction-deliv Outlet contract-antepart Fetopelv disprop-unspec Fetopelv dispropor-deliv Fetopel disprop-antepart Fetal disprop NOS-unspec Fetal disprop NOS-deliv Fetal dispro NOS-antepar Hydrocephal fetus-unspec Hydroceph fetus-deliver Hydroceph fetus-antepart Oth abn fet disprop-unsp Oth abn fet dispro-deliv Oth abn fet dispro-antep Disproportion NEC-unspec Disproportion NEC-deliv Dispropor NEC-antepartum Disproportion NOS-unspec Disproportion NOS-deliv Dispropor NOS-antepartum Cong abn uter preg-unsp Congen abn uterus-deliv Cong abn uter-del w p/p Congen abn uter-antepart Congen abn uter-postpart Uter tumor in preg-unsp Uterine tumor-delivered Uterine tumor-del w p/p Uterine tumor-antepartum Uterine tumor-postpartum Prev c-delivery unspec Prev c-delivery-delivrd Prev c-delivery-antepart Retrovert uterus-unspec Retrovert uterus-deliver Retrovert uter-del w p/p Retrovert uter-antepart Retrovert uter-postpart Abn grav uterus NEC-unsp Abn uterus NEC-delivered October 2012 Maternity diagnoses (age 12 through 55) 65442 65443 65444 65450 65451 65452 65453 65454 65460 65461 65462 65463 65464 65470 65471 65472 65473 65474 65480 65481 65482 65483 65484 65490 65491 65492 65493 65494 65500 65501 65503 65510 65511 65513 65520 65521 65523 65530 65531 65533 65540 65541 65543 65550 65551 65553 65560 65561 65563 65570 65571 65573 65580 65581 65583 65590 65591 65593 65600 65601 65603 65610 65611 65613 65620 65621 65623 65630 Abn uterus NEC-del w p/p Abn uterus NEC-antepart Abn uterus NEC-postpart Cerv incompet preg-unsp Cervical incompet-deliv Cerv incompet-del w p/p Cerv incompet-antepartum Cerv incompet-postpartum Abn cervix NEC preg-unsp Abn cervix NEC-delivered Abn cervix NEC-del w p/p Abn cervix NEC-antepart Abn cervix NEC-postpart Abn vagina in preg-unsp Abnorm vagina-delivered Abnorm vagina-del w p/p Abnorm vagina-antepartum Abnorm vagina-postpartum Abn vulva in preg-unspec Abnormal vulva-delivered Abnormal vulva-del w p/p Abnormal vulva-antepart Abnormal vulva-postpart Abn pel NEC in preg-unsp Abn pelv org NEC-deliver Abn pelv NEC-deliv w p/p Abn pelv org NEC-antepar Abn pelv org NEC-postpar Fetal cns malform-unspec Fetal cns malform-deliv Fetal cns malfor-antepar Fetal chromos abn-unspec Fetal chromoso abn-deliv Fet chromo abn-antepart Famil heredit dis-unspec Famil heredit dis-deliv Famil hered dis-antepart Fet damg d/t virus-unsp Fet damg d/t virus-deliv Fet damg d/t virus-antep Fet damg d/t dis-unspec Fet damg d/t dis-deliver Fet damg d/t dis-antepar Fetal damg d/t drug-unsp Fet damag d/t drug-deliv Fet damg d/t drug-antepa Radiat fetal damag-unsp Radiat fetal damag-deliv Radiat fet damag-antepar Decrease fetl movmt unsp Decrease fetal movmt del Dec fetal movmt antepart Fetal abnorm NEC-unspec Fetal abnorm NEC-deliver Fetal abnorm NEC-antepar Fetal abnorm NOS-unspec Fetal abnorm NOS-deliver Fetal abnorm NOS-antepar Fetal-maternal hem-unsp Fetal-maternal hem-deliv Fetal-matern hem-antepar Rh isoimmunization-unsp Rh isoimmunizat-deliver Rh isoimmunizat-antepart Abo isoimmunization-unsp Abo isoimmunizat-deliver Abo isoimmunizat-antepar Fetal distress-unspec October 2012 65631 65633 65640 65641 65643 65650 65651 65653 65660 65661 65663 65670 65671 65673 65680 65681 65683 65690 65691 65693 65700 65701 65703 65800 65801 65803 65810 65811 65813 65820 65821 65823 65830 65831 65833 65840 65841 65843 65880 65881 65883 65890 65891 65893 65900 65901 65903 65910 65911 65913 65920 65921 65923 65930 65931 65933 65940 65941 65943 65950 65951 65953 65960 65961 65963 65970 65971 65973 Fetal distress-delivered Fetal distress-antepart Intrauterine death-unsp Intrauter death-deliver Intrauter death-antepart Poor fetal growth-unspec Poor fetal growth-deliv Poor fetal grth-antepart Excess fetal grth-unspec Excess fetal grth-deliv Excess fet grth-antepart Oth placent cond-unspec Oth placent cond-deliver Oth placent cond-antepar Fet/plac prob NEC-unspec Fet/plac prob NEC-deliv Fet/plac prob NEC-antepa Fet/plac prob NOS-unspec Fet/plac prob NOS-deliv Fet/plac prob NOS-antepa Polyhydramnios-unspec Polyhydramnios-delivered Polyhydramnios-antepart Oligohydramnios-unspec Oligohydramnios-deliver Oligohydramnios-antepar Prem rupt membran-unspec Prem rupt membran-deliv Prem rupt memb-antepart Prolong rupt memb-unspec Prolong rupt memb-deliv Prolong rup memb-antepar Artific rupt membr-unsp Artific rupt membr-deliv Artif rupt memb-antepart Amniotic infection-unsp Amniotic infection-deliv Amniotic infect-antepart Amniotic prob NEC-unspec Amniotic prob NEC-deliv Amnion prob NEC-antepart Amniotic prob NOS-unspec Amniotic prob NOS-deliv Amnion prob NOS-antepart Fail mechan induct-unsp Fail mech induct-deliver Fail mech induct-antepar Fail induction NOS-unsp Fail induction NOS-deliv Fail induct NOS-antepart Pyrexia in labor-unspec Pyrexia in labor-deliver Pyrexia in labor-antepar Septicemia in labor-unsp Septicem in labor-deliv Septicem in labor-antepa Grand multiparity-unspec Grand multiparity-deliv Grand multiparity-antepa Elderly primigravid-unsp Elderly primigravida-del Elder primigravid-antepa Elderly multigravida-uns Elderly multigravida-del Elderly multigravd-antep Abn ftl hrt rate/rhy-uns Abn ftl hrt rate/rhy-del Abn ftl hrt rate/rhy-ant Edit code lists 1.13 Maternity diagnoses (age 12 through 55) 65980 65981 65983 65990 65991 65993 66000 66001 66003 66010 66011 66013 66020 66021 66023 66030 66031 66033 66040 66041 66043 66050 66051 66053 66060 66061 66063 66070 66071 66073 66080 66081 66083 66090 66091 66093 66100 66101 66103 66110 66111 66113 66120 66121 66123 66130 66131 66133 66140 66141 66143 66190 66191 66193 66200 66201 66203 66210 66211 66213 66220 66221 66223 66230 66231 66233 66300 66301 Complic labor NEC-unsp Complic labor NEC-deliv Compl labor NEC-antepart Complic labor NOS-unsp Complic labor NOS-deliv Compl labor NOS-antepart Obstruct/fet malpos-unsp Obstruc/fet malpos-deliv Obstruc/fet malpos-antep Bony pelv obstruc-unspec Bony pelv obstruct-deliv Bony pelv obstruc-antepa Abn pelv tiss obstr-unsp Abn pelv tis obstr-deliv Abn pelv tis obstr-antep Persist occipitpost-unsp Persist occiptpost-deliv Persist occiptpost-antep Shoulder dystocia-unspec Shoulder dystocia-deliv Shoulder dystocia-antepa Locked twins-unspecified Locked twins-delivered Locked twins-antepartum Fail trial lab NOS-unsp Fail trial lab NOS-deliv Fail trial lab NOS-antep Failed forcep NOS-unspec Failed forceps NOS-deliv Fail forceps NOS-antepar Obstruc labor NEC-unspec Obstruct labor NEC-deliv Obstruc labor NEC-antepa Obstruc labor NOS-unspec Obstruct labor NOS-deliv Obstruc labor NOS-antepa Prim uterine inert-unsp Prim uterine inert-deliv Prim uter inert-antepart Sec uterine inert-unspec Sec uterine inert-deliv Sec uterine inert-antepa Uterine inertia NEC-unsp Uterine inert NEC-deliv Uterine inert NEC-antepa Precipitate labor-unspec Precipitate labor-deliv Precipitate labor-antepa Uter dystocia NOS-unspec Uter dystocia NOS-deliv Uter dystocia NOS-antepa Abnormal labor NOS-unsp Abnormal labor NOS-deliv Abnorm labor NOS-antepar Prolonged 1st stage-unsp Prolong 1st stage-deliv Prolong 1st stage-antepa Prolonged labor NOS-unsp Prolong labor NOS-deliv Prolong labor NOS-antepa Prolonged 2nd stage-unsp Prolong 2nd stage-deliv Prolong 2nd stage-antepa Delay del 2nd twin-unsp Delay del 2nd twin-deliv Delay del 2 twin-antepar Cord prolapse-unspec Cord prolapse-delivered 1.14 Definitions of Medicare Code Edits 66303 66310 66311 66313 66320 66321 66323 66330 66331 66333 66340 66341 66343 66350 66351 66353 66360 66361 66363 66380 66381 66383 66390 66391 66393 66400 66401 66404 66410 66411 66414 66420 66421 66424 66430 66431 66434 66440 66441 66444 66450 66451 66454 66460 66461 66464 66480 66481 66484 66490 66491 66494 66500 66501 66503 66510 66511 66520 66522 66524 66530 66531 66534 66540 66541 66544 66550 66551 Cord prolapse-antepartum Cord around neck-unspec Cord around neck-deliver Cord around neck-antepar Cord compress NEC-unspec Cord compress NEC-deliv Cord compres NEC-antepar Cord entangle NEC-unspec Cord entangle NEC-deliv Cord entangl NEC-antepar Short cord-unspecified Short cord-delivered Short cord-antepartum Vasa previa-unspecified Vasa previa-delivered Vasa previa-antepartum Vasc lesion cord-unspec Vasc lesion cord-deliver Vasc lesion cord-antepar Cord complicat NEC-unsp Cord complicat NEC-deliv Cord compl NEC-antepart Cord complicat NOS-unsp Cord complicat NOS-deliv Cord compl NOS-antepart Del w 1 deg lacerat-unsp Del w 1 deg lacerat-del Del w 1 deg lac-postpart Del w 2 deg lacerat-unsp Del w 2 deg lacerat-del Del w 2 deg lac-postpart Del w 3 deg lacerat-unsp Del w 3 deg lacerat-del Del w 3 deg lac-postpart Del w 4 deg lacerat-unsp Del w 4 deg lacerat-del Del w 4 deg lac-postpart Ob perineal lac NOS-unsp Ob perineal lac NOS-del Perineal lac NOS-postpar Ob perineal hematom-unsp Ob perineal hematoma-del Perin hematoma-postpart Anal sphincter tear NOS Anal sphincter tear-del Anal sphinctr tear w p/p Ob perin traum NEC-unsp Ob perineal trau NEC-del Perin traum NEC-postpart Ob perin traum NOS-unsp Ob perineal trau NOS-del Perin traum NOS-postpart Prelabor rupt uter-unsp Prelabor rupt uterus-del Prelab rupt uter-antepar Rupture uterus NOS-unsp Rupture uterus NOS-deliv Inversion of uterus-unsp Invers uterus-del w p/p Invers uterus-postpart Lacerat of cervix-unspec Lacerat of cervix-deliv Lacer of cervix-postpart High vaginal lacer-unsp High vaginal lacer-deliv High vaginal lac-postpar Ob inj pelv org NEC-unsp Ob inj pelv org NEC-del October 2012 Maternity diagnoses (age 12 through 55) 67150 67151 67152 67153 67154 67180 67181 67182 67183 67184 67190 67191 67192 67193 67194 67200 67202 67204 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67414 67420 67422 67424 67430 67432 67434 67440 67442 67444 67450 67451 67452 67453 67454 67480 67482 67484 Thrombosis NEC preg-unsp Thrombosis NEC-delivered Thromb NEC-deliv w p/p Thrombosis NEC-antepart Thrombosis NEC-postpart Ven compl preg NEC-unsp Venous compl NEC-deliver Ven comp NEC-deliv w p/p Venous compl NEC-antepar Venous compl NEC-postpar Ven compl preg NOS-unsp Venous compl NOS-deliver Ven comp NOS-deliv w p/p Venous compl NOS-antepar Venous compl NOS-postpar Puerperal pyrexia-unspec Puerp pyrexia-del w p/p Puerp pyrexia-postpartum Ob air embolism-unspec Ob air embolism-deliver Ob air embol-deliv w p/p Ob air embolism-antepart Ob air embolism-postpart Amniotic embolism-unspec Amniotic embolism-deliv Amniot embol-deliv w p/p Amniotic embol-antepart Amniotic embol-postpart Ob pulm embol NOS-unspec Pulm embol NOS-delivered Pulm embol NOS-del w p/p Pulm embol NOS-antepart Pulm embol NOS-postpart Ob pyemic embol-unspec Ob pyemic embol-deliver Ob pyem embol-del w p/p Ob pyemic embol-antepart Ob pyemic embol-postpart Ob pulmon embol NEC-unsp Pulmon embol NEC-deliver Pulm embol NEC-del w p/p Pulmon embol NEC-antepar Pulmon embol NEC-postpar Puerp cerebvasc dis-unsp Puerp cerebvas dis-deliv Cerebvas dis-deliv w p/p Cerebrovasc dis-antepart Cerebrovasc dis-postpart Disrupt c-sect wnd-unsp Disrupt c-sect-del w p/p Disrupt c-sect-postpart Disrupt perineum-unspec Disrupt perin-del w p/p Disrupt perineum-postpar Ob surg compl NEC-unspec Ob surg compl-del w p/p Ob surg comp NEC-postpar Placental polyp-unspec Placent polyp-del w p/p Placental polyp-postpart Peripart cardiomy-unspec Peripartum cardiomy-del Peripart card del w p/p Peripartum card-antepart Peripartum card-postpart Puerp compl NEC-unspec Puerp comp NEC-del w p/p Puerp compl NEC-postpart October 2012 67490 67492 67494 67500 67501 67502 67503 67504 67510 67511 67512 67513 67514 67520 67521 67522 67523 67524 67580 67581 67582 67583 67584 67590 67591 67592 67593 67594 67600 67601 67602 67603 67604 67610 67611 67612 67613 67614 67620 67621 67622 67623 67624 67630 67631 67632 67633 67634 67640 67641 67642 67643 67644 67650 67651 67652 67653 67654 67660 67661 67662 67663 67664 67680 67681 67682 67683 67684 Puerp compl NOS-unspec Puerp comp NOS-del w p/p Puerp compl NOS-postpart Infect nipple preg-unsp Infect nipple-delivered Infect nipple-del w p/p Infect nipple-antepartum Infect nipple-postpartum Breast abscess preg-unsp Breast abscess-delivered Breast abscess-del w p/p Breast abscess-antepart Breast abscess-postpart Mastitis in preg-unspec Mastitis-delivered Mastitis-deliv w p/p Mastitis-antepartum Mastitis-postpartum Breast inf preg NEC-unsp Breast infect NEC-deliv Breast inf NEC-del w p/p Breast inf NEC-antepart Breast inf NEC-postpart Breast inf preg NOS-unsp Breast infect NOS-deliv Breast inf NOS-del w p/p Breast inf NOS-antepart Breast inf NOS-postpart Retract nipple preg-unsp Retracted nipple-deliver Retract nipple-del w p/p Retract nipple-antepart Retract nipple-postpart Cracked nipple preg-unsp Cracked nipple-delivered Cracked nipple-del w p/p Cracked nipple-antepart Cracked nipple-postpart Breast engorge-unspec Breast engorge-delivered Breast engorge-del w p/p Breast engorge-antepart Breast engorge-postpart Breast dis preg NEC-unsp Breast dis NEC-delivered Breast dis NEC-del w p/p Breast dis NEC-antepart Breast dis NEC-postpart Lactation fail-unspec Lactation fail-delivered Lactation fail-del w p/p Lactation fail-antepart Lactation fail-postpart Suppr lactation-unspec Suppr lactation-deliver Suppr lactat-del w p/p Suppr lactation-antepar Suppr lactation-postpart Galactorrhea preg-unspec Galactorrhea-delivered Galactorrhea-del w p/p Galactorrhea-antepartum Galactorrhea-postpartum Lactation dis NEC-unspec Lactation dis NEC-deliv Lactat dis NEC-del w p/p Lactat dis NEC-antepart Lactat dis NEC-postpart Edit code lists 1.15 Maternity diagnoses (age 12 through 55) 66554 66560 66561 66564 66570 66571 66572 66574 66580 66581 66582 66583 66584 66590 66591 66592 66593 66594 66600 66602 66604 66610 66612 66614 66620 66622 66624 66630 66632 66634 66700 66702 66704 66710 66712 66714 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66900 66901 66902 66903 66904 66910 66911 Inj pelv org NEC-postpar Damage to pelvic jt-unsp Damage to pelvic jt-del Damage pelvic jt-postpar Ob pelvic hematoma-unsp Ob pelvic hematoma-deliv Pelvic hematom-del w pp Pelvic hematoma-postpart Ob trauma NEC-unspec Ob trauma NEC-delivered Ob trauma NEC-del w p/p Ob trauma NEC-antepartum Ob trauma NEC-postpartum Ob trauma NOS-unspec Ob trauma NOS-delivered Ob trauma NOS-del w p/p Ob trauma NOS-antepartum Ob trauma NOS-postpartum Third-stage hem-unspec Thrd-stage hem-del w p/p Third-stage hem-postpart Postpartum hem NEC-unsp Postpa hem NEC-del w p/p Postpart hem NEC-postpar Delay p/part hem-unspec Delay p/p hem-del w p/p Delay p/part hem-postpar Postpart coagul def-unsp P/p coag def-del w p/p Postpart coag def-postpa Retain placenta NOS-unsp Retnd plac NOS-del w p/p Retain plac NOS-postpart Retain prod concept-unsp Ret prod conc-del w p/p Ret prod concept-postpar Pulm compl in del-unspec Pulm compl in del-deliv Pulm complic-del w p/p Pulm complicat-antepart Pulm complicat-postpart Heart compl in del-unsp Heart compl in del-deliv Heart compl-del w p/p Heart complic-antepart Heart complic-postpart Cns compl labor/del-unsp Cns compl lab/del-deliv Cns complic-del w p/p Cns compl in del-antepar Cns compl in del-postpar Anesth comp del NEC-unsp Anesth compl NEC-deliver Anesth compl NEC-del p/p Anesth compl antepartum Anesth compl-postpartum Anesth comp del NOS-unsp Anesth compl NOS-deliver Anesth compl NOS-del p/p Anesth compl-antepartum Anesth compl-postpartum Maternal distress-unspec Maternal distress-deliv Matern distres-del w p/p Matern distress-antepar Matern distress-postpart Obstetric shock-unspec Obstetric shock-deliver 1.16 Definitions of Medicare Code Edits 66912 66913 66914 66920 66921 66922 66923 66924 66930 66932 66934 66940 66941 66942 66943 66944 66950 66951 66960 66961 66970 66971 66980 66981 66982 66983 66984 66990 66991 66992 66993 66994 67000 67002 67004 67010 67012 67014 67020 67022 67024 67030 67032 67034 67080 67082 67084 67100 67101 67102 67103 67104 67110 67111 67112 67113 67114 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 Obstet shock-deliv w p/p Obstetric shock-antepar Obstetric shock-postpart Matern hypotens syn-unsp Matern hypoten syn-deliv Matern hypoten-del w p/p Matern hypotens-antepar Matern hypotens-postpart Ac kidny fail w del-unsp Ac kidney fail-del w p/p Ac kidney fail-postpart Oth ob surg compl-unspec Oth ob compl-delivered Oth ob compl-deliv w p/p Complc ob surg anteprtm Oth ob surg compl-postpa Forcep deliv NOS-unspec Forcep deliv NOS-deliver Breech extr NOS-unspec Breech extr NOS-deliver Cesarean deliv NOS-unsp Cesarean delivery NOS Compl lab/deliv NEC-unsp Comp lab/deliv NEC-deliv Compl del NEC-del w p/p Compl deliv NEC-antepar Compl deliv NEC-postpart Compl lab/deliv NOS-unsp Comp lab/deliv NOS-deliv Compl del NOS-del w p/p Compl deliv NOS-antepar Compl deliv NOS-postpart Maj puerp inf NOS-unsp Maj puer inf NOS-del p/p Major puerp inf NOS-p/p Puerp endometritis-unsp Puerp endomet del w p/p Puerp endomet-postpart Puerperal sepsis-unsp Puerprl sepsis-del w p/p Puerperl sepsis-postpart Puerp septc thromb-unsp Prp sptc thrmb-del w p/p Prp septc thrmb-postpart Maj prp infec NEC-unspec Maj prp inf NEC-dl w p/p Maj puerp infec NEC-p/p Varic vein leg preg-unsp Varicose vein leg-deliv Varic vein leg-del w p/p Varic vein leg-antepart Varic vein leg-postpart Varic vulva preg-unspec Varicose