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
| Official URL: http://terminology.hl7.org/v2plusvocab/ValueSet/hl7VSOCEEditCodeV100 | Version: 1.0.0 | |||
| Active as of 2025-08-05 | Computable Name: Hl7VSOCEEditCodeV100 | |||
| Other Identifiers: OID:2.16.840.1.113883.21.470 | ||||
Copyright/Legal: HL7 Inc., 2024 |
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Value Set of codes that specify the edits that result from processing the HCPCS/CPT procedures for a record after evaluating all the codes, revenue codes, and modifiers.
References
This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)
http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100
Expansion performed internally based on codesystem OCE Edit Code (2.4 - 1.0.0) v1.0.0 (CodeSystem)
This value set contains 42 concepts
| Code | System | Display (en-US) | Definition |
| 1 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid diagnosis code | Invalid diagnosis code |
| 10 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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) |
| 11 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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) |
| 12 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Questionable covered service | Questionable covered service |
| 13 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Additional payment for service not provided by Medicare | Additional payment for service not provided by Medicare |
| 14 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Code indicates a site of service not included in OPPS | Code indicates a site of service not included in OPPS |
| 15 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Service unit out of range for procedure | Service unit out of range for procedure |
| 16 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Multiple bilateral procedures without modifier 50 (see Appendix A) | Multiple bilateral procedures without modifier 50 (see Appendix A) |
| 17 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Multiple bilateral procedures with modifier 50 (see Appendix A) | Multiple bilateral procedures with modifier 50 (see Appendix A) |
| 18 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Inpatient procedure | Inpatient procedure |
| 19 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Diagnosis and age conflict | Diagnosis and age conflict |
| 20 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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 |
| 21 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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) |
| 22 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid modifier | Invalid modifier |
| 23 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid date | Invalid date |
| 24 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Date out of OCE range | Date out of OCE range |
| 25 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid age | Invalid age |
| 26 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid sex | Invalid sex |
| 27 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Only incidental services reported | Only incidental services reported |
| 28 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Code not recognized by Medicare; alternate code for same service available | Code not recognized by Medicare; alternate code for same service available |
| 29 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Partial hospitalization service for non-mental health diagnosis | Partial hospitalization service for non-mental health diagnosis |
| 3 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Diagnosis and sex conflict | Diagnosis and sex conflict |
| 30 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Insufficient services on day of partial hospitalization | Insufficient services on day of partial hospitalization |
| 31 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Partial hospitalization on same day as ECT or type "T" procedure | Partial hospitalization on same day as ECT or type "T" procedure |
| 32 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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 |
| 33 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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 |
| 34 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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 |
| 35 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Only activity therapy and/or occupational therapy services provided | Only activity therapy and/or occupational therapy services provided |
| 36 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Extensive mental health services provided on day of ECT or significant procedure | Extensive mental health services provided on day of ECT or significant procedure |
| 37 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Terminated bilateral procedure or terminated procedure with units greater than one | Terminated bilateral procedure or terminated procedure with units greater than one |
| 38 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Inconsistency between implanted device and implantation procedure | Inconsistency between implanted device and implantation procedure |
| 39 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Mutually exclusive procedure that would be allowed if appropriate modifier were present | Mutually exclusive procedure that would be allowed if appropriate modifier were present |
| 4 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Medicare secondary payer alert | Medicare secondary payer alert |
| 40 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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 |
| 41 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid revenue code | Invalid revenue code |
| 42 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | 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) |
| 5 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | E-code as reason for visit | E-code as reason for visit |
| 6 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Invalid procedure code | Invalid procedure code |
| 7 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Procedure and age conflict | Procedure and age conflict |
| 8 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Procedure and sex conflict | Procedure and sex conflict |
| 9 | http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-csV100 | Nov-covered service | Nov-covered service |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |