v2+ Vocabulary
0.3.0 - Working Draft to present the concept ideas (FO)

v2+ Vocabulary - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

CodeSystem: OCE Edit Code (2.4 - 1.0.0) (Experimental)

Official URL: http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 Version: 1.0.0
Active as of 2025-08-05 Computable Name: Cms-OCEEditCode-csV100
Other Identifiers: OID:2.16.840.1.113883.6.301.9

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Code system of concepts specifying the action to be taken during reimbursement calculations. Used in HL7 Version 2.x messaging in the GP2 segment.

This Code system is referenced in the content logical definition of the following value sets:

Properties

This code system defines the following properties for its concepts

NameCodeURITypeDescription
version introduced versionIntroduced http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionIntroduced string version when was this code introduced
version deprecated versionDeprecated http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionDeprecated string version when was this code deprecated
status status http://hl7.org/fhir/concept-properties#status code A code that indicates the status of the concept. Typical values are active, experimental, deprecated, and retired
comment, to suppress IG-publisher warning, to be replaced with standard later comment http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#comment string A string that provides additional detail pertinent to the use or understanding of the concept
usage usage http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#usage string usage notes for this code
modified modified http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#modified dateTime date of last modification

Concepts

This case-sensitive code system http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 defines the following codes:

CodeDisplayDefinitionversion introduced
1 Invalid diagnosis code Invalid diagnosis code 2.4
10 Non-covered service submitted for verification of denial (condition code 21 from header information on claim) Non-covered service submitted for verification of denial (condition code 21 from header information on claim) 2.4
11 Non-covered service submitted for FI review (condition code 20 from header information on claim) Non-covered service submitted for FI review (condition code 20 from header information on claim) 2.4
12 Questionable covered service Questionable covered service 2.4
13 Additional payment for service not provided by Medicare Additional payment for service not provided by Medicare 2.4
14 Code indicates a site of service not included in OPPS Code indicates a site of service not included in OPPS 2.4
15 Service unit out of range for procedure Service unit out of range for procedure 2.4
16 Multiple bilateral procedures without modifier 50 (see Appendix A) Multiple bilateral procedures without modifier 50 (see Appendix A) 2.4
17 Multiple bilateral procedures with modifier 50 (see Appendix A) Multiple bilateral procedures with modifier 50 (see Appendix A) 2.4
18 Inpatient procedure Inpatient procedure 2.4
19 Mutually exclusive procedure that is not allowed even if appropriate modifier present Mutually exclusive procedure that is not allowed even if appropriate modifier present 2.4
2 Diagnosis and age conflict Diagnosis and age conflict 2.4
20 Component of a comprehensive procedure that is not allowed even if appropriate modifier present Component of a comprehensive procedure that is not allowed even if appropriate modifier present 2.4
21 Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B) Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B) 2.4
22 Invalid modifier Invalid modifier 2.4
23 Invalid date Invalid date 2.4
24 Date out of OCE range Date out of OCE range 2.4
25 Invalid age Invalid age 2.4
26 Invalid sex Invalid sex 2.4
27 Only incidental services reported Only incidental services reported 2.4
28 Code not recognized by Medicare; alternate code for same service available Code not recognized by Medicare; alternate code for same service available 2.4
29 Partial hospitalization service for non-mental health diagnosis Partial hospitalization service for non-mental health diagnosis 2.4
3 Diagnosis and sex conflict Diagnosis and sex conflict 2.4
30 Insufficient services on day of partial hospitalization Insufficient services on day of partial hospitalization 2.4
31 Partial hospitalization on same day as ECT or type "T" procedure Partial hospitalization on same day as ECT or type "T" procedure 2.4
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 Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days 2.4
33 Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services 2.4
34 Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria 2.4
35 Only activity therapy and/or occupational therapy services provided Only activity therapy and/or occupational therapy services provided 2.4
36 Extensive mental health services provided on day of ECT or significant procedure Extensive mental health services provided on day of ECT or significant procedure 2.4
37 Terminated bilateral procedure or terminated procedure with units greater than one Terminated bilateral procedure or terminated procedure with units greater than one 2.4
38 Inconsistency between implanted device and implantation procedure Inconsistency between implanted device and implantation procedure 2.4
39 Mutually exclusive procedure that would be allowed if appropriate modifier were present Mutually exclusive procedure that would be allowed if appropriate modifier were present 2.4
4 Medicare secondary payer alert Medicare secondary payer alert 2.4
40 Component of a comprehensive procedure that would be allowed if appropriate modifier were present Component of a comprehensive procedure that would be allowed if appropriate modifier were present 2.4
41 Invalid revenue code Invalid revenue code 2.4
42 Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B) Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B) 2.4
5 E-code as reason for visit E-code as reason for visit 2.4
6 Invalid procedure code Invalid procedure code 2.4
7 Procedure and age conflict Procedure and age conflict 2.4
8 Procedure and sex conflict Procedure and sex conflict 2.4
9 Nov-covered service Nov-covered service 2.4