vulva-delivered Varicose vulva-del w p/p Varicose vulva-antepart Varicose vulva-postpart Thrombophleb preg-unspec Thrombophlebitis-deliver Thrombophleb-deliv w p/p Thrombophlebit-antepart Thrombophlebit-postpart Deep thromb antepar-unsp Deep throm antepar-deliv Deep vein thromb-antepar Deep thromb postpar-unsp Thromb postpar-del w p/p Deep vein thromb-postpar October 2012 Maternity diagnoses (age 12 through 55) 67690 67691 67692 67693 67694 67800 67801 67803 67810 67811 67813 67900 67901 67902 67903 67904 67910 67911 67912 67913 67914 7923 7965 V230 V231 V232 V233 V2341 V2342 V2349 V235 V237 V2381 V2382 V2383 V2384 V2385 V2386 V2387 V2389 V239 V240 V270 V271 V272 V273 V274 V275 V276 V277 V279 V280 V281 V282 V286 V2881 V2882 V2889 V616 V617 V7242 V8901 V8902 V8903 V8904 V8905 V8909 V9100 Lactation dis NOS-unspec Lactation dis NOS-deliv Lactat dis NOS-del w p/p Lactat dis NOS-antepart Lactat dis NOS-postpart Fetal hematologic-unspec Fetal hematologic-deliv Fetal hematologic-ante Fetal conjoin twins-unsp Fetal conjoin twins-del Fetal conjoin twins-ante Mat comp in utero-unsp Mat comp in utero-del Mat comp in utro-del-p/p Mat comp in utero-ante Mat comp in utero-p/p Fetal comp in utero-unsp Fetal comp in utero-del Ftl cmp in utro-del-p/p Fetal comp in utero-ante Fetal comp in utero-p/p Abn find-amniotic fluid Abn find antenatl screen Preg w hx of infertility Preg w hx-trophoblas dis Preg w hx of abortion Grand multiparity Preg w hx pre-term labor Preg w hx ectopic preg Preg w poor obs hx NEC Preg w poor reproduct hx Insufficnt prenatal care Suprv elderly primigrav Suprv elderly multigrav Suprv young primigravida Suprv young multigravida Pregnt-assist repro tech Preg-hx in utro prev prg Preg w incon fetl viabil Suprv high-risk preg NEC Suprv high-risk preg NOS Postpart care after del Deliver-single liveborn Deliver-single stillborn Deliver-twins, both live Del-twins, 1 nb, 1 sb Deliver-twins, both sb Del-mult birth, all live Del-mult brth, some live Del-mult birth, all sb Outcome of delivery NOS Screening-chromosom anom Screen-alphafetoprotein Screen by amniocent NEC Antenatal screen strep b Scrn fetal anatmc survey Scrn risk preterm labor Antenatal screening NEC Illegitimate pregnancy Unwanted pregnancy NEC Pregnancy test-positive Sus amntc cav/mem nt fnd Sus placentl prob nt fnd Sus fetal anomaly nt fnd Sus fetal growth not fnd Sus cervcl shortn nt fnd Oth sus mat/ftl nt fnd Twin gest-plac/sac NOS October 2012 V9101 V9102 V9103 V9109 V9110 V9111 V9112 V9119 V9120 V9121 V9122 V9129 V9190 V9191 V9192 V9199 Twin gest-monochr/monoam Twin gest-monochr/diamni Twin gest-dich/diamniotc Twin gest-plac/sac undet Tripl gest-plac/sac NOS Triplet gest 2+ monochor Triplet gest 2+ monoamn Tripl gest-plac/sac und Quad gest-plac/sac NOS Quad gest 2+ monochorion Quad gest 2+ monoamniotc Quad gest-plac/sac undet Mult gest-plac/sac NOS Mult gest 2+ monochr NEC Mult gest 2+ monoamn NEC Mult gest-plac/sac undet Edit code lists 1.17 Adult diagnoses (age 15 through 124) 25631 2900 29010 29011 29012 29013 29020 29021 2903 29040 29041 29042 29043 2909 33520 36610 36611 36612 36613 36614 36615 36616 36617 36618 36619 37401 37411 37927 41400 41401 41402 41403 41404 41405 41407 4143 42971 42979 4370 4400 4401 44020 44021 44022 44023 44029 44030 44031 44032 4408 4409 4540 4541 4542 4549 4570 500 501 5165 5710 5711 5712 5713 60000 60001 Premature menopause Senile dementia uncomp Presenile dementia Presenile delirium Presenile delusion Presenile depression Senile delusion Senile depressive Senile delirium Vascular dementia,uncomp Vasc dementia w delirium Vasc dementia w delusion Vasc dementia w depressn Senile psychot cond NOS Amyotrophic sclerosis Senile cataract NOS Pseudoexfol lens capsule Incipient cataract Ant subcaps senile catar Post subcap senile catar Cortical senile cataract Senile nuclear cataract Mature cataract Hypermature cataract Senile cataract NEC Senile entropion Senile ectropion Vitreomacular adhesion Cor ath unsp vsl ntv/gft Crnry athrscl natve vssl Crn ath atlg vn bps grft Crn ath nonatlg blg grft Cor ath artry bypas grft Cor ath bypass graft NOS Cor ath bps graft tp hrt Cor ath d/t lpd rch plaq Acq cardiac septl defect Other sequelae of MI NEC Cerebral atherosclerosis Aortic atherosclerosis Renal artery atheroscler Athscl extrm ntv art NOS Ath ext ntv at w claudct Ath ext ntv at w rst pn Ath ext ntv art ulcrtion Athrsc extrm ntv art oth Athscl extrm bps gft NOS Ath ext autologs bps gft Ath ext nonautlg bps gft Atherosclerosis NEC Atherosclerosis NOS Leg varicosity w ulcer Leg varicosity w inflam Varicos leg ulcer/inflam Asympt varicose veins Postmastect lymphedema Coal workers' pneumocon Asbestosis Adlt pul Langs cell hist Alcoholic fatty liver Ac alcoholic hepatitis Alcohol cirrhosis liver Alcohol liver damage NOS BPH w/o urinary obs/LUTS BPH w urinary obs/LUTS 1.18 Definitions of Medicare Code Edits 60010 60011 60020 60021 6003 60090 60091 6010 6011 6012 6013 6014 6018 6019 6020 6021 6022 6028 6029 6060 6061 6068 6069 60784 6101 61181 61182 61183 6120 6121 7286 7837 79093 79981 99580 99581 99582 99583 99584 99585 V114 V2385 V4981 V510 V6221 V6222 V6229 V7101 V850 V851 V8521 V8522 V8523 V8524 V8525 V8530 V8531 V8532 V8533 V8534 V8535 V8536 V8537 V8538 V8539 Nod prostate w/o ur obst Nod prostate w ur obst BPH loc w/o ur obs/LUTS BPH loc w urin obs/LUTS Cyst of prostate BPH NOS w/o ur obs/LUTS BPH NOS w ur obs/LUTS Acute prostatitis Chronic prostatitis Abscess of prostate Prostatocystitis Prostatitis in oth dis Prostatic inflam dis NEC Prostatitis NOS Calculus of prostate Prostatic congest/hemorr Atrophy of prostate Prostatic disorders NEC Prostatic disorder NOS Azoospermia Oligospermia Male infertility NEC Male infertility NOS Impotence, organic orign Diffus cystic mastopathy Ptosis of breast Hypoplasia of breast Capslr contrctr brst imp Deformity reconst breast Disproportn reconst brst Contracted palmar fascia Failure to thrive-adult Elvtd prstate spcf antgn Decreased libido Adult maltreatment NOS Adult physical abuse Adult emotnl/psych abuse Adult sexual abuse Adult neglect-nutrition Oth adult abuse/neglect Hx combat/stress reactn Pregnt-assist repro tech Asympt postmeno status Brst reconst fol mastect Hx military deployment Hx retrn military deploy Occupationl circumst NEC Obsv-adult antisoc behav BMI less than 19,adult BMI between 19-24,adult BMI 25.0-25.9,adult BMI 26.0-26.9,adult BMI 27.0-27.9,adult BMI 28.0-28.9,adult BMI 29.0-29.9,adult BMI 30.0-30.9,adult BMI 31.0-31.9,adult BMI 32.0-32.9,adult BMI 33.0-33.9,adult BMI 34.0-34.9,adult BMI 35.0-35.9,adult BMI 36.0-36.9,adult BMI 37.0-37.9,adult BMI 38.0-38.9,adult BMI 39.0-39.9,adult October 2012 Adult diagnoses (age 15 through 124) V8541 V8542 V8543 V8544 V8545 BMI 40.0-44.9, adult BMI 45.0-49.9, adult BMI 50.0-59.9, adult BMI 60.0-69.9, adult BMI 70 and over, adult October 2012 Edit code lists 1.19 5. Sex conflict Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis or procedure on the patient’s record. For example, a male patient with cervical cancer (diagnosis) or a female patient with a prostatectomy (procedure). In both instances, the indicated diagnosis or the procedure conflicts with the stated sex of the patient. Therefore, either the patient’s diagnosis, procedure or sex is presumed to be incorrect. The following pages contain lists of male and female related ICD-9-CM diagnosis and procedure codes with corresponding English descriptions. 1.20 Definitions of Medicare Code Edits October 2012 Diagnoses for females only 01660 01661 01662 01663 01664 01665 01666 01670 01671 01672 01673 01674 01675 01676 05411 05412 09815 09816 09817 09835 09836 09837 1121 13101 1740 1741 1742 1743 1744 1745 1746 1748 1749 179 1800 1801 1808 1809 181 1820 1821 1828 1830 1832 1833 1834 1835 1838 1839 1840 1841 1842 1843 1844 1848 1849 1986 2180 2181 2182 2189 2190 2191 2198 2199 TB ovary & tube-unspec TB ovary & tube-no exam TB ovary/tube-exam unkn TB ovary & tube-micro dx TB ovary & tube-cult dx TB ovary & tube-histo dx TB ovary & tube-oth test TB female gen NEC-unspec TB fem gen NEC-no exam TB fem gen NEC-exam unkn TB fem gen NEC-micro dx TB fem gen NEC-cult dx TB fem gen NEC-histo dx TB fem gen NEC-oth test Herpetic vulvovaginitis Herpetic ulcer of vulva Gc cervicitis (acute) Gc endometritis (acute) Acute gc salpingitis Gc cervicitis, chronic Gc endometritis, chronic Gc salpingitis (chronic) Candidal vulvovaginitis Trichomonal vaginitis Malig neo nipple Mal neo breast-central Mal neo breast up-inner Mal neo breast low-inner Mal neo breast up-outer Mal neo breast low-outer Mal neo breast-axillary Malign neopl breast NEC Malign neopl breast NOS Malig neopl uterus NOS Malig neo endocervix Malig neo exocervix Malig neo cervix NEC Mal neo cervix uteri NOS Malignant neopl placenta Malig neo corpus uteri Mal neo uterine isthmus Mal neo body uterus NEC Malign neopl ovary Mal neo fallopian tube Mal neo broad ligament Malig neo parametrium Mal neo round ligament Mal neo adnexa NEC Mal neo adnexa NOS Malign neopl vagina Mal neo labia majora Mal neo labia minora Malign neopl clitoris Malign neopl vulva NOS Mal neo female genit NEC Mal neo female genit NOS Second malig neo ovary Submucous leiomyoma Intramural leiomyoma Subserous leiomyoma Uterine leiomyoma NOS Benign neo cervix uteri Benign neo corpus uteri Benign neo uterus NEC Benign neo uterus NOS October 2012 220 2210 2211 2212 2218 2219 2331 2332 23330 23331 23332 23339 2360 2361 2362 2363 2560 2561 2562 25631 25639 2564 2568 2569 30273 30276 30651 30652 34640 34641 34642 34643 4566 5164 6140 6141 6142 6143 6144 6145 6146 6147 6148 6149 6150 6151 6159 6160 61610 61611 6162 6163 6164 61650 61651 61681 61689 6169 6170 6171 6172 6173 6174 6175 6176 Benign neoplasm ovary Ben neo fallopian tube Benign neoplasm vagina Benign neoplasm vulva Ben neo fem genital NEC Ben neo fem genital NOS Ca in situ cervix uteri Ca in situ uterus NEC Ca in situ fem gen NOS Carcinoma in situ vagina Carcinoma in situ vulva Ca in situ fem gen NEC Uncert behav neo uterus Unc behav neo placenta Unc behav neo ovary Unc behav neo female NEC Hyperestrogenism Ovarian hyperfunc NEC Postablativ ovarian fail Premature menopause Ovarian failure NEC Polycystic ovaries Ovarian dysfunction NEC Ovarian dysfunction NOS Female orgasmic disorder Dyspareunia,psychogenic Psychogenic vaginismus Psychogenic dysmenorrhea Menst mgr wo ntrc wo st Menstl mgrn w ntrc wo st Menstl mgr wo ntrc w st Menstl mgrn w ntrc w st Vulval varices Lymphangioleiomyomatosis Ac salpingo-oophoritis Chr salpingo-oophoritis Salpingo-oophoritis NOS Acute parametritis Chronic parametritis Ac pelv peritonitis-fem Fem pelvic periton adhes Chr pelv periton NEC-fem Fem pelv inflam dis NEC Fem pelv inflam dis NOS Ac uterine inflammation Chr uterine inflammation Uterine inflam dis NOS Cervicitis Vaginitis NOS Vaginitis in oth disease Bartholin's gland cyst Bartholin's glnd abscess Abscess of vulva NEC Ulceration of vulva NOS Vulvar ulcer in oth dis Mucositis cerv,vag,vulva Inflm cerv,vag,vulva NEC Female gen inflam NOS Uterine endometriosis Ovarian endometriosis Tubal endometriosis Pelv perit endometriosis Vaginal endometriosis Intestinal endometriosis Endometriosis in scar Edit code lists 1.21 Diagnoses for females only 6178 6179 61800 61801 61802 61803 61804 61805 61809 6181 6182 6183 6184 6185 6186 6187 61881 61882 61883 61884 61889 6189 6190 6191 6192 6198 6199 6200 6201 6202 6203 6204 6205 6206 6207 6208 6209 6210 6211 6212 62130 62131 62132 62133 62134 62135 6214 6215 6216 6217 6218 6219 6220 62210 62211 62212 6222 6223 6224 6225 6226 6227 6228 6229 6230 6231 6232 6233 Endometriosis NEC Endometriosis NOS Vaginal wall prolpse NOS Cystocele, midline Cystocele, lateral Urethrocele Rectocele Perineocele Cystourethrocele Uterine prolapse Uterovag prolaps-incompl Uterovag prolaps-complet Utervaginal prolapse NOS Postop vaginal prolapse Vaginal enterocele Old lacer pelvic muscle Incomptnce pubocerv tiss Incomptnce rectovag tiss Pelvic muscle wasting Cervical stump prolapse Genital prolapse NEC Genital prolapse NOS Urin-genital fistul, fem Digest-genit fistul, fem Genital-skin fistul, fem Fem genital fistula NEC Fem genital fistula NOS Follicular cyst of ovary Corpus luteum cyst Ovarian cyst NEC/NOS Acq atrophy ovary & tube Prolapse of ovary & tube Torsion of ovary or tube Broad ligament lacer syn Broad ligament hematoma Noninfl dis ova/adnx NEC Noninfl dis ova/adnx NOS Polyp of corpus uteri Chr uterine subinvolutn Hypertrophy of uterus Endometrial hyperpla NOS Simp endo hyper w/o atyp Comp endo hyper w/o atyp Endomet hyperpla w atyp Ben endomet hyperplasia Endomet intraepithl neop Hematometra Intrauterine synechiae Malposition of uterus Chr inversion of uterus Disorders of uterus NEC Disorder of uterus NOS Erosion/ectropion cervix Dysplasia of cervix NOS Mild dysplasia of cervix Mod dysplasia of cervix Leukoplakia of cervix Old laceration of cervix Stricture of cervix Incompetence of cervix Hypertrophic elong cervx Mucous polyp of cervix Noninflam dis cervix NEC Noninflam dis cervix NOS Dysplasia of vagina Leukoplakia of vagina Stricture of vagina Tight hymenal ring 1.22 Definitions of Medicare Code Edits 6234 6235 6236 6237 6238 6239 62401 62402 62409 6241 6242 6243 6244 6245 6246 6248 6249 6250 6251 6252 6253 6254 6255 6256 62570 62571 62579 6258 6259 6260 6261 6262 6263 6264 6265 6266 6267 6268 6269 6270 6271 6272 6273 6274 6278 6279 6280 6281 6282 6283 6284 6288 6289 6290 6291 62920 62921 62922 62923 62929 62931 62932 62981 62989 6299 630 6310 6318 Old vaginal laceration Noninfect vag leukorrhea Vaginal hematoma Polyp of vagina Noninflam dis vagina NEC Noninflam dis vagina NOS Vulvar intraeph neopl I Vulvr intraepth neopl II Dystrophy of vulva NEC Atrophy of vulva Hypertrophy of clitoris Hypertrophy of labia Old laceration of vulva Hematoma of vulva Polyp of labia and vulva Noninflam dis vulva NEC Noninflam dis vulva NOS Dyspareunia Vaginismus Mittelschmerz Dysmenorrhea Premenstrual tension Pelvic congestion synd Fem stress incontinence Vulvodynia NOS Vulvar vestibulitis Other vulvodynia Fem genital symptoms NEC Fem genital symptoms NOS Absence of menstruation Scanty menstruation Excessive menstruation Pubertal menorrhagia Irregular menstruation Ovulation bleeding Metrorrhagia Postcoital bleeding Menstrual disorder NEC Menstrual disorder NOS Premenopause menorrhagia Postmenopausal bleeding Sympt fem climact state Atrophic vaginitis Sympt state w artif meno Menopausal disorder NEC Menopausal disorder NOS Infertility-anovulation Infertil-pituitary orig Infertility-tubal origin Infertility-uterine orig Infertil-cervical orig Female infertility NEC Female infertility NOS Hematocele, female NEC Hydrocele canal nuck-fem Genital mutilation NOS Genital mutilatn type I Genital mutilatn type II Genital muilatn type III Fem genital mutilate NEC Eros imp vag mesh in tis Exp imp vag mesh-vagina Rec preg loss wo cur prg Female genital disor NEC Female genital dis NOS Hydatidiform mole Inapp chg hCG early preg Oth abn prod conception October 2012 Diagnoses for females only 632 63300 63301 63310 63311 63320 63321 63380 63381 63390 63391 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 63500 63501 63502 63510 63511 63512 63520 63521 63522 63530 63531 63532 63540 63541 63542 63550 63551 63552 63560 63561 63562 63570 63571 63572 63580 63581 63582 Missed abortion Abd preg w/o intrau preg Abd preg w intraut preg Tubal preg w/o intra prg Tubal preg w intra preg Ovarn preg w/o intra prg Ovarian preg w intra prg Ect preg NEC w/o int prg Ectpc prg NEC w int preg Ect preg NOS w/o int prg Ectp preg NOS w int preg Spon abor w pel inf-unsp Spon abor w pelv inf-inc Spon abor w pel inf-comp Spon abort w hemorr-unsp Spon abort w hemorr-inc Spon abort w hemorr-comp Spon ab w pel damag-unsp Spon ab w pelv damag-inc Spon ab w pel damag-comp Spon ab w ren fail-unsp Spon ab w ren fail-inc Spon ab w ren fail-comp Spon ab w metab dis-unsp Spon ab w metab dis-inc Spon ab w metab dis-comp Spon abort w shock-unsp Spon abort w shock-inc Spon abort w shock-comp Spon abort w embol-unsp Spon abort w embol-inc Spon abort w embol-comp Spon ab w compl NEC-unsp Spon ab w compl NEC-inc Spon ab w compl NEC-comp Spon ab w compl NOS-unsp Spon ab w compl NOS-inc Spon ab w compl NOS-comp Spon abort uncompl-unsp Spon abort uncompl-inc Spon abort uncompl-comp Leg abor w pelv inf-unsp Leg abor w pelv inf-inc Leg abor w pelv inf-comp Legal abor w hemorr-unsp Legal abort w hemorr-inc Legal abor w hemorr-comp Leg ab w pelv damag-unsp Leg ab w pelv damag-inc Leg ab w pelv damag-comp Leg abor w ren fail-unsp Leg abor w ren fail-inc Leg abor w ren fail-comp Leg ab w metab dis-unsp Leg ab w metab dis-inc Leg ab w metab dis-comp Legal abort w shock-unsp Legal abort w shock-inc Legal abort w shock-comp Legal abort w embol-unsp Legal abort w embol-inc Legal abort w embol-comp Leg ab w compl NEC-unsp Leg ab w compl NEC-inc Leg ab w compl NEC-comp Leg ab w compl NOS-unsp Leg ab w compl NOS-inc Leg ab w compl NOS-comp October 2012 63590 63591 63592 63600 63601 63602 63610 63611 63612 63620 63621 63622 63630 63631 63632 63640 63641 63642 63650 63651 63652 63660 63661 63662 63670 63671 63672 63680 63681 63682 63690 63691 63692 63700 63701 63702 63710 63711 63712 63720 63721 63722 63730 63731 63732 63740 