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