| 001ICM |
Invalid diagnosis, 4th/5th digit |
Code(s) billed without a required fourth or fifth digit, or, claim billed without at least one diagnosis |
| 001ICM |
Invalid diagnosis |
Code use was not valid on the date of service |
| 002IAG |
Facility diagnosis age conflict |
Diagnosis code is inconsistent with a patient's age |
| 003ISX |
Facility diagnosis sex conflict |
Diagnosis code is inconsistent with a patient's sex |
| 005EPD |
E-code as principal diagnosis |
E-codes cannot be used as the primary diagnosis |
| 0006IPC |
Invalid HCPCS code |
HCPCS code is not valid for date of service |
| 008CSX |
HCPCS gender conflict |
HCPCS code is not valid for the patient's gender |
| 017IBP |
Inappropriate bilateral procedure - Different claim OR Same claim |
Bilateral procedure is incorrectly billed |
| 019:MEP |
Unbundle rule - Mutually exclusive procedures
- History line in same claim |
Mutually exclusive procedures cannot be billed together, based on Hospital National Correct Coding Initiative |
| 019hMEP |
Unbundle rule - Mutually exclusive procedures (history claim) |
Mutually exclusive procedures cannot be billed together, based on Hospital National Correct Coding Initiative |
| 019MEP |
Unbundle rule - Mutually exclusive procedures
- History line in different claim |
Mutually exclusive procedures cannot be billed together, based on Hospital National Correct Coding Initiative |
| 020:CCP |
Unbundle rule - Code 2 of a pair that is not allowed
- History line in Different claim |
Column 2 code cannot be billed with column 1 code on the same day of service |
| 020hCCP |
Unbundle rule - Code 2 of a pair that is not allowed
- (history edit) |
Column 2 code cannot be billed with column 1 code on the same day of service |
| 020CCP |
Unbundle rule - Code 2 of a pair that is not allowed
- Hist |
Column 2 code cannot be billed with column 1 code on the same day of service |
| 021EMO |
Medical visit on same day as procedure
- Different claims
- Same claim
|
E&M and procedure billed on the same date of service without appropriate modifier |
| 023BDS |
Service date missing
Service date not within from and through dates |
Dates billed are not within a normal date range |
| 025AGE |
Outpatient invalid age |
Patient's age is not between 0 and 124 years |
| 026SEX |
Outpatient invalid sex |
Patient's gender is not reported |
| 037TBP |
Inappropriate reporting of terminated bilateral procedure
- Modifier 50
- Multiple units |
Identifies terminated HCPCS procedure codes billed without appropriate modifier |
| 039hMEO |
Unbundle rule - Mutually exclusive procedure with appropriate modifier (history edit) |
Identifies mutually exclusive procedures billed without appropriate modifier |
| 039MEO |
Unbundle rule - Mutually exclusive procedure with appropriate modifier
- History line in different claim
- Mutually exclusi |
Identifies mutually exclusive procedures billed without appropriate modifier |
| 040:CCO |
Unbundle rule - Code 2 of code pair with appropriate modifier
- Hitory in different claim |
Column 2 code cannot be billed with column 1 code on the same day of service |
| 040CCO |
Unbundle rule - Code 2 of code pair with appropriate modifier
- History in same claim |
Column 2 code cannot be billed with column 1 code on the same day of service |
| 040hCCO |
Unbundle rule - Code 2 of code pair w/appropria |
Column 2 code cannot be billed with column 1 code on the same day of service |
| 067SPA |
Services provided prior to FDA approval |
Biologic medication has not been FDA-approved |
| 074UBP |
Outpatient incorrect units for bilateral procedure |
Conditionally or independent bilateral service with units of service greater than one |
| ACTf |
Missing or invalid account ID |
Missing or invalid account ID |
| DADI1-5 |
Invalid diagnosis or procedure code |
ICD-9 code doesn't match with admitting or procedure diagnosis |
| DASC1 |
Age conflict |
Age is inconsistent with billed diagnosis |
| DASC2 |
Sex conflict |
Gender is inconsistent with billed diagnosis |
| DASC3 |
Age and sex conflict |
Age and gender inconsistent with billed diagnosis |
| DDAS1 |
Age conflict |
Age is inconsistent with billed diagnosis |
| DDAS2 |
Sex conflict |