63741 63742 63750 63751 63752 63760 63761 63762 63770 63771 63772 63780 63781 63782 63790 63791 63792 6380 6381 6382 6383 6384 Legal abort uncompl-unsp Legal abort uncompl-inc Legal abort uncompl-comp Illeg ab w pelv inf-unsp Illeg ab w pelv inf-inc Illeg ab w pelv inf-comp Illeg ab w hemorr-unspec Illeg ab w hemorr-inc Illeg ab w hemorr-comp Illeg ab w pel damg-unsp Illeg ab w pel damag-inc Illeg ab w pel damg-comp Illeg ab w ren fail-unsp Illeg ab w ren fail-inc Illeg ab w ren fail-comp Illeg ab w met dis-unsp Illeg ab w metab dis-inc Illeg ab w met dis-comp Illeg abort w shock-unsp Illeg abort w shock-inc Illeg abort w shock-comp Illeg ab w embolism-unsp Illeg ab w embolism-inc Illeg ab w embolism-comp Illg ab w compl NEC-unsp Illeg ab w compl NEC-inc Illg ab w compl NEC-comp Illg ab w compl NOS-unsp Illeg ab w compl NOS-inc Illg ab w compl NOS-comp Illeg abort uncompl-unsp Illeg abort uncompl-inc Illeg abort uncompl-comp Abort NOS w pel inf-unsp Abort NOS w pel inf-inc Abort NOS w pel inf-comp Abort NOS w hemorr-unsp Abort NOS w hemorr-inc Abort NOS w hemorr-comp Ab NOS w pelv damag-unsp Ab NOS w pelv damag-inc Ab NOS w pelv damag-comp Ab NOS w renal fail-unsp Ab NOS w renal fail-inc Ab NOS w renal fail-comp Ab NOS w metab dis-unsp Ab NOS w metab dis-inc Ab NOS w metab dis-comp Abort NOS w shock-unsp Abort NOS w shock-inc Abort NOS w shock-comp Ab NOS w embolism-unsp Ab NOS w embolism-inc Ab NOS w embolism-comp Ab NOS w compl NEC-unsp Ab NOS w compl NEC-inc Ab NOS w compl NEC-comp Ab NOS w compl NOS-unsp Ab NOS w compl NOS-inc Ab NOS w compl NOS-comp Ab NOS uncomplicat-unsp Ab NOS uncomplicat-inc Ab NOS uncomplicat-comp Attem abort w pelvic inf Attem abort w hemorrhage Attem abort w pelv damag Attem abort w renal fail Attem abor w metabol dis Edit code lists 1.23 Diagnoses for females only 6385 6386 6387 6388 6389 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64120 64121 64123 64130 64131 64133 64180 64181 64183 64190 64191 64193 64200 64201 64202 64203 64204 64210 64211 64212 64213 64214 64220 64221 64222 64223 64224 64230 64231 64232 64233 64234 64240 64241 64242 64243 64244 64250 64251 Attem abortion w shock Attemp abort w embolism Attemp abort w compl NEC Attemp abort w compl NOS Attempted abort uncompl Postabortion gu infect Postabortion hemorrhage Postabort pelvic damage Postabort kidney failure Postabort metabolic dis Postabortion shock Postabortion embolism Postabortion compl NEC Postabortion compl NOS Threatened abort-unspec Threatened abort-deliver Threaten abort-antepart Hem early preg NEC-unsp Hem early preg NEC-deliv Hem early pg NEC-antepar Hemorr early preg-unspec Hem early preg-delivered Hem early preg-antepart Placenta previa-unspec Placenta previa-deliver Placenta previa-antepart Placenta prev hem-unspec Placenta prev hem-deliv Placen prev hem-antepart Prem separ placen-unspec Prem separ placen-deliv Prem separ plac-antepart Coag def hemorr-unspec Coag def hemorr-deliver Coag def hemorr-antepart Antepart hem NEC-unspec Antepartum hem NEC-deliv Antepart hem NEC-antepar Antepart hem NOS-unspec Antepartum hem NOS-deliv Antepart hem NOS-antepar Essen hyperten preg-unsp Essen hyperten-delivered Essen hyperten-del w p/p Essen hyperten-antepart Essen hyperten-postpart Renal hyperten preg-unsp Renal hyperten pg-deliv Renal hyperten-del p/p Renal hyperten-antepart Renal hyperten-postpart Old hyperten preg-unspec Old hyperten NEC-deliver Old hyperten-deliv w p/p Old hyperten NEC-antepar Old hyperten NEC-postpar Trans hyperten preg-unsp Trans hyperten-delivered Trans hyperten-del w p/p Trans hyperten-antepart Trans hyperten-postpart Mild/NOS preeclamp-unsp Mild/NOS preeclamp-deliv Mild preeclamp-del w p/p Mild/NOS preeclamp-antep Mild/NOS preeclamp-p/p Severe preeclamp-unspec Severe preeclamp-deliver 1.24 Definitions of Medicare Code Edits 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64290 64291 64292 64293 64294 64300 64301 64303 64310 64311 64313 64320 64321 64323 64380 64381 64383 64390 64391 64393 64400 64403 64410 64413 64420 64421 64510 64511 64513 64520 64521 64523 64600 64601 64603 64610 64611 64612 64613 64614 64620 64621 64622 64623 64624 64630 64631 64633 64640 64641 64642 64643 64644 64650 64651 Sev preeclamp-del w p/p Sev preeclamp-antepartum Sev preeclamp-postpartum Eclampsia-unspecified Eclampsia-delivered Eclampsia-deliv w p/p Eclampsia-antepartum Eclampsia-postpartum Tox w old hyperten-unsp Tox w old hyperten-deliv Tox w old hyp-del w p/p Tox w old hyper-antepart Tox w old hyper-postpart Hyperten preg NOS-unspec Hypertens NOS-delivered Hypertens NOS-del w p/p Hypertens NOS-antepartum Hypertens NOS-postpartum Mild hyperem grav-unspec Mild hyperem grav-deliv Mild hyperemesis-antepar Hyperem w metab dis-unsp Hyperem w metab dis-del Hyperem w metab-antepart Late vomit of preg-unsp Late vomit of preg-deliv Late vomit preg-antepart Vomit compl preg-unspec Vomit compl preg-deliver Vomit compl preg-antepar Vomit of preg NOS-unspec Vomit of preg NOS-deliv Vomit of pg NOS-antepart Threat prem labor-unspec Thrt prem labor-antepart Threat labor NEC-unspec Threat labor NEC-antepar Early onset deliv-unspec Early onset delivery-del Post term preg-unsp Post term preg-del Post term preg-antepar Prolonged preg-unsp Prolonged preg-del Prolonged preg-antepar Papyraceous fetus-unspec Papyraceous fetus-deliv Papyraceous fet-antepar Edema in preg-unspec Edema in preg-delivered Edema in preg-del w p/p Edema in preg-antepartum Edema in preg-postpartum Renal dis preg NOS-unsp Renal dis NOS-delivered Renal dis NOS-del w p/p Renal dis NOS-antepartum Renal dis NOS-postpartum Recur preg loss-unspec Recurnt preg loss-deliv Recurnt preg loss-antep Neuritis of preg-unspec Neuritis-delivered Neuritis-delivered w p/p Neuritis of preg-antepar Neuritis of preg-postpar Bacteriuria preg-unspec Asym bacteriuria-deliver October 2012 Diagnoses for females only 64652 64653 64654 64660 64661 64662 64663 64664 64670 64671 64673 64680 64681 64682 64683 64684 64690 64691 64693 64700 64701 64702 64703 64704 64710 64711 64712 64713 64714 64720 64721 64722 64723 64724 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64750 64751 64752 64753 64754 64760 64761 64762 64763 64764 64780 64781 64782 64783 64784 64790 64791 64792 64793 64794 64800 64801 64802 64803 Asy bacteruria-del w p/p Asy bacteriuria-antepart Asy bacteriuria-postpart Gu infect in preg-unspec Gu infection-delivered Gu infection-deliv w p/p Gu infection-antepartum Gu infection-postpartum Liver/bil trct disr-unsp Liver/bil trct disr-del Liver/bil trct disr-ante Preg compl NEC-unspec Preg compl NEC-delivered Preg compl NEC-del w p/p Preg compl NEC-antepart Preg compl NEC-postpart Preg compl NOS-unspec Preg compl NOS-delivered Preg compl NOS-antepart Syphilis in preg-unspec Syphilis-delivered Syphilis-delivered w p/p Syphilis-antepartum Syphilis-postpartum Gonorrhea in preg-unspec Gonorrhea-delivered Gonorrhea-deliver w p/p Gonorrhea-antepartum Gonorrhea-postpartum Other VD in preg-unspec Other vd-delivered Other vd-delivered w p/p Other vd-antepartum Other vd-postpartum TB in preg-unspecified Tuberculosis-delivered Tuberculosis-deliv w p/p Tuberculosis-antepartum Tuberculosis-postpartum Malaria in preg-unspec Malaria-delivered Malaria-delivered w p/p Malaria-antepartum Malaria-postpartum Rubella in preg-unspec Rubella-delivered Rubella-delivered w p/p Rubella-antepartum Rubella-postpartum Oth virus in preg-unspec Oth viral dis-delivered Oth viral dis-del w p/p Oth viral dis-antepartum Oth viral dis-postpartum Inf dis in preg NEC-unsp Infect dis NEC-delivered Infect dis NEC-del w p/p Infect dis NEC-antepart Infect dis NEC-postpart Infect in preg NOS-unsp Infect NOS-delivered Infect NOS-deliver w p/p Infect NOS-antepartum Infect NOS-postpartum Diabetes in preg-unspec Diabetes-delivered Diabetes-delivered w p/p Diabetes-antepartum October 2012 64804 64810 64811 64812 64813 64814 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64840 64841 64842 64843 64844 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 64870 64871 64872 64873 64874 64880 64881 64882 64883 64884 64890 64891 64892 64893 64894 64900 64901 64902 64903 64904 64910 64911 64912 64913 64914 64920 64921 64922 64923 64924 64930 64931 64932 64933 64934 64940 64941 Diabetes-postpartum Thyroid dysfun preg-unsp Thyroid dysfunc-deliver Thyroid dysfun-del w p/p Thyroid dysfunc-antepart Thyroid dysfunc-postpart Anemia in preg-unspec Anemia-delivered Anemia-delivered w p/p Anemia-antepartum Anemia-postpartum Drug depend preg-unspec Drug dependence-deliver Drug dependen-del w p/p Drug dependence-antepart Drug dependence-postpart Mental dis preg-unspec Mental disorder-deliver Mental dis-deliv w p/p Mental disorder-antepart Mental disorder-postpart Congen CV dis preg-unsp Congen CV dis-delivered Congen CV dis-del w p/p Congen CV dis-antepartum Congen CV dis-postpartum CV dis NEC preg-unspec CV dis NEC preg-deliver CV dis NEC-deliver w p/p CV dis NEC-antepartum CV dis NEC-postpartum Bone disord in preg-unsp Bone disorder-delivered Bone disorder-del w p/p Bone disorder-antepartum Bone disorder-postpartum Abn glucose in preg-unsp Abn glucose toler-deliv Abn glucose-deliv w p/p Abn glucose-antepartum Abn glucose-postpartum Oth curr cond preg-unsp Oth curr cond-delivered Oth curr cond-del w p/p Oth curr cond-antepartum Oth curr cond-postpartum Tobacco use disord-unsp Tobacco use disor-delliv Tobacco use dis-del-p/p Tobacco use dis-antepart Tobacco use dis-postpart Obesity-unspecified Obesity-delivered Obesity-delivered w p/p Obesity-antepartum Obesity-postpartum Bariatric surg stat-unsp Bariatric surg stat-del Bariatric surg-del w p/p Bariatrc surg stat-antep Bariatrc surg stat w p/p Coagulation def-unspec Coagulation def-deliv Coagulatn def-del w p/p Coagulation def-antepart Coagulation def-postpart Epilepsy-unspecified Epilepsy-delivered Edit code lists 1.25 Diagnoses for females only 64942 64943 64944 64950 64951 64953 64960 64961 64962 64963 64964 64970 64971 64973 64981 64982 650 65100 65101 65103 65110 65111 65113 65120 65121 65123 65130 65131 65133 65140 65141 65143 65150 65151 65153 65160 65161 65163 65170 65171 65173 65180 65181 65183 65190 65191 65193 65200 65201 65203 65210 65211 65213 65220 65221 65223 65230 65231 65233 65240 65241 65243 65250 65251 65253 65260 65261 65263 Epilepsy-delivered w p/p Epilepsy-antepartum Epilepsy-postpartum Spotting-unspecified Spotting-delivered Spotting-antepartum Uterine size descrp-unsp Uterine size descrep-del Uterine size-del w p/p Uterine size des-antepar Uterine size descrep-p/p Cervical shortening-unsp Cervical shortening-del Cervical shortening-ante Spon labr w plan C/S-del Lbr w plan C/S-del w p/p Normal delivery Twin pregnancy-unspec Twin pregnancy-delivered Twin pregnancy-antepart Triplet pregnancy-unspec Triplet pregnancy-deliv Triplet preg-antepartum Quadruplet preg-unspec Quadruplet preg-deliver Quadruplet preg-antepart Twins w fetal loss-unsp Twins w fetal loss-del Twins w fetal loss-ante Triplets w fet loss-unsp Triplets w fet loss-del Triplets w fet loss-ante Quads w fetal loss-unsp Quads w fetal loss-del Quads w fetal loss-ante Mult ges w fet loss-unsp Mult ges w fet loss-del Mult ges w fet loss-ante Mul gest-fet reduct unsp Mult gest-fet reduct del Mul gest-fet reduct ante Multi gestat NEC-unspec Multi gestat NEC-deliver Multi gest NEC-antepart Multi gestat NOS-unspec Mult gestation NOS-deliv Multi gest NOS-antepart Unstable lie-unspecified Unstable lie-delivered Unstable lie-antepartum Cephalic vers NOS-unspec Cephalic vers NOS-deliv Cephal vers NOS-antepart Breech presentat-unspec Breech presentat-deliver Breech present-antepart Transv/obliq lie-unspec Transver/obliq lie-deliv Transv/obliq lie-antepar Face/brow present-unspec Face/brow present-deliv Face/brow pres-antepart High head at term-unspec High head at term-deliv High head term-antepart Mult gest malpresen-unsp Mult gest malpres-deliv Mult ges malpres-antepar 1.26 Definitions of Medicare Code Edits 65270 65271 65273 65280 65281 65283 65290 65291 65293 65300 65301 65303 65310 65311 65313 65320 65321 65323 65330 65331 65333 65340 65341 65343 65350 65351 65353 65360 65361 65363 65370 65371 65373 65380 65381 65383 65390 65391 65393 65400 65401 65402 65403 65404 65410 65411 65412 65413 65414 65420 65421 65423 65430 65431 65432 65433 65434 65440 65441 65442 65443 65444 65450 65451 65452 65453 65454 65460 Prolapsed arm-unspec Prolapsed arm-delivered Prolapsed arm-antepart Malposition NEC-unspec Malposition NEC-deliver Malposition NEC-antepart Malposition NOS-unspec Malposition NOS-deliver Malposition NOS-antepart Pelvic deform NOS-unspec Pelvic deform NOS-deliv Pelv deform NOS-antepart Contract pelv NOS-unspec Contract pelv NOS-deliv Contrac pelv NOS-antepar Inlet contraction-unspec Inlet contraction-deliv Inlet contract-antepart Outlet contraction-unsp Outlet contraction-deliv Outlet contract-antepart Fetopelv disprop-unspec Fetopelv dispropor-deliv Fetopel disprop-antepart Fetal disprop NOS-unspec Fetal disprop NOS-deliv Fetal dispro NOS-antepar Hydrocephal fetus-unspec Hydroceph fetus-deliver Hydroceph fetus-antepart Oth abn fet disprop-unsp Oth abn fet dispro-deliv Oth abn fet dispro-antep Disproportion NEC-unspec Disproportion NEC-deliv Dispropor NEC-antepartum Disproportion NOS-unspec Disproportion NOS-deliv Dispropor NOS-antepartum Cong abn uter preg-unsp Congen abn uterus-deliv Cong abn uter-del w p/p Congen abn uter-antepart Congen abn uter-postpart Uter tumor in preg-unsp Uterine tumor-delivered Uterine tumor-del w p/p Uterine tumor-antepartum Uterine tumor-postpartum Prev c-delivery unspec Prev c-delivery-delivrd Prev c-delivery-antepart Retrovert uterus-unspec Retrovert uterus-deliver Retrovert uter-del w p/p Retrovert uter-antepart Retrovert uter-postpart Abn grav uterus NEC-unsp Abn uterus NEC-delivered Abn uterus NEC-del w p/p Abn uterus NEC-antepart Abn uterus NEC-postpart Cerv incompet preg-unsp Cervical incompet-deliv Cerv incompet-del w p/p Cerv incompet-antepartum Cerv incompet-postpartum Abn cervix NEC preg-unsp October 2012 Diagnoses for females only 65461 65462 65463 65464 65470 65471 65472 65473 65474 65480 65481 65482 65483 65484 65490 65491 65492 65493 65494 65500 65501 65503 65510 65511 65513 65520 65521 65523 65530 65531 65533 65540 65541 65543 65550 65551 65553 65560 65561 65563 65570 65571 65573 65580 65581 65583 65590 65591 65593 65600 65601 65603 65610 65611 65613 65620 65621 65623 65630 65631 65633 65640 65641 65643 65650 65651 65653 65660 Abn cervix NEC-delivered Abn cervix NEC-del w p/p Abn cervix NEC-antepart Abn cervix NEC-postpart Abn vagina in preg-unsp Abnorm vagina-delivered Abnorm vagina-del w p/p Abnorm vagina-antepartum Abnorm vagina-postpartum Abn vulva in preg-unspec Abnormal vulva-delivered Abnormal vulva-del w p/p Abnormal vulva-antepart Abnormal vulva-postpart Abn pel NEC in preg-unsp Abn pelv org NEC-deliver Abn pelv NEC-deliv w p/p Abn pelv org NEC-antepar Abn pelv org NEC-postpar Fetal cns malform-unspec Fetal cns malform-deliv Fetal cns malfor-antepar Fetal chromos abn-unspec Fetal chromoso abn-deliv Fet chromo abn-antepart Famil heredit dis-unspec Famil heredit dis-deliv Famil hered dis-antepart Fet damg d/t virus-unsp Fet damg d/t virus-deliv Fet damg d/t virus-antep Fet damg d/t dis-unspec Fet damg d/t dis-deliver Fet damg d/t dis-antepar Fetal damg d/t drug-unsp Fet damag d/t drug-deliv Fet damg d/t drug-antepa Radiat fetal damag-unsp Radiat fetal damag-deliv Radiat fet damag-antepar Decrease fetl movmt unsp Decrease fetal movmt del Dec fetal movmt antepart Fetal abnorm NEC-unspec Fetal abnorm NEC-deliver Fetal abnorm NEC-antepar Fetal abnorm NOS-unspec Fetal abnorm NOS-deliver Fetal abnorm NOS-antepar Fetal-maternal hem-unsp Fetal-maternal hem-deliv Fetal-matern hem-antepar Rh isoimmunization-unsp Rh isoimmunizat-deliver Rh isoimmunizat-antepart Abo isoimmunization-unsp Abo isoimmunizat-deliver Abo isoimmunizat-antepar Fetal distress-unspec Fetal distress-delivered Fetal distress-antepart Intrauterine death-unsp Intrauter death-deliver Intrauter death-antepart Poor fetal growth-unspec Poor fetal growth-deliv Poor fetal grth-antepart Excess fetal grth-unspec October 2012 65661 65663 65670 65671 65673 65680 65681 65683 65690 65691 65693 65700 65701 65703 65800 65801 65803 65810 65811 65813 65820 65821 65823 65830 65831 65833 65840 65841 65843 65880 65881 65883 65890 65891 65893 65900 65901 65903 65910 65911 65913 65920 65921 65923 65930 65931 65933 65940 65941 65943 65950 65951 65953 65960 65961 65963 65970 65971 65973 65980 65981 65983 65990 65991 65993 66000 66001 66003 Excess fetal grth-deliv Excess fet grth-antepart Oth placent cond-unspec Oth placent cond-deliver Oth placent cond-antepar Fet/plac prob NEC-unspec Fet/plac prob NEC-deliv Fet/plac prob NEC-antepa Fet/plac prob NOS-unspec Fet/plac prob NOS-deliv Fet/plac prob NOS-antepa Polyhydramnios-unspec Polyhydramnios-delivered Polyhydramnios-antepart Oligohydramnios-unspec Oligohydramnios-deliver Oligohydramnios-antepar Prem rupt membran-unspec Prem rupt membran-deliv Prem rupt memb-antepart Prolong rupt memb-unspec Prolong rupt memb-deliv Prolong rup memb-antepar Artific rupt membr-unsp Artific rupt membr-deliv Artif rupt memb-antepart Amniotic infection-unsp Amniotic infection-deliv Amniotic infect-antepart Amniotic prob NEC-unspec Amniotic prob NEC-deliv Amnion prob NEC-antepart Amniotic prob NOS-unspec Amniotic prob NOS-deliv Amnion prob NOS-antepart Fail mechan induct-unsp Fail mech induct-deliver Fail mech induct-antepar Fail induction NOS-unsp Fail induction NOS-deliv Fail induct NOS-antepart Pyrexia in labor-unspec Pyrexia in labor-deliver Pyrexia in labor-antepar Septicemia in labor-unsp Septicem in labor-deliv Septicem in labor-antepa Grand multiparity-unspec Grand multiparity-deliv Grand multiparity-antepa Elderly primigravid-unsp Elderly primigravida-del Elder primigravid-antepa Elderly multigravida-uns Elderly multigravida-del Elderly multigravd-antep Abn ftl hrt rate/rhy-uns Abn ftl hrt rate/rhy-del Abn ftl hrt rate/rhy-ant Complic labor NEC-unsp Complic labor NEC-deliv Compl labor NEC-antepart Complic labor NOS-unsp Complic labor NOS-deliv Compl labor NOS-antepart Obstruct/fet malpos-unsp Obstruc/fet malpos-deliv Obstruc/fet malpos-antep Edit code lists 1.27 Diagnoses for females only 66010 66011 66013 66020 66021 66023 66030 66031 66033 66040 66041 66043 66050 66051 66053 66060 66061 66063 66070 66071 66073 66080 66081 66083 66090 66091 66093 66100 66101 66103 66110 66111 66113 66120 66121 66123 66130 66131 66133 66140 66141 66143 66190 66191 66193 66200 66201 66203 66210 66211 66213 66220 66221 66223 66230 66231 66233 66300 66301 66303 66310 66311 66313 66320 66321 66323 66330 66331 Bony pelv obstruc-unspec Bony pelv obstruct-deliv Bony pelv obstruc-antepa Abn pelv tiss obstr-unsp Abn pelv tis obstr-deliv Abn pelv tis obstr-antep Persist occipitpost-unsp Persist occiptpost-deliv Persist occiptpost-antep Shoulder dystocia-unspec Shoulder dystocia-deliv Shoulder dystocia-antepa Locked twins-unspecified Locked twins-delivered Locked twins-antepartum Fail trial lab NOS-unsp Fail trial lab NOS-deliv Fail trial lab NOS-antep Failed forcep NOS-unspec Failed forceps NOS-deliv Fail forceps NOS-antepar Obstruc labor NEC-unspec Obstruct labor NEC-deliv Obstruc labor NEC-antepa Obstruc labor NOS-unspec Obstruct labor NOS-deliv Obstruc labor NOS-antepa Prim uterine inert-unsp Prim uterine inert-deliv Prim uter inert-antepart Sec uterine inert-unspec Sec uterine inert-deliv Sec uterine inert-antepa Uterine inertia NEC-unsp Uterine inert NEC-deliv Uterine inert NEC-antepa Precipitate labor-unspec Precipitate labor-deliv Precipitate labor-antepa Uter dystocia NOS-unspec Uter dystocia NOS-deliv Uter dystocia NOS-antepa Abnormal labor NOS-unsp Abnormal labor NOS-deliv Abnorm labor NOS-antepar Prolonged 1st stage-unsp Prolong 1st stage-deliv Prolong 1st stage-antepa Prolonged labor NOS-unsp Prolong labor NOS-deliv Prolong labor NOS-antepa Prolonged 2nd stage-unsp Prolong 2nd stage-deliv Prolong 2nd stage-antepa Delay del 2nd twin-unsp Delay del 2nd twin-deliv Delay del 2 twin-antepar Cord prolapse-unspec Cord prolapse-delivered Cord prolapse-antepartum Cord around neck-unspec Cord around neck-deliver Cord around neck-antepar Cord compress NEC-unspec Cord compress NEC-deliv Cord compres NEC-antepar Cord entangle NEC-unspec Cord entangle NEC-deliv 1.28 Definitions of Medicare Code Edits 66333 66340 66341 66343 66350 66351 66353 66360 66361 66363 66380 66381 66383 66390 66391 66393 66400 66401 66404 66410 66411 66414 66420 66421 66424 66430 66431 66434 66440 66441 66444 66450 66451 66454 66460 66461 66464 66480 66481 66484 66490 66491 66494 66500 66501 66503 66510 66511 66520 66522 66524 66530 66531 66534 66540 66541 66544 66550 66551 66554 66560 66561 66564 66570 66571 66572 66574 66580 Cord entangl NEC-antepar Short cord-unspecified Short cord-delivered Short cord-antepartum Vasa previa-unspecified Vasa previa-delivered Vasa previa-antepartum Vasc lesion cord-unspec Vasc lesion cord-deliver Vasc lesion cord-antepar Cord complicat NEC-unsp Cord complicat NEC-deliv Cord compl NEC-antepart Cord complicat NOS-unsp Cord complicat NOS-deliv Cord compl NOS-antepart Del w 1 deg lacerat-unsp Del w 1 deg lacerat-del Del w 1 deg lac-postpart Del w 2 deg lacerat-unsp Del w 2 deg lacerat-del Del w 2 deg lac-postpart Del w 3 deg lacerat-unsp Del w 3 deg lacerat-del Del w 3 deg lac-postpart Del w 4 deg lacerat-unsp Del w 4 deg lacerat-del Del w 4 deg lac-postpart Ob perineal lac NOS-unsp Ob perineal lac NOS-del Perineal lac NOS-postpar Ob perineal hematom-unsp Ob perineal hematoma-del Perin hematoma-postpart Anal sphincter tear NOS Anal sphincter tear-del Anal sphinctr tear w p/p Ob perin traum NEC-unsp Ob perineal trau NEC-del Perin traum NEC-postpart Ob perin traum NOS-unsp Ob perineal trau NOS-del Perin traum NOS-postpart Prelabor rupt uter-unsp Prelabor rupt uterus-del Prelab rupt uter-antepar Rupture uterus NOS-unsp Rupture uterus NOS-deliv Inversion of uterus-unsp Invers uterus-del w p/p Invers uterus-postpart Lacerat of cervix-unspec Lacerat of cervix-deliv Lacer of cervix-postpart High vaginal lacer-unsp High vaginal lacer-deliv High vaginal lac-postpar Ob inj pelv org NEC-unsp Ob inj pelv org NEC-del Inj pelv org NEC-postpar Damage to pelvic jt-unsp Damage to pelvic jt-del Damage pelvic jt-postpar Ob pelvic hematoma-unsp Ob pelvic hematoma-deliv Pelvic hematom-del w pp Pelvic hematoma-postpart Ob trauma NEC-unspec October 2012 Diagnoses for females only 66581 66582 66583 66584 66590 66591 66592 66593 66594 66600 66602 66604 66610 66612 66614 66620 66622 66624 66630 66632 66634 66700 66702 66704 66710 66712 66714 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66900 66901 66902 66903 66904 66910 66911 66912 66913 66914 66920 66921 66922 66923 66924 66930 Ob trauma NEC-delivered Ob trauma NEC-del w p/p Ob trauma NEC-antepartum Ob trauma NEC-postpartum Ob trauma NOS-unspec Ob trauma NOS-delivered Ob trauma NOS-del w p/p Ob trauma NOS-antepartum Ob trauma NOS-postpartum Third-stage hem-unspec Thrd-stage hem-del w p/p Third-stage hem-postpart Postpartum hem NEC-unsp Postpa hem NEC-del w p/p Postpart hem NEC-postpar Delay p/part hem-unspec Delay p/p hem-del w p/p Delay p/part hem-postpar Postpart coagul def-unsp P/p coag def-del w p/p Postpart coag def-postpa Retain placenta NOS-unsp Retnd plac NOS-del w p/p Retain plac NOS-postpart Retain prod concept-unsp Ret prod conc-del w p/p Ret prod concept-postpar Pulm compl in del-unspec Pulm compl in del-deliv Pulm complic-del w p/p Pulm complicat-antepart Pulm complicat-postpart Heart compl in del-unsp Heart compl in del-deliv Heart compl-del w p/p Heart complic-antepart Heart complic-postpart Cns compl labor/del-unsp Cns compl lab/del-deliv Cns complic-del w p/p Cns compl in del-antepar Cns compl in del-postpar Anesth comp del NEC-unsp Anesth compl NEC-deliver Anesth compl NEC-del p/p Anesth compl antepartum Anesth compl-postpartum Anesth comp del NOS-unsp Anesth compl NOS-deliver Anesth compl NOS-del p/p Anesth compl-antepartum Anesth compl-postpartum Maternal distress-unspec Maternal distress-deliv Matern distres-del w p/p Matern distress-antepar Matern distress-postpart Obstetric shock-unspec Obstetric shock-deliver Obstet shock-deliv w p/p Obstetric shock-antepar Obstetric shock-postpart Matern hypotens syn-unsp Matern hypoten syn-deliv Matern hypoten-del w p/p Matern hypotens-antepar Matern hypotens-postpart Ac kidny fail w del-unsp October 2012 66932 66934 66940 66941 66942 66943 66944 66950 66951 66960 66961 66970 66971 66980 66981 66982 66983 66984 66990 66991 66992 66993 66994 67000 67002 67004 67010 67012 67014 67020 67022 67024 67030 67032 67034 67080 67082 67084 67100 67101 67102 67103 67104 67110 67111 67112 67113 67114 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67150 67151 67152 67153 67154 67180 67181 67182 67183 Ac kidney fail-del w p/p Ac kidney fail-postpart Oth ob surg compl-unspec Oth ob compl-delivered Oth ob compl-deliv w p/p Complc ob surg anteprtm Oth ob surg compl-postpa Forcep deliv NOS-unspec Forcep deliv NOS-deliver Breech extr NOS-unspec Breech extr NOS-deliver Cesarean deliv NOS-unsp Cesarean delivery NOS Compl lab/deliv NEC-unsp Comp lab/deliv NEC-deliv Compl del NEC-del w p/p Compl deliv NEC-antepar Compl deliv NEC-postpart Compl lab/deliv NOS-unsp Comp lab/deliv NOS-deliv Compl del NOS-del w p/p Compl deliv NOS-antepar Compl deliv NOS-postpart Maj puerp inf NOS-unsp Maj puer inf NOS-del p/p Major puerp inf NOS-p/p Puerp endometritis-unsp Puerp endomet del w p/p Puerp endomet-postpart Puerperal sepsis-unsp Puerprl sepsis-del w p/p Puerperl sepsis-postpart Puerp septc thromb-unsp Prp sptc thrmb-del w p/p Prp septc thrmb-postpart Maj prp infec NEC-unspec Maj prp inf NEC-dl w p/p Maj puerp infec NEC-p/p Varic vein leg preg-unsp Varicose vein leg-deliv Varic vein leg-del w p/p Varic vein leg-antepart Varic vein leg-postpart Varic vulva preg-unspec Varicose vulva-delivered Varicose vulva-del w p/p Varicose vulva-antepart Varicose vulva-postpart Thrombophleb preg-unspec Thrombophlebitis-deliver Thrombophleb-deliv w p/p Thrombophlebit-antepart Thrombophlebit-postpart Deep thromb antepar-unsp Deep throm antepar-deliv Deep vein thromb-antepar Deep thromb postpar-unsp Thromb postpar-del w p/p Deep vein thromb-postpar Thrombosis NEC preg-unsp Thrombosis NEC-delivered Thromb NEC-deliv w p/p Thrombosis NEC-antepart Thrombosis NEC-postpart Ven compl preg NEC-unsp Venous compl NEC-deliver Ven comp NEC-deliv w p/p Venous compl NEC-antepar Edit code lists 1.29 Diagnoses for females only 67184 67190 67191 67192 67193 67194 67200 67202 67204 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67414 67420 67422 67424 67430 67432 67434 67440 67442 67444 67450 67451 67452 67453 67454 67480 67482 67484 67490 67492 67494 67500 67501 67502 67503 67504 67510 Venous compl NEC-postpar Ven compl preg NOS-unsp Venous compl NOS-deliver Ven comp NOS-deliv w p/p Venous compl NOS-antepar Venous compl NOS-postpar Puerperal pyrexia-unspec Puerp pyrexia-del w p/p Puerp pyrexia-postpartum Ob air embolism-unspec Ob air embolism-deliver Ob air embol-deliv w p/p Ob air embolism-antepart Ob air embolism-postpart Amniotic embolism-unspec Amniotic embolism-deliv Amniot embol-deliv w p/p Amniotic embol-antepart Amniotic embol-postpart Ob pulm embol NOS-unspec Pulm embol NOS-delivered Pulm embol NOS-del w p/p Pulm embol NOS-antepart Pulm embol NOS-postpart Ob pyemic embol-unspec Ob pyemic embol-deliver Ob pyem embol-del w p/p Ob pyemic embol-antepart Ob pyemic embol-postpart Ob pulmon embol NEC-unsp Pulmon embol NEC-deliver Pulm embol NEC-del w p/p Pulmon embol NEC-antepar Pulmon embol NEC-postpar Puerp cerebvasc dis-unsp Puerp cerebvas dis-deliv Cerebvas dis-deliv w p/p Cerebrovasc dis-antepart Cerebrovasc dis-postpart Disrupt c-sect wnd-unsp Disrupt c-sect-del w p/p Disrupt c-sect-postpart Disrupt perineum-unspec Disrupt perin-del w p/p Disrupt perineum-postpar Ob surg compl NEC-unspec Ob surg compl-del w p/p Ob surg comp NEC-postpar Placental polyp-unspec Placent polyp-del w p/p Placental polyp-postpart Peripart cardiomy-unspec Peripartum cardiomy-del Peripart card del w p/p Peripartum card-antepart Peripartum card-postpart Puerp compl NEC-unspec Puerp comp NEC-del w p/p Puerp compl NEC-postpart Puerp compl NOS-unspec Puerp comp NOS-del w p/p Puerp compl NOS-postpart Infect nipple preg-unsp Infect nipple-delivered Infect nipple-del w p/p Infect nipple-antepartum Infect nipple-postpartum Breast abscess preg-unsp 1.30 Definitions of Medicare Code Edits 67511 67512 67513 67514 67520 67521 67522 67523 67524 67580 67581 67582 67583 67584 67590 67591 67592 67593 67594 67600 67601 67602 67603 67604 67610 67611 67612 67613 67614 67620 67621 67622 67623 67624 67630 67631 67632 67633 67634 67640 67641 67642 67643 67644 67650 67651 67652 67653 67654 67660 67661 67662 67663 67664 67680 67681 67682 67683 67684 67690 67691 67692 67693 67694 677 67800 67801 67803 Breast abscess-delivered Breast abscess-del w p/p Breast abscess-antepart Breast abscess-postpart Mastitis in preg-unspec Mastitis-delivered Mastitis-deliv w p/p Mastitis-antepartum Mastitis-postpartum Breast inf preg NEC-unsp Breast infect NEC-deliv Breast inf NEC-del w p/p Breast inf NEC-antepart Breast inf NEC-postpart Breast inf preg NOS-unsp Breast infect NOS-deliv Breast inf NOS-del w p/p Breast inf NOS-antepart Breast inf NOS-postpart Retract nipple preg-unsp Retracted nipple-deliver Retract nipple-del w p/p Retract nipple-antepart Retract nipple-postpart Cracked nipple preg-unsp Cracked nipple-delivered Cracked nipple-del w p/p Cracked nipple-antepart Cracked nipple-postpart Breast engorge-unspec Breast engorge-delivered Breast engorge-del w p/p Breast engorge-antepart Breast engorge-postpart Breast dis preg NEC-unsp Breast dis NEC-delivered Breast dis NEC-del w p/p Breast dis NEC-antepart Breast dis NEC-postpart Lactation fail-unspec Lactation fail-delivered Lactation fail-del w p/p Lactation fail-antepart Lactation fail-postpart Suppr lactation-unspec Suppr lactation-deliver Suppr lactat-del w p/p Suppr lactation-antepar Suppr lactation-postpart Galactorrhea preg-unspec Galactorrhea-delivered Galactorrhea-del w p/p Galactorrhea-antepartum Galactorrhea-postpartum Lactation dis NEC-unspec Lactation dis NEC-deliv Lactat dis NEC-del w p/p Lactat dis NEC-antepart Lactat dis NEC-postpart Lactation dis NOS-unspec Lactation dis NOS-deliv Lactat dis NOS-del w p/p Lactat dis NOS-antepart Lactat dis NOS-postpart Late effct cmplcatn preg Fetal hematologic-unspec Fetal hematologic-deliv Fetal hematologic-ante October 2012 Diagnoses for females only 67810 67811 67813 67900 67901 67902 67903 67904 67910 67911 67912 67913 67914 71630 71631 71632 71633 71634 71635 71636 71637 71638 71639 7520 75210 75211 75219 7522 75231 75232 75233 75234 75235 75236 75239 75240 75241 75242 75243 75244 75245 75246 75247 75249 7923 79500 79501 79502 79503 79504 79505 79506 79507 79508 79509 79510 79511 79512 79513 79514 79515 79516 79518 79519 79582 7965 8674 8675 Fetal conjoin twins-unsp Fetal conjoin twins-del Fetal conjoin twins-ante Mat comp in utero-unsp Mat comp in utero-del Mat comp in utro-del-p/p Mat comp in utero-ante Mat comp in utero-p/p Fetal comp in utero-unsp Fetal comp in utero-del Ftl cmp in utro-del-p/p Fetal comp in utero-ante Fetal comp in utero-p/p Climact arthritis-unspec Climact arthritis-shlder Climact arthritis-up/arm Climact arthrit-forearm Climact arthritis-hand Climact arthritis-pelvis Climact arthritis-l/leg Climact arthritis-ankle Climact arthritis NEC Climact arthritis-mult Anomalies of ovaries Tubal/broad lig anom NOS Embryonic cyst of adnexa Tubal/broad lig anom NEC Doubling of uterus Agenesis of uterus Hypoplasia of uterus Unicornuate uterus Bicornuate uterus Septate uterus Arcuate uterus Anomalies of uterus NEC Cervix/fem gen anom NOS Embryon cyst fem gen NEC Imperforate hymen Cervical agenesis Cervical duplication Vaginal agenesis Transv vaginal septum Longitud vaginal septum Cervix/fem gen anom NEC Abn find-amniotic fluid Abn glandular pap smear Pap smear (ASC-US) Pap smear (ASC-H) Pap smear cervix w LGSIL Pap smear cervix w HGSIL Cervical (HPV) DNA pos Pap smr cytol evid malig Sat cerv smr-no trnsfrm Unsat cerv cytlogy smear Abn pap cervix HPV NEC Abn gland pap smr vagina Pap smear vag w ASC-US Pap smear vagina w ASC-H Pap smear vagina w LGSIL Pap smear vagina w HGSIL Vag hi risk HPV-DNA pos Pap smr vag-cytol malig Vaginl cytol smr unsatis Oth abn Pap smr vag/HPV Elev ca antigen 125 Abn find antenatl screen Uterus injury-closed Uterus injury-open October 2012 8784 8785 8786 8787 90255 90256 90281 90282 9391 9392 9474 99632 V074 V1040 V1041 V1042 V1043 V1044 V1221 V131 V1321 V1322 V1323 V1324 V1329 V1521 V220 V221 V222 V230 V231 V232 V233 V2341 V2342 V2349 V235 V237 V2381 V2382 V2383 V2384 V2385 V2386 V2387 V2389 V239 V240 V241 V242 V2501 V2511 V2512 V2513 V253 V2541 V2542 V2543 V255 V261 V2631 V2632 V2651 V2681 V270 V271 V272 V273 Open wound of vulva Open wound vulva-compl Open wound of vagina Open wound vagina-compl Injury uterine artery Injury uterine vein Injury ovarian artery Injury ovarian vein Foreign body uterus Foreign bdy vulva/vagina Burn of vagina & uterus Malfunction iud Hormone replace postmeno Hx-female genit malg NOS Hx-cervical malignancy Hx-uterus malignancy NEC Hx of ovarian malignancy Hx-female genit malg NEC Hx gestational diabetes Hx-trophoblastic disease History-pre-term labor Hx of cervical dysplasia Hx vaginal dysplasia Hx vulvar dysplasia Hx-genital/obs dis NEC Hx in utero proc in preg Supervis normal 1st preg Supervis oth normal preg Preg state, incidental Preg w hx of infertility Preg w hx-trophoblas dis Preg w hx of abortion Grand multiparity Preg w hx pre-term labor Preg w hx ectopic preg Preg w poor obs hx NEC Preg w poor reproduct hx Insufficnt prenatal care Suprv elderly primigrav Suprv elderly multigrav Suprv young primigravida Suprv young multigravida Pregnt-assist repro tech Preg-hx in utro prev prg Preg w incon fetl viabil Suprv high-risk preg NEC Suprv high-risk preg NOS Postpart care after del Postpart care-lactation Rout postpart follow-up Prescrip-oral contracept Insertion of iud Removal of iud Remove/insert iud Menstrual extraction Contracept pill surveill Iud surveillance Srvl mplnt sbdrm cntrcep Nsrt mplnt sbdrm cntrcep Artificial insemination Fem genetic test dis car Female genetic test NEC Tubal ligation status Assist repro fertility Deliver-single liveborn Deliver-single stillborn Deliver-twins, both live Del-twins, 1 nb, 1 sb Edit code lists 1.31 Diagnoses for females only V274 V275 V276 V277 V279 V280 V281 V282 V283 V284 V285 V286 V2881 V2882 V2889 V289 V4551 V4981 V5042 V524 V5970 V5971 V5972 V5973 V5974 V616 V617 V6701 V7231 V7232 V7240 V7241 V7242 V7611 V762 V7646 V7647 V824 V8402 V8404 V8801 V8802 V8803 V8901 V8902 V8903 V8904 V8905 V8909 V9100 V9101 V9102 V9103 V9109 V9110 V9111 V9112 V9119 V9120 V9121 V9122 V9129 V9190 V9191 V9192 V9199 Deliver-twins, both sb Del-mult birth, all live Del-mult brth, some live Del-mult birth, all sb Outcome of delivery NOS Screening-chromosom anom Screen-alphafetoprotein Screen by amniocent NEC Scr fetl malfrm-ultrasnd Screen-fetal retardation Screen-isoimmunization Antenatal screen strep b Scrn fetal anatmc survey Scrn risk preterm labor Antenatal screening NEC Antenatal screening NOS Prsc ntrutr cntrcptv dvc Asympt postmeno status Prphylct orgn rmvl ovary Fit/adj breast pros/impl Egg donor NEC Egg donor age <35 anon Egg donor age <35 desig Egg donor age 35+ anon Egg donor age 35+ desig Illegitimate pregnancy Unwanted pregnancy NEC Follow-up vag pap smear Routine gyn examination Pap smear confirmation Pregnancy test unconfirm Pregnancy test negative Pregnancy test-positive Screen mammogram hi risk Screen mal neop-cervix Screen malig neop-ovary Screen malig neop-vagina Mat pstntl scr-chrm anom Genetc sus mal neo ovary Genetc susc mal neo endo Acq absnce cervix/uterus Acq ab ut remn cerv stmp Acq absnc cerv/remain ut Sus amntc cav/mem nt fnd Sus placentl prob nt fnd Sus fetal anomaly nt fnd Sus fetal growth not fnd Sus cervcl shortn nt fnd Oth sus mat/ftl nt fnd Twin gest-plac/sac NOS Twin gest-monochr/monoam Twin gest-monochr/diamni Twin gest-dich/diamniotc Twin gest-plac/sac undet Tripl gest-plac/sac NOS Triplet gest 2+ monochor Triplet gest 2+ monoamn Tripl gest-plac/sac und Quad gest-plac/sac NOS Quad gest 2+ monochorion Quad gest 2+ monoamniotc Quad gest-plac/sac undet Mult gest-plac/sac NOS Mult gest 2+ monochr NEC Mult gest 2+ monoamn NEC Mult gest-plac/sac undet 1.32 Definitions of Medicare Code Edits October 2012 Procedures for females only 6501 6509 6511 6512 6513 6514 6519 6521 6522 6523 6524 6525 6529 6531 6539 6541 6549 6551 6552 6553 6554 6561 6562 6563 6564 6571 6572 6573 6574 6575 6576 6579 6581 6589 6591 6592 6593 6594 6595 6599 6601 6602 6611 6619 6621 6622 6629 6631 6632 6639 664 6651 6652 6661 6662 6663 6669 6671 6672 6673 6674 6679 668 6691 6692 Laparoscopic oophorotomy Other oophorotomy Ovarian aspirat biopsy Ovarian biopsy NEC Lap biopsy of ovary Oth lap dx proc ovaries Ovarian dx procedure NEC Ovarian cyst marsupializ Ovarian wedge resection Lap marsup ovarian cyst Lap wedge resect ovary Oth lap loc exc dest ova Local destr ova les NEC Lap unilat oophorectomy Oth unilat oophorectomy Lap uni salpingo-oophor Oth uni salpingo-oophor Oth remove both ovaries Oth remove remain ovary Lap remove both ovaries Lap remove remain ovary Oth remove ovaries/tubes Oth remove rem ova/tube Lap remove ovaries/tubes Lap remove rem ova/tube Oth simple suture ovary Oth reimplant of ovary Oth salpingo-oophoroplas Lap simple suture ovary Lap reimplant of ovary Lap salpingo-oophoroplas Repair of ovary NEC Lap adhesiolys ova/tube Adhesiolysis ovary/tube Aspiration of ovary Transplantation of ovary Manual rupt ovarian cyst Ovarian denervation Ovarian torsion release Ovarian operation NEC Salpingotomy Salpingostomy Fallopian tube biopsy Fallop tube dx proc NEC Bilat endosc crush tube Bilat endosc divis tube Bilat endos occ tube NEC Bilat tubal crushing NEC Bilat tubal division NEC Bilat tubal destruct NEC Total unilat salpingect Remove both fallop tubes Remove solitary fal tube Destroy fallop tube les Remov tube & ectop preg Bilat part salpingec NOS Partial salpingectom NEC Simpl suture fallop tube Salpingo-oophorostomy Salpingo-salpingostomy Salpingo-uterostomy Fallop tube repair NEC Fallopian tube insufflat Fallopian tube aspirat Unilat fallop tube destr October 2012 6693 6694 6695 6696 6697 6699 670 6711 6712 6719 672 6731 6732 6733 6739 674 6751 6759 6761 6762 6769 680 6811 6812 6813 6814 6815 6816 6819 6821 6822 6823 6824 6825 6829 6831 6839 6841 6849 6851 6859 6861 6869 6871 6879 688 689 6901 6902 6909 6919 6921 6922 6923 6929 693 6941 6942 6949 6951 6952 6959 696 697 6991 Impl fallop tube prosth Remov fallop tube prosth Blow therapeut into tube Fallopian tube dilation Bury fimbriae in uterus Fallopian tube op NEC Cervical canal dilation Endocervical biopsy Cervical biopsy NEC Cervical dx procedur NEC Conization of cervix Cervical cyst marsupial Cervical les cauterizat Cervical les cryotherapy Cervical les destruc NEC Amputation of cervix Transab cerclage cervix Oth rep int cervical os Suture cervical lacerat Cervical fistula repair Cervical repair NEC Hysterotomy Digital exam of uterus Hysteroscopy Open uterine biopsy Open uterine ligament bx Clos uterine ligament bx Closed uterine biopsy Uterus/adnex dx proc NEC Endomet synechiae divis Incision uterine septum Endometrial ablation Uterine art emb w coils Uterine art emb w/o coil Uterine les destruct NEC Lap scervic hysterectomy Subtotl abd hyst NEC/NOS Lap total abdominal hyst Total abd hyst NEC/NOS Lap ast vag hysterectomy Vag hysterectomy NEC/NOS Lap radical abdomnl hyst Radical abd hyst NEC/NOS Lap radical vaginal hyst Radical vag hyst NEC/NOS Pelvic evisceration Hysterectomy NEC/NOS D & C for preg terminat D & C post delivery D & C NEC Destruc uter support NEC Interposit op uterin lig Uterine suspension NEC Vag repair invers uterus Uterus/adnexa repair NEC Paracerv uterine denerv Suture uterine lacerat Closure uterine fistula Uterine repair NEC Aspirat curet-preg termi Aspirat curet-post deliv Aspir curett uterus NEC Menstrual extraction Insertion of iud Insert uterine device Edit code lists 1.33 Procedures for females only 6992 6993 6994 6995 6996 6997 6998 6999 700 7011 7012 7013 7014 7021 7022 7023 7024 7029 7031 7032 7033 704 7050 7051 7052 7053 7054 7055 7061 7062 7071 7072 7073 7074 7075 7076 7077 7078 7079 708 7091 7092 7093 7094 7095 7101 7109 7111 7119 7121 7122 7123 7124 7129 713 714 715 7161 7162 7171 7172 7179 718 719 720 721 7221 7229 Artificial insemination Insertion of laminaria Man replace invert uter Incision of cervix Remove cervical cerclage Remove penetrat cerv FB Uterine support op NEC Uterine operation NEC Culdocentesis Hymenotomy Culdotomy Intralum vag adhesiolys Vaginotomy NEC Vaginoscopy Culdoscopy Cul-de-sac biopsy Vaginal biopsy Vagin/cul-de-sac dx NEC Hymenectomy Excis cul-de-sac lesion Excision vaginal lesion Vaginal obliteration Cystocel/rectocel repair Cystocele repair Rectocele repair Cysto & recto w grf/pros Rep cystocel w grft/pros Rep rectocele w grf/pros Vaginal construction Vaginal reconstruction Suture vagina laceration Repair colovagin fistula Repair rectovag fistula Rep vaginoent fistul NEC Repair vag fistula NEC Hymenorrhaphy Vaginal suspens & fixat Vag susp/fix w grft/pros Vaginal repair NEC Vaginal vault obliterat Vaginal operation NEC Cul-de-sac operation NEC Cul-de-sac grf/pros NEC Insert biological graft Insert synth graft/prost Vulvar adhesiolysis Incis vulva/perineum NEC Vulvar biopsy Vulvar diagnos proc NEC Percutan bartholin aspir Incise bartholin's gland Bartholin gland marsup Destruc bartholin gland Bartholin's gland op NEC Local vulvar excis NEC Operations on clitoris Radical vulvectomy Unilateral vulvectomy Bilateral vulvectomy Suture vulvar laceration Repair vulvar fistula Vulvar/perin repair NEC Other vulvar operations Other female genital ops Low forceps operation Low forceps w episiotomy Mid forceps w episiotomy Mid forceps op NEC 1.34 Definitions of Medicare Code Edits 7231 7239 724 7251 7252 7253 7254 726 7271 7279 728 729 7301 7309 731 7321 7322 733 734 7351 7359 736 738 7391 7392 7393 7394 7399 740 741 742 743 744 7491 7499 750 751 752 7531 7532 7533 7534 7535 7536 7537 7538 754 7550 7551 7552 7561 7562 7569 757 758 7591 7592 7593 7594 7599 8781 8782 8783 8784 8785 8789 8846 8878 High forceps w episiot High forceps op NEC Forceps rotat fetal head Part brch extrac w forcp Part breech extract NEC Tot brch extrac w forcep Tot breech extrac NEC Forceps-aftercoming head Vacuum ext del w episiot Vacuum extract del NEC Instrument delivery NEC Instrument delivery NOS Induct labor-rupt memb Artif rupt membranes NEC Surg induct labor NEC Int/comb version no extr Int/comb version w extr Failed forceps Medical induction labor Manual rotat fetal head Manual assist deliv NEC Episiotomy Fetal ops-facilitate del Ext version-assist deliv Replace prolapsed cord Incis cx to assist deliv Pubiotomy to assist del Ops assisting deliv NEC Classical c-section Low cervical c-section Extraperitoneal c-sect Rem extratub ectop preg Cesarean section NEC Hysterotomy to termin pg Cesarean section NOS Intra-amnion inj for ab Diagnostic amniocentesis Intrauterine transfusion Amnioscopy Fetal ekg Fetal blood sample/bx Other fetal monitoring Dx proc fetus/amnion NEC Correction fetal defect Amnioinfusion Fetal pulse oximetry Manual removal-placenta Repair ob lac uterus NOS Repair ob lacerat cervix Repair ob lac corp uteri Repair ob lac blad/ureth Repair ob lac rect/anus Repair ob laceration NEC Manual explor uterus p/p Ob tamponade uterus/vag Evac ob inc hemat perin Evac ob hemat vulva/vag Surg corr invert uterus Man replac invert uterus Obstetric operation NEC X-ray of gravid uterus Gas hysterosalpingogram Dye hysterosalpingogram Percutaneous hysterogram Tube & uterus x-ray NEC Female genital x-ray NEC Contrast placentogram Dx ultrasound-grav uter October 2012 Procedures for females only 8926 9141 9142 9143 9144 9145 9146 9149 9217 9614 9615 9616 9617 9618 9644 9724 9725 9726 9771 9772 9773 9774 9775 9816 9817 9823 9998 Gynecologic examination Bact smear-female genit Culture-female genital C & s-female genital Parasitology-female gen Toxicology-female genit Cell blk/pap-female gen Micro exam-femal gen NEC Placental scan Vaginal packing Vaginal mold insertion Other vaginal dilation Vag diaphragm insertion Oth vagin pessary insert Vaginal douche Replace vag diaphragm Replace vaginal pessary Replace vag/vulv packing Removal iud Remov intrauterine pack Remov vaginal diaphragm Removal oth vag pessary Remov vag/vulv packing Remov intralum uter FB Remov intralum vag FB Removal vulvar FB Milk extraction October 2012 Edit code lists 1.35 Diagnoses for males only 01640 01641 01642 01643 01644 01645 01646 01650 01651 01652 01653 01654 01655 01656 05413 0720 09812 09813 09814 09832 09833 09834 13103 1750 1759 185 1860 1869 1871 1872 1873 1874 1875 1876 1877 1878 1879 2144 2220 2221 2222 2223 2224 2228 2229 2334 2335 2336 2364 2365 2366 2570 2571 2579 30274 30275 4564 60000 60001 60010 60011 60020 60021 6003 60090 TB epididymis-unspec TB epididymis-no exam TB epididymis-exam unkn TB epididymis-micro dx TB epididymis-cult dx TB epididymis-histo dx TB epididymis-oth test TB male genit NEC-unspec TB male gen NEC-no exam TB male gen NEC-ex unkn TB male gen NEC-micro dx TB male gen NEC-cult dx TB male gen NEC-histo dx TB male gen NEC-oth test Herpetic infect of penis Mumps orchitis Gc prostatitis (acute) Gc orchitis (acute) Gc sem vesiculit (acute) Gc prostatitis, chronic Gc orchitis, chronic Gc sem vesiculitis, chr Trichomonal prostatitis Mal neo male nipple Mal neo male breast NEC Malign neopl prostate Mal neo undescend testis Malig neo testis NEC Malign neopl prepuce Malig neo glans penis Malig neo penis body Malig neo penis NOS Malig neo epididymis Mal neo spermatic cord Malign neopl scrotum Mal neo male genital NEC Mal neo male genital NOS Lipoma spermatic cord Benign neoplasm testis Benign neoplasm penis Benign neoplasm prostate Benign neo epididymis Benign neoplasm scrotum Ben neo male genital NEC Ben neo male genital NOS Ca in situ prostate Ca in situ penis Ca in situ male gen NEC Unc behav neo testis Unc behav neo prostate Unc behav neo male NEC Testicular hyperfunction Postablat testic hypofun Testicular dysfunct NOS Male orgasmic disorder Premature ejaculation Scrotal varices BPH w/o urinary obs/LUTS BPH w urinary obs/LUTS Nod prostate w/o ur obst Nod prostate w ur obst BPH loc w/o ur obs/LUTS BPH loc w urin obs/LUTS Cyst of prostate BPH NOS w/o ur obs/LUTS 1.36 Definitions of Medicare Code Edits 60091 6010 6011 6012 6013 6014 6018 6019 6020 6021 6022 6023 6028 6029 6030 6031 6038 6039 6040 60490 60491 60499 605 6060 6061 6068 6069 6070 6071 6072 6073 60781 60782 60783 60784 60785 60789 6079 6080 6081 60820 60821 60822 60823 60824 6083 6084 60881 60882 60883 60884 60885 60886 60887 60889 6089 75251 75252 75261 75262 75263 75264 75265 75269 75281 BPH NOS w ur obs/LUTS Acute prostatitis Chronic prostatitis Abscess of prostate Prostatocystitis Prostatitis in oth dis Prostatic inflam dis NEC Prostatitis NOS Calculus of prostate Prostatic congest/hemorr Atrophy of prostate Dysplasia of prostate Prostatic disorders NEC Prostatic disorder NOS Encysted hydrocele Infected hydrocele Hydrocele NEC Hydrocele NOS Orchitis with abscess Orchitis/epididymit NOS Orchitis in oth disease Orchitis/epididymit NEC Redun prepuce & phimosis Azoospermia Oligospermia Male infertility NEC Male infertility NOS Leukoplakia of penis Balanoposthitis Inflam dis, penis NEC Priapism Balanitis xerotica oblit Vascular disorder, penis Edema of penis Impotence, organic orign Peyronie's disease Disorder of penis NEC Disorder of penis NOS Seminal vesiculitis Spermatocele Torsion of testis NOS Extravag tors sperm cord Intravag tors sperm cord Torsion appendix testis Torsion appy epididymis Atrophy of testis Male gen inflam dis NEC Male gen dis in oth dis Hematospermia Male gen vascul dis NEC Chylocele, tunic vaginal Stricture, male gen orgn Edema, male genital orgn Retrograde ejaculation Male genital dis NEC Male genital dis NOS Undescended testis Retractile testis Hypospadias Epispadias Congenital chordee Micropenis Hidden penis Penile anomalies NEC Scrotal transposition October 2012 Diagnoses for males only 7587 78832 79093 7922 8780 8781 8782 8783 9393 95913 V1045 V1046 V1047 V1048 V1049 V1361 V2634 V2635 V2639 V2652 V502 V7644 V7645 V8403 Klinefelter's syndrome Stress incontinence male Elvtd prstate spcf antgn Abn findings-semen Open wound of penis Open wound penis-compl Opn wound scrotum/testes Opn wnd scrot/test-compl Foreign body penis Fx corpus cavrnosm penis Hx-male genit malig NOS Hx-prostatic malignancy Hx-testicular malignancy Hx-epididymis malignancy Hx-male genit malig NEC Hx-hypospadias Male genetc test dis car Test male/fem preg loss Male genetic test NEC Vasectomy status Routine circumcision Scrn malig neop-prostate Screen malig neop-testis Genetc sus mal neo prost October 2012 Edit code lists 1.37 Procedures for males only 600 6011 6012 6013 6014 6015 6018 6019 6021 6029 603 604 605 6061 6062 6069 6071 6072 6073 6079 6081 6082 6091 6092 6093 6094 6095 6096 6097 6099 610 6111 6119 612 613 6141 6142 6149 6191 6192 6199 620 6211 6212 6219 622 623 6241 6242 625 6261 6269 627 6291 6292 6299 6301 6309 Incision of prostate Closed prostatic biopsy Open prostatic biopsy Clos seminal vesicles bx Open seminal vesicles bx Periprostatic biopsy Prostatic dx proced NEC Semin ves dx proced NEC Transureth prostatectomy Oth transureth prostatec Suprapubic prostatectomy Retropubic prostatectomy Radical prostatectomy Los excis prostatic les Perineal prostatectomy Prostatectomy NEC Percut semin ves aspirat Seminal vesicle incision Seminal vesicle excision Seminal vesicle op NEC Periprostatic incision Periprostatic excision Percut prostatic aspirat Injection into prostate Repair of prostate Control prostate hemorr Trans bal dil pros ureth Tu destr prostate by mt Oth tu destr pros - rt Prostatic operation NEC Scrotum & tunica i & d Scrotum & tunica biopsy Scrot/tunica dx proc NEC Excision of hydrocele Scrotal les destruction Suture scrotal lacerat Scrotal fistula repair Scrotum/tunic repair NEC Percut tunica aspiration Excision tunica les NEC Scrotum & tunica op NEC Incision of testes Closed testicular biopsy Open testicular biopsy Testes dx procedure NEC Testicular les destruct Unilateral orchiectomy Remove both testes Remove solitary testis Orchiopexy Suture testicular lacer Testicular repair NEC Insert testicular prosth Aspiration of testes Injection into testes Testicular operation NEC Spermatic cord/vas biops Spermat cord/vas dx NEC 1.38 Definitions of Medicare Code Edits 631 632 633 634 6351 6352 6353 6359 636 6370 6371 6372 6373 6381 6382 6383 6384 6385 6389 6391 6392 6393 6394 6395 6399 640 6411 6419 642 643 6441 6442 6443 6444 6445 6449 645 6491 6492 6493 6494 6495 6496 6497 6498 6499 8791 8792 8793 8794 8795 8799 9824 9994 9995 9996 Exc spermatic varicocele Excise epididymis cyst Excise cord/epid les NEC Epididymectomy Suture cord & epid lacer Reduction torsion testes Transplant spermat cord Cord & epidid repair NEC Vasotomy Male sterilization NOS Ligation of vas deferens Spermatic cord ligation Vasectomy Suture vas & epidid lac Postop vas reconstruct Epididymovasostomy Removal vas ligature Remov vas deferens valve Vas & epididy repair NEC Spermatocele aspiration Epididymotomy Spermatic cord incision Sperm cord adhesiolysis Insert valve in vas def Cord/epid/vas ops NEC Circumcision Penile biopsy Penile diagnost proc NEC Local excis penile les Amputation of penis Suture penile laceration Release of chordee Construction of penis Reconstruction of penis Replantation of penis Penile repair NEC Sex transformat op NEC Dorsal/lat slit prepuce Incision of penis Division of penile adhes Fit ext penile prosthes Ins noninfl penis prosth Remove int penile prosth Ins inflate penis prosth Penile operation NEC Male genital op NEC Contr semin vesiculogram Prostat/sem ves xray NEC Contrast epididymogram Contrast vasogram Epididymis/vas x-ray NEC Male genital x-ray NEC Removal scrotal/penis FB Prostatic massage Stretching of foreskin Sperm collection October 2012 6. Manifestation code as principal diagnosis 6. Manifestation code as principal diagnosis Manifestation codes describe the manifestation of an underlying disease, not the disease itself, and therefore should not be used as a principal diagnosis. The following list contains ICD-9-CM diagnoses with corresponding English descriptions identified as manifestation codes. Manifestations not allowed as principal diagnosis 2842 28952 28983 29410 29411 3207 3210 3211 3212 3213 3214 3218 32301 32302 3231 3232 32341 32342 32361 32362 32363 32371 32372 32701 32702 32714 32715 32726 32727 32737 32744 3302 3303 3317 3344 3362 3363 3371 34121 34710 34711 3571 3572 3573 3574 3581 35839 3595 3596 36201 36202 36203 36204 Myelophthisis Splenic sequestration Myelofibrosis Dementia w/o behav dist Dementia w behavior dist Mening in oth bact dis Cryptococcal meningitis Mening in oth fungal dis Mening in oth viral dis Trypanosomiasis meningit Meningit d/t sarcoidosis Mening in oth nonbac dis Enceph/encephmye oth dis Myelitis-oth viral dis Rickettsial encephalitis Protozoal encephalitis Ot encph/mye ot inf else Oth myelitis ot inf else Inf ac dis encephalomyel Postinf encephalitis NEC Postinfectious myelitis Toxic encph & encephlomy Toxic myelitis Insomnia in other dis Insomnia dt mental disor Hypersomnia in other dis Hypersom dt mental disor Sleep hypovent oth dis Cntrl sleep apnea ot dis Circadian rhym oth dis Parasomnia oth diseases Cereb degen in lipidosis Cerb deg chld in oth dis Cereb degen in oth dis Cerebel atax in oth dis Comb deg cord in oth dis Myelopathy in oth dis Aut neuropthy in oth dis Acute myelitis oth cond Narclpsy w/o cat oth dis Narcolepsy w cat oth dis Neurpthy in col vasc dis Neuropathy in diabetes Neuropathy in malig dis Neuropathy in other dis Myasthenia in oth dis Lambert-Eaton syn ot dis Myopathy in endocrin dis Infl myopathy in oth dis Diabetic retinopathy NOS Prolif diab retinopathy Nonprolf db retnoph NOS Mild nonprolf db retnoph October 2012 36205 36206 36207 36271 36272 36411 36544 36641 36642 36643 36644 37044 37105 37215 37231 37233 3734 3735 3736 37451 37613 37621 37622 38013 38015 38202 4200 4211 4220 42491 4257 4258 44381 45620 45621 4841 4843 4845 4846 4847 4848 5161 5171 5172 5173 5178 52510 52511 52512 52513 52519 5670 5731 Mod nonprolf db retinoph Sev nonprolf db retinoph Diabetic macular edema Ret dystrph in lipidoses Ret dystrph in syst dis Chr iridocyl in oth dis Glaucoma w systemic synd Diabetic cataract Tetanic cataract Myotonic cataract Cataract w syndrome NEC Keratitis in exanthema Phthisical cornea Parasitic conjunctivitis Rosacea conjunctivitis Mucocutan dis conjunctiv Infect derm lid w deform Infec dermatitis lid NEC Parasitic infest eyelid Xanthelasma Parasite infest, orbit Thyrotoxic exophthalmos Exophthalm ophthalmopleg Ac infect extern ear NEC Chr mycot otitis externa Ac supp OM in oth dis Ac pericardit in oth dis Ac endocardit in oth dis Ac myocardit in oth dis Endocarditis in oth dis Metabolic cardiomyopathy Cardiomyopath in oth dis Angiopathy in other dis Bleed esoph var oth dis Esoph varice oth dis NOS Pneum w cytomeg incl dis Pneumonia in whoop cough Pneumonia in anthrax Pneum in aspergillosis Pneum in oth sys mycoses Pneum in infect dis NEC Idio pulm hemosiderosis Rheumatic pneumonia Syst sclerosis lung dis Acute chest syndrome Lung involv in oth dis Acq absence of teeth NOS Loss of teeth d/t trauma Loss teeth d/t peri dis Loss of teeth d/t caries Loss of teeth NEC Peritonitis in infec dis Hepatitis in viral dis Edit code lists 1.39 Manifestations not allowed as principal diagnosis 5732 58081 58181 58281 58381 59081 5954 59801 6014 60491 60881 61611 61651 6281 71110 71111 71112 71113 71114 71115 71116 71117 71118 71119 71120 71121 71122 71123 71124 71125 71126 71127 71128 71129 71130 71131 71132 71133 71134 71135 71136 71137 71138 71139 71140 71141 71142 71143 71144 71145 71146 71147 71148 71149 71150 71151 71152 71153 71154 71155 71156 71157 71158 71159 71160 71161 71162 71163 Hepatitis in oth inf dis Ac nephritis in oth dis Nephrotic syn in oth dis Chr nephritis in oth dis Nephritis NOS in oth dis Pyelonephrit in oth dis Cystitis in oth dis Ureth strict:oth infect Prostatitis in oth dis Orchitis in oth disease Male gen dis in oth dis Vaginitis in oth disease Vulvar ulcer in oth dis Infertil-pituitary orig Reiter arthritis-unspec Reiter arthritis-shlder Reiter arthritis-up/arm Reiter arthritis-forearm Reiter arthritis-hand Reiter arthritis-pelvis Reiter arthritis-l/leg Reiter arthritis-ankle Reiter arthritis NEC Reiter arthritis-mult Behcet arthritis-unspec Behcet arthritis-shlder Behcet arthritis-up/arm Behcet arthritis-forearm Behcet arthritis-hand Behcet arthritis-pelvis Behcet arthritis-l/leg Behcet arthritis-ankle Behcet arthritis NEC Behcet arthritis-mult Dysenter arthrit-unspec Dysenter arthrit-shlder Dysenter arthrit-up/arm Dysenter arthrit-forearm Dysenter arthrit-hand Dysenter arthrit-pelvis Dysenter arthrit-l/leg Dysenter arthrit-ankle Dysenter arthrit NEC Dysenter arthrit-mult Bact arthritis-unspec Bact arthritis-shlder Bact arthritis-up/arm Bact arthritis-forearm Bact arthritis-hand Bact arthritis-pelvis Bact arthritis-l/leg Bact arthritis-ankle Bact arthritis NEC Bact arthritis-mult Viral arthritis-unspec Viral arthritis-shlder Viral arthritis-up/arm Viral arthritis-forearm Viral arthritis-hand Viral arthritis-pelvis Viral arthritis-l/leg Viral arthritis-ankle Viral arthritis NEC Viral arthritis-mult Mycotic arthritis-unspec Mycotic arthritis-shlder Mycotic arthritis-up/arm Mycotic arthrit-forearm 1.40 Definitions of Medicare Code Edits 71164 71165 71166 71167 71168 71169 71170 71171 71172 71173 71174 71175 71176 71177 71178 71179 71180 71181 71182 71183 71184 71185 71186 71187 71188 71189 71210 71211 71212 71213 71214 71215 71216 71217 71218 71219 71220 71221 71222 71223 71224 71225 71226 71227 71228 71229 71230 71231 71232 71233 71234 71235 71236 71237 71238 71239 7130 7131 7132 7133 7134 7135 7136 7137 7138 72081 72701 73070 Mycotic arthritis-hand Mycotic arthritis-pelvis Mycotic arthritis-l/leg Mycotic arthritis-ankle Mycotic arthritis NEC Mycotic arthritis-mult Helminth arthrit-unspec Helminth arthrit-shlder Helminth arthrit-up/arm Helminth arthrit-forearm Helminth arthrit-hand Helminth arthrit-pelvis Helminth arthrit-l/leg Helminth arthrit-ankle Helminth arthrit NEC Helminth arthrit-mult Inf arthritis NEC-unspec Inf arthritis NEC-shlder Inf arthritis NEC-up/arm Inf arthrit NEC-forearm Inf arthritis NEC-hand Inf arthritis NEC-pelvis Inf arthritis NEC-l/leg Inf arthritis NEC-ankle Inf arthrit NEC-oth site Inf arthritis NEC-mult Dicalc phos cryst-unspec Dicalc phos cryst-shlder Dicalc phos cryst-up/arm Dicalc phos crys-forearm Dicalc phos cryst-hand Dicalc phos cryst-pelvis Dicalc phos cryst-l/leg Dicalc phos cryst-ankle Dicalc phos cry-site NEC Dicalc phos cryst-mult Pyrophosph cryst-unspec Pyrophosph cryst-shlder Pyrophosph cryst-up/arm Pyrophosph cryst-forearm Pyrophosph cryst-hand Pyrophosph cryst-pelvis Pyrophosph cryst-l/leg Pyrophosph cryst-ankle Pyrophos cryst-site NEC Pyrophos cryst-mult Chondrocalcin NOS-unspec Chondrocalcin NOS-shlder Chondrocalcin NOS-up/arm Chondrocalc NOS-forearm Chondrocalcin NOS-hand Chondrocalcin NOS-pelvis Chondrocalcin NOS-l/leg Chondrocalcin NOS-ankle Chondrocalc NOS-oth site Chondrocalcin NOS-mult Arthrop w endocr/met dis Arthrop w noninf GI dis Arthropath w hematol dis Arthropathy w skin dis Arthropathy w resp dis Arthropathy w nerve dis Arthrop w hypersen react Arthrop w system dis NEC Arthrop w oth dis NEC Spondylopathy in oth dis Synovitis in oth dis Polio osteopathy-unspec October 2012 Manifestations not allowed as principal diagnosis 73071 73072 73073 73074 73075 73076 73077 73078 73079 73080 73081 73082 73083 73084 73085 73086 73087 73088 73089 7311 7318 73740 73741 73742 73743 7740 77431 7745 78061 78452 78552 V4031 Polio osteopathy-shlder Polio osteopathy-up/arm Polio osteopathy-forearm Polio osteopathy-hand Polio osteopathy-pelvis Polio osteopathy-l/leg Polio osteopathy-ankle Polio osteopathy NEC Polio osteopathy-mult Bone infect NEC-unspec Bone infect NEC-shlder Bone infect NEC-up/arm Bone infect NEC-forearm Bone infect NEC-hand Bone infect NEC-pelvis Bone infect NEC-l/leg Bone infect NEC-ankle Bone infect NEC-oth site Bone infect NEC-mult Osteitis def in oth dis Bone involv in oth dis Spin curv NOS in oth dis Kyphosis in oth dis Lordosis in oth dis Scoliosis in oth dis Perinat jaund-hered anem Neonat jaund in oth dis Perinatal jaundice NEC Fever in other diseases Flncy dsord cond elsewhr Septic shock Wandering-dis elsewhere October 2012 Edit code lists 1.41 7. Non-specific principal diagnosis 7. Non-specific principal diagnosis 8. Questionable admission Effective 10/01/07, the non-specific principal diagnosis edit was discontinued and will appear for claims processed using MCE version 2.0-23.0 only. Some diagnoses are not usually sufficient justification for admission to an acute care hospital. For example, if a patient is given code 4011 for benign hypertension, then the patient would have a questionable admission, since benign hypertension is not normally sufficient justification for admission to a hospital. The following list contains diagnosis codes with corresponding English descriptions identified as questionable admission when used as a principal diagnosis. Questionable admissions - principal diagnosis only 25000 27800 3804 4011 4262 4263 4264 79093 7962 9999 V08 V5331 V5332 V5339 DMII wo cmp nt st uncntr Obesity NOS Impacted cerumen Benign hypertension Left bb hemiblock Left bb block NEC Rt bundle branch block Elvtd prstate spcf antgn Elev bl pres w/o hypertn Complic med care NEC/NOS Asymp hiv infectn status Ftng cardiac pacemaker Ftng autmtc dfibrillator Ftng oth cardiac device 1.42 Definitions of Medicare Code Edits October 2012 9. Unacceptable principal diagnosis 9. Unacceptable principal diagnosis There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis. There are a few usually unacceptable principal diagnosis codes that are considered “acceptable” when a secondary diagnosis is also coded on the record. If no secondary diagnosis is present for this subset of codes, the message REQUIRES SECONDARY DX will appear. The following pages contain a list of codes with corresponding English descriptions identified as unacceptable when entered as principal diagnosis. ➤ October 2012 Note: Codes that require a secondary diagnosis are indicated with an asterisk (*). Edit code lists 1.43 Unacceptable principal diagnoses 1992 23877 27950 27951 27952 27953 3051 3533 35831 36570 36571 36572 36573 36574 3708 4142 4143 4144 41512 4233 4404 449 51282 5735 6113 69550 69551 69552 69553 69554 69555 69556 69557 69558 69559 78951 7981 7982 7989 99802 V010 V011 V012 V013 V014 V015 V016 V0181 V0189 V019 V020 V021 V022 V023 V024 V0251 V0252 V0253 V0254 V0259 V0260 V0261 V0262 V0269 V027 Malig neopl-transp organ Post tp lymphprolif dis Graft-versus-host NOS Ac graft-versus-host dis Chronc graft-vs-host dis Ac on chrn grft-vs-host Tobacco use disorder Thoracic root lesion NEC Lambert-Eaton synd neopl Glaucoma stage NOS Mild stage glaucoma Moderate stage glaucoma Severe stage glaucoma Indeterm stage glaucoma Keratitis NEC Chr tot occlus cor artry Cor ath d/t lpd rch plaq Cor ath d/t calc cor lsn Septic pulmonary embolsm Cardiac tamponade Chr tot occl art extrem Septic arterial embolism Sec spont pneumothorax Hepatopulmonary syndrome Fat necrosis of breast Exfol d/t eryth <10% bdy Exfl d/t eryth 10-19 bdy Exfl d/t eryth 20-29 bdy Exfl d/t eryth 30-39 bdy Exfl d/t eryth 40-49 bdy Exfl d/t eryth 50-59 bdy Exfl d/t eryth 60-69 bdy Exfl d/t eryth 70-79 bdy Exfl d/t eryth 80-89 bdy Exfl d/t eryth >=90% bdy Malignant ascites Instantaneous death Death within 24 hr sympt Unattended death Postop shock, septic Cholera contact Tuberculosis contact Poliomyelitis contact Smallpox contact Rubella contact Rabies contact Venereal dis contact Contact/exposure-anthrax Communic dis contact NEC Communic dis contact NOS Cholera carrier Typhoid carrier Amebiasis carrier GI pathogen carrier NEC Diphtheria carrier Group b streptoc carrier Streptococus carrier NEC Meth susc Staph carrier Meth resis Staph carrier Bacteria dis carrier NEC Viral hep carrier NOS Hepatitis B carrier Hepatitis C carrier Viral hep carrier NEC Gonorrhea carrier 1.44 Definitions of Medicare Code Edits V028 V029 V030 V031 V032 V033 V034 V035 V036 V037 V0381 V0382 V0389 V039 V040 V041 V042 V043 V044 V045 V046 V047 V0481 V0482 V0489 V050 V051 V052 V053 V054 V058 V059 V060 V061 V062 V063 V064 V065 V066 V068 V069 V071 V072 V0731 V074 V0751 V0752 V0759 V079 V090 V091 V092 V093 V094 V0950 V0951 V096 V0970 V0971 V0980 V0981 V0990 V0991 V1000 V1001 V1002 V1003 V1004 Venereal dis carrier NEC Carrier NEC Vaccin for cholera Vacc-typhoid-paratyphoid Vaccin for tuberculosis Vaccin for plague Vaccin for tularemia Vaccin for diphtheria Vaccin for pertussis Tetanus toxoid inoculat Nd vac hmophlus inflnz b Nd vac strptcs pneumni b Nd other specf vacnation Vaccin for bact dis NOS Vaccin for poliomyelitis Vaccin for smallpox Vaccin for measles Vaccin for rubella Vaccin for yellow fever Vaccin for rabies Vaccin for mumps Vaccin for common cold Vaccin for influenza Vaccination for RSV Vaccn/inoc viral dis NEC Arbovirus enceph vaccin Vacc arboviral dis NEC Vaccin for leishmaniasis Need prphyl vc vrl hepat Need prphyl vc varicella Vaccin for disease NEC Vaccin for singl dis NOS Vaccin for cholera + tab Vaccination for DTP-DTaP Vaccin for dtp + tab Vaccin for dtp + polio Vac-measle-mumps-rubella Vaccination for Td-DT Nd vac strp pnumn/inflnz Vac-dis combinations NEC Vac-dis combinations NOS Desensitiza to allergens Prophylact immunotherapy Prophylac fluoride admin Hormone replace postmeno Use of SERMs Use aromatase inhibitors Use oth agnt af estrogen Prophyl or tx meas NOS Inf mcrg rstn pncllins Inf mcrg rstn b-lactam Inf mcrg rstn macrolides Inf mcrg rstn ttrcycln Inf mcrg rstn amnglcsds Inf mcr rst qn flr nt ml Inf mcrg rstn qn flrq ml Inf mcrg rstn sulfnmides Inf mcr rst oth ag nt ml Inf mcrg rstn oth ag mlt Inf mcr rst ot drg nt ml Inf mcrg rstn oth drg ml Infc mcrg drgrst nt mult Infc mcrg drgrst mult Hx of GI malignancy NOS Hx of tongue malignancy Hx-oral/pharynx malg NEC Hx-esophageal malignancy Hx of gastric malignancy October 2012 Unacceptable principal diagnoses V1005 V1006 V1007 V1009 V1011 V1012 V1020 V1021 V1022 V1029 V103 V1040 V1041 V1042 V1043 V1044 V1045 V1046 V1047 V1048 V1049 V1050 V1051 V1052 V1053 V1059 V1060 V1061 V1062 V1063 V1069 V1071 V1072 V1079 V1081 V1082 V1083 V1084 V1085 V1086 V1087 V1088 V1089 V1090 V1091 V110 V111 V112 V113 V114 V118 V119 V1200 V1201 V1202 V1203 V1204 V1209 V121 V1221 V1229 V123 V1240 V1241 V1242 V1249 V1250 V1251 Hx of colonic malignancy Hx-rectal & anal malign Hx of liver malignancy Hx of GI malignancy NEC Hx-bronchogenic malignan Hx-tracheal malignancy Hx-resp org malignan NOS Hx-laryngeal malignancy Hx-nose/ear/sinus malig Hx-intrathoracic mal NEC Hx of breast malignancy Hx-female genit malg NOS Hx-cervical malignancy Hx-uterus malignancy NEC Hx of ovarian malignancy Hx-female genit malg NEC Hx-male genit malig NOS Hx-prostatic malignancy Hx-testicular malignancy Hx-epididymis malignancy Hx-male genit malig NEC Hx-urinary malignan NOS Hx of bladder malignancy Hx of kidney malignancy Hx malig renal pelvis Hx-urinary malignan NEC Hx of leukemia NOS Hx of lymphoid leukemia Hx of myeloid leukemia Hx of monocytic leukemia Hx of leukemia NEC Hx-lymphosarcoma Hx-hodgkin's disease Hx-lymphatic malign NEC Hx of bone malignancy Hx-malig skin melanoma Hx-skin malignancy NEC Hx of eye malignancy Hx of brain malignancy Hx-malign nerve syst NEC Hx of thyroid malignancy Hx-endocrine malign NEC Hx of malignancy NEC Hx malig neoplasm NOS Hx malig neuroendo tumor Hx of schizophrenia Hx of affective disorder Hx of neurosis Hx of alcoholism Hx combat/stress reactn Hx-mental disorder NEC Hx-mental disorder NOS Prsnl hst unsp nfct prst Prsnl hst tuberculosis Prsnl hst poliomyelitis Personal histry malaria Hx Methicln resist Staph Prsnl hst oth nfct parst Hx-nutrition deficiency Hx gestational diabetes Hx-endocr/meta/immun dis Hx-blood diseases Hx nerv sys/snse org NOS Hx benign neoplasm brain Personl hx infection CNS Hx nerv sys/snse org NEC Hx-circulatory dis NOS Hx-ven thrombosis/embols October 2012 V1252 V1253 V1254 V1255 V1259 V1260 V1261 V1269 V1270 V1271 V1272 V1279 V1300 V1301 V1302 V1303 V1309 V131 V1321 V1322 V1323 V1324 V1329 V133 V134 V1351 V1352 V1359 V1361 V1362 V1363 V1364 V1365 V1366 V1367 V1368 V1369 V137 V1381 V1389 V139 V140 V141 V142 V143 V144 V145 V146 V147 V148 V149 V1501 V1502 V1503 V1504 V1505 V1506 V1507 V1508 V1509 V151 V1521 V1522 V1529 V153 V1541 V1542 V1549 Hx-thrombophlebitis Hx sudden cardiac arrest Hx TIA/stroke w/o resid Hx pulmonary embolism Hx-circulatory dis NEC Hx resp system dis NOS Prsnl hx recur pneumonia Hx resp system dis NEC Prsnl hst unspc dgstv ds Prsnl hst peptic ulcr ds Prsnl hst colonic polyps Prsnl hst ot spf dgst ds Prsnl hst urnr dsrd unsp Prsnl hst urnr dsrd calc Personal history UTI Personl hx nephrotic syn Prsn hst ot spf urn dsrd Hx-trophoblastic disease History-pre-term labor Hx of cervical dysplasia Hx vaginal dysplasia Hx vulvar dysplasia Hx-genital/obs dis NEC Hx-skin/subcutan tis dis Hx of arthritis Hx pathological fracture Hx stress fracture Hx musculoskletl dis NEC Hx-hypospadias Hx-cong malform-gu Hx-cong malform-nervous Hx-cong malform-eye,face Hx-cong malform-heart Hx-cong malform-resp sys Hx-cong malform-digest Hx-cong malform-skin,ms Hx-congenital malfor NEC Hx-perinatal problems Hx of anaphylaxis Hx diseases NEC Hx of disease NOS Hx-penicillin allergy Hx-antibiot allergy NEC Hx-sulfonamides allergy Hx-anti-infect allergy Hx-anesthetic allergy Hx-narcotic allergy Hx-analgesic allergy Hx-vaccine allergy Hx-drug allergy NEC Hx-drug allergy NOS Hx-peanut allergy Hx-milk prod allergy Hx-eggs allergy Hx-seafood allergy Hx-other food allergy Hx-allergy insct/arachnd Hx-latex allergy Hx-radiogrphc dye allrgy Hx-allergy NEC Hx-major cardiovasc surg Hx in utero proc in preg Hx in utero proc fetus Hx surgery to organs NEC Hx of irradiation Hx of physical abuse Hx of emotional abuse Psychological trauma NEC Edit code lists 1.45 Unacceptable principal diagnoses V1551 V1552 V1553 V1559 V156 V157 V1580 V1581 V1582 V1583 V1584 V1585 V1586 V1587 V1588 V1589 V159 V160 V161 V162 V163 V1640 V1641 V1642 V1643 V1649 V1651 V1652 V1659 V166 V167 V168 V169 V170 V171 V172 V173 V1741 V1749 V175 V176 V177 V1781 V1789 V180 V1811 V1819 V182 V183 V184 V1851 V1859 V1861 V1869 V187 V188 V189 V190 V1911 V1919 V192 V193 V194 V195 V196 V197 V198 V201 Hx traumatic fracture Hx traumatc brain injury Hx retained FB, rem Hx injury NEC Hx of poisoning Hx of contraception Hx failed mod sedation Hx of past noncompliance History of tobacco use Hx underimmunizn status Hx-contct/expos asbestos Hx-cont/exps haz bdy fld Hx-contact/exposure lead Hx of ECMO Personal history of fall Hx-health hazards NEC Hx-health hazard NOS Family hx-gi malignancy Fm hx-trach/bronchog mal Fam hx-intrathoracic mal Family hx-breast malig Fm hx genital malig NOS Fm hx ovary malignancy Fm hx prostate malig Fm hx testis malig Fm hx genital malig NEC Family hx-kidney malig Fam hx-bladder malig Fam hx-urinry malig NEC Family hx-leukemia Fam hx-lymph neoplas NEC Family hx-malignancy NEC Family hx-malignancy NOS Fam hx-psychiatric cond Family hx-stroke Fam hx-neurolog dis NEC Fam hx-ischem heart dis Fam hx sudden card death Fam hx-cardiovas dis NEC Family hx-asthma Fam hx-chr resp cond NEC Family hx-arthritis Family hx osteoporosis Fam hx musculosk dis NEC Fam hx-diabetes mellitus Fam hx MEN syndrome Fm hx endo/metab dis NEC Family hx-anemia Fam hx-blood disord NEC Fm hx-intellect disablty Family hx colonic polyps Fam hx digest disord NEC Fam hx-polycystic kidney Fam hx-kidney dis NEC Family hx-gu disease NEC Fm hx-infect/parasit dis Fam hx genet dis carrier Family hx-blindness Family history glaucoma Family hx-eye disord NEC Family hx-deafness Family hx-ear disord NEC Family hx-skin condition Fam hx-congen anomalies Family hx-allergic dis Consanguinity Family hx-condition NEC Care of healthy chld NEC 1.46 Definitions of Medicare Code Edits V202 V2031 V2032 V210 V211 V212 V2130 V2131 V2132 V2133 V2134 V2135 V218 V219 V220 V221 V222 V230 V231 V232 V233 V2341 V2342 V2349 V235 V237 V2381 V2382 V2383 V2384 V2385 V2386 V2387 V2389 V239 V241 V242 V2501 V2502 V2503 V2504 V2509 V2511 V2512 V2513 V2540 V2541 V2542 V2543 V2549 V255 V258 V259 V261 V2621 V2622 V2629 V2631 V2632 V2633 V2634 V2635 V2639 V2641 V2642 V2649 V2651 V2652 Routin child health exam Health supvsn nb <8 days Health supv nb 8-28 days Rapid childhood growth Puberty Adolescence growth NEC Low birthwt status NOS Low birthwt status <500g Low birthwt 500-999g Low birthwt 1000-1499g Low birthwt 1500-1999g Low birthwt 2000-2500g Constit state in dev NEC Constit state in dev NOS Supervis normal 1st preg Supervis oth normal preg Preg state, incidental Preg w hx of infertility Preg w hx-trophoblas dis Preg w hx of abortion Grand multiparity Preg w hx pre-term labor Preg w hx ectopic preg Preg w poor obs hx NEC Preg w poor reproduct hx Insufficnt prenatal care Suprv elderly primigrav Suprv elderly multigrav Suprv young primigravida Suprv young multigravida Pregnt-assist repro tech Preg-hx in utro prev prg Preg w incon fetl viabil Suprv high-risk preg NEC Suprv high-risk preg NOS Postpart care-lactation Rout postpart follow-up Prescrip-oral contracept Initiate contracept NEC Contracept mgmt-emergncy Natrl fam pln-avoid preg Contraceptive mangmt NEC Insertion of iud Removal of iud Remove/insert iud Contracept surveill NOS Contracept pill surveill Iud surveillance Srvl mplnt sbdrm cntrcep Contracept surveill NEC Nsrt mplnt sbdrm cntrcep Contraceptive mangmt NEC Contraceptive mangmt NOS Artificial insemination Fertility testing Sterilzation rev aftcare Investigate & test NEC Fem genetic test dis car Female genetic test NEC Genetic counseling Male genetc test dis car Test male/fem preg loss Male genetic test NEC Natrl family plan counsl Fertlity preserv counsel Procr mgmt cnsl/adv NEC Tubal ligation status Vasectomy status October 2012 Unacceptable principal diagnoses V2681 V2682 V2689 V269 V270 V271 V272 V273 V274 V275 V276 V277 V279 V280 V281 V282 V283 V284 V285 V286 V2881 V2882 V2889 V289 V293 V299 V302 V312 V322 V332 V342 V352 V362 V372 V391 V392 V400 V401 V402 V4039 V409 V410 V411 V412 V413 V414 V415 V416 V417 V418 V419 V420 V421 V422 V423 V424 V425 V426 V427 V4281 V4282 V4283 V4284 V4289 V429 V430 V431 V4321 Assist repro fertility Fertility preserv proc Procreative managemt NEC Procreative mangmt NOS Deliver-single liveborn Deliver-single stillborn Deliver-twins, both live Del-twins, 1 nb, 1 sb Deliver-twins, both sb Del-mult birth, all live Del-mult brth, some live Del-mult birth, all sb Outcome of delivery NOS Screening-chromosom anom Screen-alphafetoprotein Screen by amniocent NEC Scr fetl malfrm-ultrasnd Screen-fetal retardation Screen-isoimmunization Antenatal screen strep b Scrn fetal anatmc survey Scrn risk preterm labor Antenatal screening NEC Antenatal screening NOS NB obs genetc/metabl cnd NB obsrv unsp suspct cnd Single liveborn-nonhosp Twin, mate lb-nonhosp Twin, mate sb-nonhosp Twin NOS-nonhosp Oth multiple nb-nonhosp Oth multiple sb-nonhosp Multiple nb/sb-nonhosp Mult birth NOS-nonhosp Liveborn NOS-before adm Liveborn NOS-nonhosp Problems with learning Prob with communication Mental problems NEC Oth spc behavior problem Mental/behavior prob NOS Problems with sight Eye problems NEC Problems with hearing Ear problems NEC Voice production problem Smell and taste problem Problem w swallowing Sexual function problem Probl w special func NEC Probl w special func NOS Kidney transplant status Heart transplant status Heart valve transplant Skin transplant status Bone transplant status Cornea transplant status Lung transplant status Liver transplant status Trnspl status-bne marrow Trspl sts-perip stm cell Trnspl status-pancreas Trnspl status-intestines Trnspl status organ NEC Transplant status NOS Eye replacement NEC Lens replacement NEC Heart assist dev replace October 2012 V4322 V433 V434 V435 V4360 V4361 V4362 V4363 V4364 V4365 V4366 V4369 V437 V4381 V4382 V4383 V4389 V440 V441 V442 V443 V444 V4450 V4451 V4452 V4459 V446 V447 V448 V449 V4500 V4501 V4502 V4509 V4511 V4512 V452 V453 V454 V4551 V4552 V4559 V4561 V4569 V4572 V4573 V4574 V4575 V4576 V4577 V4578 V4579 V4581 V4582 V4583 V4584 V4585 V4586 V4587 V4588 V4589 V460 V462 V463 V468 V469 V470 V471 Artficial heart replace Heart valve replac NEC Blood vessel replac NEC Bladder replacement NEC Joint replaced unspcf Joint replaced shoulder Joint replaced elbow Joint replaced wrist Joint replaced hip Joint replaced knee Joint replaced ankle Oth spcf joint replaced Limb replacement NEC Larynx replacement Breast replacement Artific skin repl status Organ/tiss replacmnt NEC Tracheostomy status Gastrostomy status Ileostomy status Colostomy status Enterostomy status NEC Cystostomy status NOS Cutaneous-vesicos status Appendico-vesicos status Cystostomy status NEC Urinostomy status NEC Artificial vagina status Artif open status NEC Artif open status NOS Status cardc dvce unspcf Status cardiac pacemaker Status autm crd dfbrltr Status oth spcf crdc dvc Renal dialysis status Noncmplnt w renal dialys Ventricular shunt status Intestinal bypass status Arthrodesis status Prsc ntrutr cntrcptv dvc Prsc sbdrml cntrcp mplnt Prsc other cntrcptv dvc Cataract extract status Post-proc st eye/adn NEC Acquire absnce intestine Acquired absence kidney Acq absence urinary trct Acq absence of stomach Acq absence of lung Acq absnce genital organ Acquired absence of eye Acq absence of organ NEC Aortocoronary bypass Status-post ptca Breast impl remov status Dental restoratn status Insulin pump status Bariatric surgery status Trnsplnt orgn rem status TPA adm status 24 hr pta Post-proc states NEC Dependence on aspirator Depend-supplement oxygen Wheelchair dependence Machine dependence NEC Machine dependence NOS Intern organ deficiency Mech prob w internal org Edit code lists 1.47 Unacceptable principal diagnoses V472 V473 V474 V475 V479 V480 V481 V482 V483 V484 V485 V486 V487 V488 V489 V490 V491 V492 V493 V494 V495 V4960 V4961 V4962 V4963 V4964 V4965 V4966 V4967 V4970 V4971 V4972 V4973 V4974 V4975 V4976 V4977 V4981 V4982 V4983 V4984 V4985 V4986 V4987 V4989 V499 V503 V508 V509 V529 V531 V532 V534 V5350 V5351 V5359 V536 V537 V538 V5390 V5391 V5399 V549 V559 V562 V5631 V5632 V570 Cardiorespirat probl NEC Digestive problems NEC Urinary problems NEC Genital problems NEC Probl w internal org NOS Deficiencies of head Deficiencies neck/trunk Mechanical prob w head Mech prob w neck & trunk Sensory problem w head Sensor prob w neck/trunk Disfigurements of head Disfigurement neck/trunk Prob-head/neck/trunk NEC Prob-head/neck/trunk NOS Deficiencies of limbs Mechanical prob w limbs Motor problems w limbs Sensory problems w limbs Disfigurements of limbs Limb problems NEC Status amput up lmb NOS Status amput thumb Status amput oth fingers Status amput hand Status amput wrist Status amput below elbow Status amput above elbow Status amput shoulder Status amput lwr lmb NOS Status amput great toe Status amput othr toe(s) Status amput foot Status amput ankle Status amput below knee Status amput above knee Status amput hip Asympt postmeno status Dental sealant status Await organ transplnt st Bed confinement status Dual sensory impairment Do not resusctate status Physical restrain status Conditn influ health NEC Probl influ health NOS Ear piercing Elective surgery NEC Elective surgery NOS Fitting prosthesis NOS Fit contact lens/glasses Adjustment hearing aid Fit orthodontic device Fit/adjust intestinl dev Fit/adj gastric lap band Fit/adjust gi app-device Fitting urinary devices Fit orthopedic devices Adjustment of wheelchair Fit/adjust device NOS Fit/adjust insulin pump Fit/adjust device NEC Orthopedic aftercare NOS Attn to artif open NOS Fit/adj perit dial cath Hemodialysis testing Peritoneal dialysis test Breathing exercises 1.48 Definitions of Medicare Code Edits *V571 *V5721 *V5722 *V573 V574 V5781 *V5789 *V579 V582 V5830 V5831 V5832 V5862 V5863 V5864 V5865 V5868 V589 V5901 V5902 V5909 V5970 V5971 V5972 V5973 V5974 V600 V601 V602 V603 V604 V605 V606 V6081 V6089 V609 V6101 V6102 V6103 V6104 V6105 V6106 V6107 V6108 V6109 V6110 V6111 V6112 V6120 V6122 V6123 V6124 V6125 V6129 V613 V6141 V6142 V6149 V615 V616 V617 V618 V619 V620 V621 V6221 V6222 V6229 Physical therapy NEC Encntr occupatnal thrpy Encntr vocational thrpy Speech-language therapy Orthoptic training Orthotic training Rehabilitation proc NEC Rehabilitation proc NOS Blood transfusion, no dx Attn rem nonsurg dressng Attn rem surg dressing Attn removal of sutures Long-term use antibiotic Lng use antiplte/thrmbtc Long-term anti-inflamtry Long-term use steroids Lng term bisphosphonates Aftercare NOS Blood donor-whole blood Blood donor-stem cells Blood donor NEC Egg donor NEC Egg donor age <35 anon Egg donor age <35 desig Egg donor age 35+ anon Egg donor age 35+ desig Lack of housing Inadequate housing Economic problem Person living alone No family able to care Holiday relief care Person in resident inst Foster care (status) Housing/econo circum NEC Housing/econo circum NOS Fmily dsrpt-fam military Fmily dsrpt-ret military Fmily dsrpt- divorce/sep Family dsrpt-estrangmemt Famly dsrpt-chld custody Family dsrpt-foster care Family dsrpt-death membr Fmly dsrp-fam absnce NEC Family disruption NEC Consl partner prob Cnsl victm partner abuse Cnsl perp partner abuse Cnsl prnt-chld prob NOS Cnsl perp parent chld ab Cnsl prnt-biol chld prob Cnsl prnt-adpt chld prob Cnsl prnt-fstr chld prob Oth parent-child problem Problem w aged parent Alcoholism in family Substance abuse-family Family health probl NEC Multiparity Illegitimate pregnancy Unwanted pregnancy NEC Family circumstances NEC Family circumstance NOS Unemployment Adverse eff-work environ Hx military deployment Hx retrn military deploy Occupationl circumst NEC October 2012 Unacceptable principal diagnoses V623 V624 V625 V626 V6281 V6282 V6283 V6285 V6289 V629 V630 V631 V632 V638 V639 V6400 V6401 V6402 V6403 V6404 V6405 V6406 V6407 V6408 V6409 V641 V642 V643 V6441 V6442 V6443 V6511 V6519 V653 V6540 V6541 V6542 V6543 V6544 V6545 V6546 V6549 V655 V658 V659 V665 V667 V669 V679 V6801 V6809 V681 V682 V6881 V6889 V689 V690 V691 V692 V693 V695 V698 V699 V700 V702 V703 V706 V708 Educational circumstance Social maladjustment Legal circumstances Refusal of treatment Interpersonal probl NEC Bereavement, uncomplicat Cnsl perp phys/sex abuse Homicidal ideation Psychological stress NEC Psychosocial circum NOS Home remote from hospitl No medical serv in home Wait adm to oth facility No med facilities NEC No med facilities NOS No vaccination NOS No vaccin-acute illness No vaccin-chronc illness No vaccin-immune comp No vaccin-allergy to vac No vaccin-caregiv refuse No vaccination-pt refuse No vaccination-religion No vaccin-prev disease No vaccination NEC No proc/contraindication No proc/patient decision No proc for reasons NEC Lap surg convert to open Thoracoscop conv to open Arthroscopc conv to open Ped pre-brth vst-parent Person consult for anoth Dietary surveil/counsel Counseling NOS Exercise counseling Counslng sbstn use abuse Counseling injry prevent Hiv counseling Consln ot sex trnsmt dis Insulin pump training Other specfd counseling Persn w feared complaint Reason for consult NEC Reason for consult NOS Convalescence NEC Encountr palliative care Convalescence NOS Follow-up exam NOS Disability examination Issue of med certif NEC Issue repeat prescript Request expert evidence Referral-no exam/treat Administrtve encount NEC Administrtve encount NOS Lack of physical exercse Inapprt diet eat habits High-risk sexual behavr Gambling and betting Behav insomnia-childhood Oth prblms rltd lfstyle Prblm rltd lfstyle NOS Routine medical exam Gen psychiatric exam NEC Med exam NEC-admin purp Health exam-pop survey General medical exam NEC October 2012 V709 V719 V7211 V7212 V7219 V722 V725 V7260 V7261 V7262 V7263 V7269 V727 V7284 V7285 V7286 V729 V730 V731 V732 V733 V734 V735 V736 V7381 V7388 V7389 V7398 V7399 V740 V741 V742 V743 V744 V745 V746 V748 V749 V750 V751 V752 V753 V754 V755 V756 V757 V758 V759 V760 V7610 V7611 V7612 V7619 V762 V763 V7641 V7642 V7643 V7645 V7646 V7647 V7649 V7650 V7651 V7652 V7681 V7689 V769 General medical exam NOS Observ-suspect cond NOS Hearing exam-fail screen Hearing conservatn/trtmt Exam ears & hearing NEC Dental examination Radiological exam NEC Laboratory exam NOS Antibody response exam Routine physicl lab exam Pre-procedure lab exam Laboratory exam NEC Skin/sensitization tests Preop exam unspcf Oth specified exam Blood typing encounter Examination NOS Screening-poliomyelitis Screening for smallpox Screening for measles Screening for rubella Screening-yellow fever Screening-arbovirus dis Screening for trachoma Special screen exam HPV Scrn oth spcf chlmyd dis Scrn oth spcf viral dis Scrn unspcf chlmyd dis Scrn unspcf viral dis Screening for cholera Screening-pulmonary TB Screening for leprosy Screening for diphtheria Screen-bact conjunctivit Screen for veneral dis Screening for yaws Screen-bacterial dis NEC Screen-bacterial dis NOS Screen-rickettsial dis Screening for malaria Screen for leishmaniasis Screen-trypanosomiasis Screen-mycotic infect Screen-schistosomiasis Screen for filariasis Screen for helminthiasis Screen-parasitic dis NEC Screen for infec dis NOS Screen mal neop-resp org Scrn mal neo breast NOS Screen mammogram hi risk Screen mammogram NEC Scrn mal neo breast NEC Screen mal neop-cervix Screen mal neop-bladder Screen mal neop-rectum Screen mal neop-oral cav Screen mal neop-skin Screen malig neop-testis Screen malig neop-ovary