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HL7 - Version 2.4

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  2.4 2.4 DE 2.4 UK 2.4 CH  

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Table 0458: OCE edit code

Interpretation: nicht verwendet
OID Table: 2.16.840.1.113883.12.458
Codesystem OID: 2.16.840.1.113883.6.301.9 Version 1
Value Set OID: -
Binding:
Expansion: all codes from codesystem
Vocabulary Domain: tbd
Table Type: User
Case insensitive: Falsch
Section 6

Value Description German Interpretation Comment Chapter
1 Invalid diagnosis code

6
2 Diagnosis and age conflict

6
3 Diagnosis and sex conflict

6
4 Medicare secondary payer alert

6
5 E-code as reason for visit

6
6 Invalid procedure code

6
7 Procedure and age conflict

6
8 Procedure and sex conflict

6
9 Nov-covered service

6
10 Non-covered service submitted for verification of denial (condition code 21 from header information on claim)

6
11 Non-covered service submitted for FI review (condition code 20 from header information on claim)

6
12 Questionable covered service

6
13 Additional payment for service not provided by Medicare

6
14 Code indicates a site of service not included in OPPS

6
15 Service unit out of range for procedure

6
16 Multiple bilateral procedures without modifier 50 (see Appendix A)

6
17 Multiple bilateral procedures with modifier 50 (see Appendix A)

6
18 Inpatient procedure

6
19 Mutually exclusive procedure that is not allowed even if appropriate modifier present

6
20 Component of a comprehensive procedure that is not allowed even if appropriate modifier present

6
21 Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B)

6
22 Invalid modifier

6
23 Invalid date

6
24 Date out of OCE range

6
25 Invalid age

6
26 Invalid sex

6
27 Only incidental services reported

6
28 Code not recognized by Medicare; alternate code for same service available

6
29 Partial hospitalization service for non-mental health diagnosis

6
30 Insufficient services on day of partial hospitalization

6
31 Partial hospitalization on same day as ECT or type "T" procedure

6
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

6
33 Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services

6
34 Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria

6
35 Only activity therapy and/or occupational therapy services provided

6
36 Extensive mental health services provided on day of ECT or significant procedure

6
37 Terminated bilateral procedure or terminated procedure with units greater than one

6
38 Inconsistency between implanted device and implantation procedure

6
39 Mutually exclusive procedure that would be allowed if appropriate modifier were present

6
40 Component of a comprehensive procedure that would be allowed if appropriate modifier were present

6
41 Invalid revenue code

6
42 Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)

6
...


6

Comments made by the German HL7 User Group:

nicht verwendet

Used Within the following Data Elements

01602 OCE Edits per Visit Code / nicht verwendet (6.5.15.4)
01608 OCE Edit Code / nicht verwendet (6.5.16.6)

Links to Other/Further HL7 Information   generated: Aug 07, 2023 (FO)
Health Level Seven, Int. (HQ) HL7 Germany
HL7 Europe 		Frank Oemig's HL7 Site
(Infos about the database)
 HL7-Experts Network