v2+ Vocabulary
0.3.0 - Working Draft to present the concept ideas (FO)
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
| Active as of 2025-08-05 |
{
"resourceType" : "CodeSystem",
"id" : "cms-OCEEditCode-csV100",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li>Include all codes defined in <a href=\"CodeSystem-cms-OCEEditCode-csV100.html\"><code>http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100</code></a></li></ul></div>"
},
"extension" : [
{
"url" : "http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-v2versionCreated",
"valueString" : "2.4"
},
{
"url" : "http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-versionHistory",
"valueString" : "generate correct history somehow"
},
{
"url" : "http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-tableNo",
"valueString" : "0458"
}
],
"url" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100",
"identifier" : [
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.6.301.9"
}
],
"version" : "1.0.0",
"name" : "Cms-OCEEditCode-csV100",
"title" : "OCE Edit Code (2.4 - 1.0.0)",
"status" : "active",
"experimental" : true,
"date" : "2025-08-05T15:14:51+02:00",
"description" : "Code system of concepts specifying the action to be taken during reimbursement calculations. Used in HL7 Version 2.x messaging in the GP2 segment.",
"copyright" : "HL7 Inc., 2024",
"caseSensitive" : true,
"content" : "complete",
"property" : [
{
"code" : "versionIntroduced",
"uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionIntroduced",
"description" : "version when was this code introduced",
"type" : "string"
},
{
"code" : "versionDeprecated",
"uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionDeprecated",
"description" : "version when was this code deprecated",
"type" : "string"
},
{
"code" : "status",
"uri" : "http://hl7.org/fhir/concept-properties#status",
"description" : "A code that indicates the status of the concept. Typical values are active, experimental, deprecated, and retired",
"type" : "code"
},
{
"code" : "comment",
"uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#comment",
"description" : "A string that provides additional detail pertinent to the use or understanding of the concept",
"type" : "string"
},
{
"code" : "usage",
"uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#usage",
"description" : "usage notes for this code",
"type" : "string"
},
{
"code" : "modified",
"uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#modified",
"description" : "date of last modification",
"type" : "dateTime"
}
],
"concept" : [
{
"code" : "1",
"display" : "Invalid diagnosis code",
"definition" : "Invalid diagnosis code",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "10",
"display" : "Non-covered service submitted for verification of denial (condition code 21 from header information on claim)",
"definition" : "Non-covered service submitted for verification of denial (condition code 21 from header information on claim)",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "11",
"display" : "Non-covered service submitted for FI review (condition code 20 from header information on claim)",
"definition" : "Non-covered service submitted for FI review (condition code 20 from header information on claim)",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "12",
"display" : "Questionable covered service",
"definition" : "Questionable covered service",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "13",
"display" : "Additional payment for service not provided by Medicare",
"definition" : "Additional payment for service not provided by Medicare",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "14",
"display" : "Code indicates a site of service not included in OPPS",
"definition" : "Code indicates a site of service not included in OPPS",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "15",
"display" : "Service unit out of range for procedure",
"definition" : "Service unit out of range for procedure",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "16",
"display" : "Multiple bilateral procedures without modifier 50 (see Appendix A)",
"definition" : "Multiple bilateral procedures without modifier 50 (see Appendix A)",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "17",
"display" : "Multiple bilateral procedures with modifier 50 (see Appendix A)",
"definition" : "Multiple bilateral procedures with modifier 50 (see Appendix A)",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "18",
"display" : "Inpatient procedure",
"definition" : "Inpatient procedure",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "19",
"display" : "Mutually exclusive procedure that is not allowed even if appropriate modifier present",
"definition" : "Mutually exclusive procedure that is not allowed even if appropriate modifier present",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "2",
"display" : "Diagnosis and age conflict",
"definition" : "Diagnosis and age conflict",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "20",
"display" : "Component of a comprehensive procedure that is not allowed even if appropriate modifier present",
"definition" : "Component of a comprehensive procedure that is not allowed even if appropriate modifier present",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "21",
"display" : "Medical visit on same day as a type \"T\" or \"S\" procedure without modifier 25 (see Appendix B)",
"definition" : "Medical visit on same day as a type \"T\" or \"S\" procedure without modifier 25 (see Appendix B)",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "22",
"display" : "Invalid modifier",
"definition" : "Invalid modifier",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "23",
"display" : "Invalid date",
"definition" : "Invalid date",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "24",
"display" : "Date out of OCE range",
"definition" : "Date out of OCE range",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "25",
"display" : "Invalid age",
"definition" : "Invalid age",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "26",
"display" : "Invalid sex",
"definition" : "Invalid sex",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "27",
"display" : "Only incidental services reported",
"definition" : "Only incidental services reported",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "28",
"display" : "Code not recognized by Medicare; alternate code for same service available",
"definition" : "Code not recognized by Medicare; alternate code for same service available",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "29",
"display" : "Partial hospitalization service for non-mental health diagnosis",
"definition" : "Partial hospitalization service for non-mental health diagnosis",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "3",
"display" : "Diagnosis and sex conflict",
"definition" : "Diagnosis and sex conflict",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "30",
"display" : "Insufficient services on day of partial hospitalization",
"definition" : "Insufficient services on day of partial hospitalization",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "31",
"display" : "Partial hospitalization on same day as ECT or type \"T\" procedure",
"definition" : "Partial hospitalization on same day as ECT or type \"T\" procedure",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "32",
"display" : "Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days",
"definition" : "Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "33",
"display" : "Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services",
"definition" : "Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "34",
"display" : "Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria",
"definition" : "Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "35",
"display" : "Only activity therapy and/or occupational therapy services provided",
"definition" : "Only activity therapy and/or occupational therapy services provided",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "36",
"display" : "Extensive mental health services provided on day of ECT or significant procedure",
"definition" : "Extensive mental health services provided on day of ECT or significant procedure",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "37",
"display" : "Terminated bilateral procedure or terminated procedure with units greater than one",
"definition" : "Terminated bilateral procedure or terminated procedure with units greater than one",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "38",
"display" : "Inconsistency between implanted device and implantation procedure",
"definition" : "Inconsistency between implanted device and implantation procedure",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "39",
"display" : "Mutually exclusive procedure that would be allowed if appropriate modifier were present",
"definition" : "Mutually exclusive procedure that would be allowed if appropriate modifier were present",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "4",
"display" : "Medicare secondary payer alert",
"definition" : "Medicare secondary payer alert",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "40",
"display" : "Component of a comprehensive procedure that would be allowed if appropriate modifier were present",
"definition" : "Component of a comprehensive procedure that would be allowed if appropriate modifier were present",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "41",
"display" : "Invalid revenue code",
"definition" : "Invalid revenue code",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "42",
"display" : "Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)",
"definition" : "Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "5",
"display" : "E-code as reason for visit",
"definition" : "E-code as reason for visit",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "6",
"display" : "Invalid procedure code",
"definition" : "Invalid procedure code",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "7",
"display" : "Procedure and age conflict",
"definition" : "Procedure and age conflict",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "8",
"display" : "Procedure and sex conflict",
"definition" : "Procedure and sex conflict",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
},
{
"code" : "9",
"display" : "Nov-covered service",
"definition" : "Nov-covered service",
"property" : [
{
"code" : "versionIntroduced",
"valueString" : "2.4"
}
]
}
]
}