Screen malig neop-vagina Screen mal neop oth site Scrn malig neo-intes NOS Screen malig neop-colon Scrn mal neo-small intes Screen neop-nervous syst Screen neoplasm NEC Screen-neoplasm NOS Edit code lists 1.49 Unacceptable principal diagnoses V770 V771 V772 V773 V774 V775 V776 V777 V778 V7791 V7799 V780 V781 V782 V783 V788 V789 V790 V791 V792 V793 V798 V799 V8001 V8009 V801 V802 V803 V810 V811 V812 V813 V814 V815 V816 V820 V821 V822 V823 V824 V825 V826 V8271 V8279 V8281 V8289 V829 V8301 V8302 V8381 V8389 V8401 V8402 V8403 V8404 V8409 V8481 V8489 V850 V851 V8521 V8522 V8523 V8524 V8525 V8530 V8531 V8532 Screen-thyroid disorder Screen-diabetes mellitus Screen for malnutrition Screen-phenylketonuria Screen for galactosemia Screening for gout Screen-cystic fibrosis Screen-inborn err metab Screening for obesity Screen lipoid disorders Screen-endoc/nut/met NEC Screen-iron defic anemia Screen-defic anemia NEC Screen-sickle cell dis Scrn-hemoglobinopath NEC Screen-blood dis NEC Screen-blood dis NOS Screening for depression Screening for alcoholism Scrn intellect disabilty Screen-development prob Screen-mental dis NEC Screen-mental dis NOS Screen-traumtc brain inj Screen-neuro condition Screening for glaucoma Screening-eye cond NEC Screening for ear dis Scrn-ischemic heart dis Screen for hypertension Screen-cardiovasc NEC Screen-bronch/emphysema Screen-respir cond NEC Screen for nephropathy Screen for gu cond NEC Screen for skin cond Screen-rheumatoid arthr Screen-rheumat dis NEC Screen-cong hip dislocat Mat pstntl scr-chrm anom Screen-contamination NEC Multiphasic screening Screen-gentc dis carrier Genetic screening NEC Screen - osteoporosis Screen for condition NEC Screen for condition NOS Asympt hemoph a carrier Sympt hemophil a carrier Cystic fibrosis gene car Genetic carrier stat NEC Genetc sus mal neo brest Genetc sus mal neo ovary Genetc sus mal neo prost Genetc susc mal neo endo Genetic susc mal neo NEC Genetc sus mult endo neo Genetic suscept dis NEC BMI less than 19,adult BMI between 19-24,adult BMI 25.0-25.9,adult BMI 26.0-26.9,adult BMI 27.0-27.9,adult BMI 28.0-28.9,adult BMI 29.0-29.9,adult BMI 30.0-30.9,adult BMI 31.0-31.9,adult BMI 32.0-32.9,adult 1.50 Definitions of Medicare Code Edits V8533 V8534 V8535 V8536 V8537 V8538 V8539 V8541 V8542 V8543 V8544 V8545 V8551 V8552 V8553 V8554 V860 V861 V8701 V8702 V8709 V8711 V8712 V8719 V872 V8731 V8732 V8739 V8741 V8742 V8743 V8744 V8745 V8746 V8749 V8801 V8802 V8803 V8811 V8812 V8821 V8822 V8829 V8901 V8902 V8903 V8904 V8905 V8909 V9001 V9009 V9010 V9011 V9012 V902 V9031 V9032 V9033 V9039 V9081 V9083 V9089 V909 V9100 V9101 V9102 V9103 V9109 BMI 33.0-33.9,adult BMI 34.0-34.9,adult BMI 35.0-35.9,adult BMI 36.0-36.9,adult BMI 37.0-37.9,adult BMI 38.0-38.9,adult BMI 39.0-39.9,adult BMI 40.0-44.9, adult BMI 45.0-49.9, adult BMI 50.0-59.9, adult BMI 60.0-69.9, adult BMI 70 and over, adult BMI,pediatric <5% BMI,pediatric 5% - <85% BMI,pediatric 85% - <95% BMI,pediatric >= 95% Estrogen recep pstv stat Estrogen recep neg stat Contact/exposure arsenic Cont/susp expose uranium Cntct/exp hazrd metl NEC Cntct/exp aromatc amines Contact/exposure benzene Cont/exp haz aromat NEC Cont/exp hazard chem NEC Contact/exposure mold Contact/exp algae bloom Cont/exp hazard sub NEC Hx antineoplastic chemo Hx monoclonal drug thrpy Hx estrogen therapy Hx inhaled steroid thrpy Hx systemc steroid thrpy Hx immunosuppres thrpy Hx drug therapy NEC Acq absnce cervix/uterus Acq ab ut remn cerv stmp Acq absnc cerv/remain ut Acq total absnc pancreas Acq part absnce pancreas Acq absence of hip joint Acq absence knee joint Acq absence of oth joint Sus amntc cav/mem nt fnd Sus placentl prob nt fnd Sus fetal anomaly nt fnd Sus fetal growth not fnd Sus cervcl shortn nt fnd Oth sus mat/ftl nt fnd Retain deplete uran frag Retain radioac frag NEC Retained metal frag NOS Retain magnet metal frag Retain nonmag meta frag Retain plastic fragments Retained quills/spines Retained tooth Retained wood fragments Retain organic frag NEC Retained glass fragments Retain stone/crystl frag Retain FB NEC Retain FB, mat NOS Twin gest-plac/sac NOS Twin gest-monochr/monoam Twin gest-monochr/diamni Twin gest-dich/diamniotc Twin gest-plac/sac undet October 2012 Unacceptable principal diagnoses V9110 V9111 V9112 V9119 V9120 V9121 V9122 V9129 V9190 Tripl gest-plac/sac NOS Triplet gest 2+ monochor Triplet gest 2+ monoamn Tripl gest-plac/sac und Quad gest-plac/sac NOS Quad gest 2+ monochorion Quad gest 2+ monoamniotc Quad gest-plac/sac undet Mult gest-plac/sac NOS October 2012 V9191 V9192 V9199 Mult gest 2+ monochr NEC Mult gest 2+ monoamn NEC Mult gest-plac/sac undet Edit code lists 1.51 10. Non-specific O.R. procedure 10. Non-specific O.R. procedure 11. Non-covered procedure Effective 10/01/07, the non-specific O.R. procedure edit was discontinued and will appear for claims processed using MCE version 2.0-23.0 only. There are some procedures for which Medicare does not provide reimbursement. There are also procedures that would normally not be reimbursed by Medicare but due to the presence of certain diagnoses are reimbursed. The following page contains lists of non-covered procedure codes with corresponding English descriptions, and explains the circumstances in which the edit is applied. 1.52 Definitions of Medicare Code Edits October 2012 Non-covered procedures 1. The following criteria are retroactive effective November 6, 2006. The procedure shown below is identified as a non-covered procedure except when combined with non-operating room procedure code 0065 (Perc ins intracran stent). Procedure 0062 Perc angio intracran ves 2. The following criteria are retroactive effective April 26, 2006. ICD-9-CM procedure codes 5280 (Pancreat transplant NOS) and 5282 (Pancreatic homotransplan) alone [without 5569 (Kidney transplant NEC)] are considered “Non-covered procedures” except for the following condition: When either 5280 or 5282 is combined with at least one principal or secondary diagnosis code from the following diagnoses list: Diagnoses list 25001 25003 25011 25013 25021 25023 25031 25033 25041 25043 25051 25053 25061 25063 25071 25073 25081 25083 25091 25093 2513 DMI wo cmp nt st uncntrl DMI wo cmp uncntrld DMI keto nt st uncntrld DMI ketoacd uncontrold DMI hprsm nt st uncntrld DMI hprosmlr uncontrold DMI o cm nt st uncntrld DMI oth coma uncontrold DMI renl nt st uncntrld DMI renal uncntrld DMI ophth nt st uncntrld DMI ophth uncntrld DMI neuro nt st uncntrld DMI neuro uncntrld DMI circ nt st uncntrld DMI circ uncntrld DMI oth nt st uncntrld DMI oth uncntrld DMI unspf nt st uncntrld DMI unspf uncntrld Postsurg hypoinsulinemia (This code is only effective for this edit from 10/01/10 forward. It is not retroactive.) 3. The following criteria are retroactive effective May 1, 2008. The procedure shown below is identified as a non-covered procedure except when combined with diagnosis code V707 (Exam-clincal trial). Procedure 3752 Imp tot int bi ht rp sys October 2012 Edit code lists 1.53 The procedures shown below are always identified as non-covered procedures. 1171 1172 1175 1176 3735 3753 3754 3928 4493 5051 5283 5796 5797 6370 Keratomileusis Keratophakia Radial keratotomy Epikeratophakia Partial ventriculectomy Repl/rep thr unt tot hrt Repl/rep oth tot hrt sys Extracran-intracr bypass Insert gastric bubble Auxiliary liver transpl Pancreatic heterotranspl Implant bladder stimulat Replace bladder stimulat Male sterilization NOS 6371 6372 6373 645 6621 6622 6629 6631 6632 6639 9852 9859 Ligation of vas deferens Spermatic cord ligation Vasectomy Sex transformat op NEC Bilat endosc crush tube Bilat endosc divis tube Bilat endos occ tube NEC Bilat tubal crushing NEC Bilat tubal division NEC Bilat tubal destruct NEC Eswl gb/bile duct Eswl other sites The procedures shown below are identified as non-covered procedures only when any of the diagnoses in the right hand list are present as either a principal or secondary diagnosis. Procedures Diagnoses 4101 4104 4107 4109 20400 20500 20510 20511 20600 20700 20800 Auto bone mt w/o purg Auto hem stem ct w/o pur Auto hem stem ct w purg Auto bone mt w purging Ac lym leuk wo achv rmsn Ac myl leuk wo achv rmsn Ch myl leuk wo achv rmsn Chr myl leuk w rmsion Ac mono leu wo achv rmsn Ac erth/erlk wo ach rmsn Ac leu un cl wo ach rmsn The procedures shown below are identified as non-covered procedures only when any of the diagnoses in the right hand list are present as either a principal or secondary diagnosis. Procedures Diagnoses 4102 4103 4105 4108 20300 20301 Alo bone marrow trnsplnt Allogrft bone marrow NOS Allo hem stem ct w/o pur Allo hem stem ct w purg Mult mye w/o achv rmson Mult myelm w remission The procedure shown below is identified as a “Non-covered procedure” when the beneficiary is over age 60. Procedure 8465 Ins totl disc pros lumb 1.54 Definitions of Medicare Code Edits October 2012 12. Open biopsy check Effective 10/01/10, the open biopsy check edit was discontinued and will appear for claims processed using MCE version 2.0-26.0 only. 13. Bilateral procedure Certain codes do not accurately reflect procedures performed in one admission on two or more different bilateral joints of the lower extremities. A combination of these codes shows a bilateral procedure when they could be procedures performed on a single joint (i.e., duplicate procedures). For example, if 8151 (Total hip replacement) and 8152 (Partial hip replacement) are both coded on the claim, the edit “bilateral procedure” will appear. This edit instructs the fiscal intermediary to ensure that these procedures were performed on two separate joints. However, if 8151 (Total hip replacement) is coded twice, the edit would not appear because this signifies a true bilateral procedure. The following list contains the joint replacement procedure codes with corresponding English descriptions identified as “bilateral procedure” whenever two or more different joint procedures are coded, and the principal diagnosis causes assignment to MDC 8. Bilateral procedure codes 0070 0080 0085 0086 0087 8151 8152 8154 8156 October 2012 Rev hip repl-acetab/fem Rev knee replacemt-total Resrf hip,total-acet/fem Resrf hip,part-fem head Resrf hip,part-acetablum Total hip replacement Partial hip replacement Total knee replacement Total ankle replacement Edit code lists 1.55 14. Invalid age A patient’s age may be necessary for appropriate DRG determination. If the age reported is not between 0 years and 124 years, the Medicare Code Editor will assume the age is in error. 15. Invalid sex A patient’s sex (gender) may be necessary for appropriate DRG determination. The sex code reported must be either 1 (male) or 2 (female). 16. Invalid discharge status A patient’s discharge status may be necessary for appropriate DRG determination. Discharge status must be coded according to the UB-04 conventions. Valid values are: 01 = Home or self-care 02 = Disch/trans to another short term hospital 03 = Disch/trans to SNF 04 = Disch/trans to ICF (valid until 9/30/09) 04 = Cust/supp care (added 10/01/09) 05 = Disch/trans to another type of facility (valid until 03/31/08) 05 = Disch/trans to a designated cancer center or children’s hospital (added 04/01/08) 06 = Care of home health service 07 = Left against medical advice 08 = Home IV service (deleted 10/01/05) 20 = Died 21 = Court/law enfrc (added 10/1/09) 30 = Still a patient 43 = Fed hospital (added 10/01/03) 50 = Hospice-home 51 = Hospice-medical facility 61 = Swing Bed (added 10/01/2001) 62 = Rehab facility/rehab unit (added 10/01/2001) 63 = Long term care hospital (added 10/01/2001) 64 = Nursing facility–Medicaid certified (added 10/01/02) 65 = Psych hosp/unit (added 10/01/03) 66 = Critical access hospital (added 10/01/05) 70 = Discharge/transfer to another type of health care institution not defined elsewhere in the code list (added 04/01/08) 71 = Outpatient services-other facility (10/01/01–09/30/03 only) 72 = Outpatient services-this facility (10/01/01–09/30/03 only) 1.56 Definitions of Medicare Code Edits October 2012 17. Limited coverage For certain procedures whose medical complexity and serious nature incur extraordinary associated costs, Medicare limits coverage to a portion of the cost. The limited coverage edit indicates the type of limited coverage. (e.g., Heart transplant-Limited coverage, Lung transplant-Limited coverage, etc.) The following is a list of limited coverage procedure codes with corresponding English descriptions. Limited coverage 3222 3350 3351 3352 336 3751 3766 4697 5059 5280 5282 5569 Lung vol reduction surg Lung transplant NOS Unilat lung transplant Bilat lung transplant Comb heart/lung transpla Heart transplantation Implantable hrt assist Transplant of intestine Liver transplant NEC Pancreat transplant NOS Pancreatic homotransplan Kidney transplant NEC The following criteria are retroactive effective May 1, 2008. The procedure shown below is identified as a limited coverage procedure when combined with diagnosis code V707 (Exam-clincal trial). Procedure 3752 October 2012 Imp tot int bi ht rp sys Edit code lists 1.57 18.18. Wrong procedure performed Wrong procedure performed Certain E-codes indicate that the wrong procedure was performed. The following list contains the codes, with corresponding English descriptions, that indicate the wrong procedure was performed. Wrong procedure performed E8765 E8766 E8767 Perfrm wrong op/right pt Proc-pt not sched surg Rt proc-wrong side/part 19. Procedure inconsistent with length of stay 19. Procedure inconsistent with length of stay The following procedure code should only be coded on claims with a length of stay of four days or greater. Procedure inconsistent with length of stay 9672 Continuous invasive mechanical ventilation for 96 consecutive hours or more 1.58 Definitions of Medicare Code Edits October 2012 Preliminary 07/20/12 Chapter 2 Code list changes 2 07/20/12 Contents Code list changes 2.3 Changes to existing edits 2.2 Definitions of Medicare Code Edits Preliminary 2.3 Octoberl 2012 Preliminary 07/20/12 Chapter 2 Code list changes T HIS CHAPTER SUMMARIZES the changes in the edit code lists from the last release of the Medicare Code Editor (MCE) software to the current one. The code lists are part of chapter 1 in this manual. Changes to existing edits Octoberl 2012 Code 4382 (Lap vertical gastrectomy) was removed from the non- covered procedure edit effective 10/01/12. Code list changes 2.3 07/20/12 2.4 Definitions of Medicare Code Edits Preliminary Octoberl 2012 Preliminary 07/20/12 Index maternity diagnoses, 1.9 newborn diagnoses, 1.5 non-covered procedure, 1.53 pediatric diagnoses, 1.8 procedures allowed for females only, 1.33 procedures allowed for males only, 1.38 questionable admission, 1.42 unacceptable principal diagnosis, 1.44 valid discharge status, 1.56 A Adult age categories, 1.4 diagnosis codes, 1.18 Age categories, 1.4 adult, 1.4 maternity, 1.4 newborn, 1.4 pediatric, 1.4 Age conflict, 1.4 adult diagnosis codes, 1.18 maternity diagnosis codes, 1.9 newborn diagnosis codes, 1.5 pediatric diagnosis codes, 1.8 B Bilateral procedure, 1.55 C Code lists, 1.1 Codes adult diagnoses, 1.18 age conflict, 1.5, 1.8, 1.9, 1.18 diagnoses allowed for females only, 1.21 diagnoses allowed for males only, 1.36 limited coverage, 1.57 manifestations not allowed as principal dx, 1.39 Octoberl 2012 D Diagnoses allowed for females only codes, 1.21 Diagnoses allowed for males only codes, 1.36 Duplicate of PDX, 1.4 example, 1.4 E E-code as principal diagnosis, 1.4 E-codes, 1.4 Edit list, 1.3 Edits age conflict, 1.4 bilateral procedure, 1.55 duplicate of PDX, 1.4 E-code as principal diagnosis, 1.4 invalid age, 1.56 invalid discharge status, 1.56 invalid sex, 1.56 Index I.1 07/20/12 Preliminary limited coverage, 1.57 manifestation code as principal diagnosis, 1.39 non-covered procedure, 1.52 open biopsy check, 1.55 proc inconsistent w/ length of stay, 1.58 questionable admission, 1.42 requires secondary diagnosis, 1.43 sex conflict, 1.20 unacceptable principal diagnosis, 1.43 wrong procedure performed, 1.58 Example duplicate of PDX, 1.4 age categories, 1.4 diagnosis codes, 1.8 Proc inconsistent w/ length of stay, 1.58 Procedures allowed for females only codes, 1.33 Procedures allowed for males only codes, 1.38 Procedures, wrong procedure performed, 1.58 I R Invalid age, 1.56 Invalid discharge status, 1.56 Invalid sex, 1.56 Requires secondary diagnosis, 1.43 L Sex conflict, 1.20 diagnoses allowed for females only codes, 1.21 diagnoses allowed for males only codes, 1.36 procedures allowed for females only codes, 1.33 procedures allowed for males only codes, 1.38 Length of stay, 1.58 Limited coverage, 1.57 codes, 1.57 List of edits, 1.3 M Manifestation code as principal diagnosis, 1.39 Manifestations not allowed as principal dx codes, 1.39 Maternity age categories, 1.4 diagnosis codes, 1.9 N Newborn age categories, 1.4 diagnosis codes, 1.5 Non-covered procedure, 1.52 codes, 1.53 Q Questionable admission, 1.42 codes, 1.42 S U UB-04 discharge status code list, 1.56 Unacceptable principal diagnosis, 1.43 codes, 1.44 V Valid discharge status codes, 1.56 W Wrong procedure performed, 1.58 O Open biopsy check, 1.55 P Pediatric I.2 Definitions of Medicare Code Edits Octoberl 2012