HL7 - Version 2.8

2.1

2.2

2.3

2.3.1

2.4

2.5

2.6

2.7

2.8

2.9

2.9.1

2.8

2.8.1

2.8.2

Events

Segments

Msg. Types

Msg. Structs

Data Elements

Tables

Data Structs

Queries

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
Steward:	FM
Status:	Active
Section	2.C.2.373

Value	Description	Chapter
1	Invalid diagnosis code	2.C.2.373
2	Diagnosis and age conflict	2.C.2.373
3	Diagnosis and sex conflict	2.C.2.373
4	Medicare secondary payer alert	2.C.2.373
5	E-code as reason for visit	2.C.2.373
6	Invalid procedure code	2.C.2.373
7	Procedure and age conflict	2.C.2.373
8	Procedure and sex conflict	2.C.2.373
9	Nov-covered service	2.C.2.373
10	Non-covered service submitted for verification of denial (condition code 21 from header information on claim)	2.C.2.373
11	Non-covered service submitted for FI review (condition code 20 from header information on claim)	2.C.2.373
12	Questionable covered service	2.C.2.373
13	Additional payment for service not provided by Medicare	2.C.2.373
14	Code indicates a site of service not included in OPPS	2.C.2.373
15	Service unit out of range for procedure	2.C.2.373
16	Multiple bilateral procedures without modifier 50 (see Appendix A)	2.C.2.373
17	Multiple bilateral procedures with modifier 50 (see Appendix A)	2.C.2.373
18	Inpatient procedure	2.C.2.373
19	Mutually exclusive procedure that is not allowed even if appropriate modifier present	2.C.2.373
20	Component of a comprehensive procedure that is not allowed even if appropriate modifier present	2.C.2.373
21	Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B)	2.C.2.373
22	Invalid modifier	2.C.2.373
23	Invalid date	2.C.2.373
24	Date out of OCE range	2.C.2.373
25	Invalid age	2.C.2.373
26	Invalid sex	2.C.2.373
27	Only incidental services reported	2.C.2.373
28	Code not recognized by Medicare; alternate code for same service available	2.C.2.373
29	Partial hospitalization service for non-mental health diagnosis	2.C.2.373
30	Insufficient services on day of partial hospitalization	2.C.2.373
31	Partial hospitalization on same day as ECT or type "T" procedure	2.C.2.373
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	2.C.2.373
33	Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services	2.C.2.373
34	Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria	2.C.2.373
35	Only activity therapy and/or occupational therapy services provided	2.C.2.373
36	Extensive mental health services provided on day of ECT or significant procedure	2.C.2.373
37	Terminated bilateral procedure or terminated procedure with units greater than one	2.C.2.373
38	Inconsistency between implanted device and implantation procedure	2.C.2.373
39	Mutually exclusive procedure that would be allowed if appropriate modifier were present	2.C.2.373
40	Component of a comprehensive procedure that would be allowed if appropriate modifier were present	2.C.2.373
41	Invalid revenue code	2.C.2.373
42	Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)	2.C.2.373

Comments made by the German HL7 User Group:

nicht verwendet

Used Within the following Data Elements

01602 OCE Edits per Visit Code / (6.5.15.4)

01608 OCE Edit Code / (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