Gender is inconsistent with billed diagnosis |
| DDAS3 |
Age and sex conflict |
Age and gender inconsistent with billed diagnosis |
| DDPD |
Duplicate of primary diagnosis |
Secondary diagnosis is the same as primary diagnosis |
| DDSD |
Duplicate of secondary diagnosis |
Secondary diagnosis is the same as primary diagnosis |
| DIA |
Invalid age |
Age reported is not between birth and 24 |
| DID1 |
Invalid principal diagnosis code - Not found on table of valid ICD-9-CM codes |
Principal diagnosis doesn't represent current illness or injury |
| DID2 |
Invalid principal diagnosis code - Unnecessary 4th/5th digit |
Principal diagnosis doesn't represent current illness or injury |
| DID3 |
Invalid principal diagnosis code - Missing 4th/5th digit |
Principal diagnosis doesn't represent current illness or injury |
| DID4 |
Invalid principal diagnosis code - Invalid principal |
Principal diagnosis doesn't represent current illness or injury |
| DIDS |
Invalid discharge status |
Discharge status must be coded to UB-04 conventions |
| DIS |
Invalid sex |
Gender is necessary for DRG determination |
| DPDI1 |
E-code as principal diagnosis |
E-codes identify nature of injury and should not be used as primary diagnosis |
| DPDI2 |
Manifestation code as principal diagnosis |
Code identifies manifestation of underlying disease and should not be used as primary diagnosis |
| DPIP1 |
Invalid procedure code - Not found on table of valid ICD-9-CM codes |
Principal procedure doesn't represent admitting diagnosis |
| DPIP2 |
Invalid procedure code - Contains an unnecessary 4th digit |
Principal procedure doesn't represent admitting diagnosis |
| DPIP3 |
Invalid procedure code - Missing 4th digit |
Principal procedure doesn't represent admitting diagnosis |
| DPIP4 |
Invalid procedure code - Found on ICD-9 |
Principal procedure doesn't represent admitting diagnosis |
| DPNC1 |
Non-covered procedure |
Medicare non-covered procedure |
| DPSC |
Patient gender and procedure are incompatible |
Gender is inconsistent with billed diagnosis |
| DXE1 |
E-code as principal diagnosis |
E-codes identify nature of injury and should not be used as primary diagnoses |
| DXE2 |
E-code as principal diagnosis |
E-codes identify nature of injury and should not be used as primary diagnoses |
| FTDf |
Missing admission date
Missing "Statement covers period from" date
Missing "Statement covers period through" date
|
Date is missing |
| ICMf |
Missing diagnosis |
Missing principal diagnosis |
| LCAG |
LCD procedure not typical with patient age |
Patient age doesn't meet LCD rules |
| LCC |
LCD code-to-code missing or invalid |
Two procedure codes cannot be billed under LCD/NCD rules |
| LCDY |
LCD deny |
LCD policy indicates the claim line should be denied. |
| LCFR |
LCD procedure frequency exceeded |
Procedure code doesn't meet the frequency requirements of an LCD/NCD policy |
| LCG |
LCD inappropriate gender |
Patient gender doesn't meet the requirement of an LCD/NCD policy |
| LCI |
LCD missing or invalid diagnosis code |
Missing or invalid diagnosis code under LCD/NCD policy |
| LCM |
LCD missing required modifier |
Missing modifier under LCD/NCD policy |
| LCON |
LCD missing or invalid condition code(s) |
Condition code(s) does/do not meet the requirement of an LCD/NCD policy |
| LCP |
LCD missing primary diagnosis code |
|
| LCRD |
LCD review/request documentation |
Request for documentation under LCD/NCD policy |
| LCS |
LCD missing secondary diagnosis code |
Missing secondary diagnosis code under LCD/NCD policy |
| LCT |
LCD missing tertiary diagnosis code |
Missing tertiary diagnosis code under LCD/NCD policy |
| LRC |
LCD missing or invalid revenue code |
Revenue code doesn't meet the requirement of an LCD/NCD policy |
| LTOB |
Invalid type of bill |
Type of bill doesn't meet the requirement of an LCD/NCD policy |
| LVC |
LCD missing or invalid value code(s) |
Value codes don't meet the requirement of an LCD/NCD policy |
| MUEf |
Medicare medically unlikely edits |
Medicare medically unlikely edits |
| PSCF |
Missing or invalid patient status code |
Missing or invalid patient status code; effective 1/1/2012 in conjunction with 5010 implementation. |
| SOAf |
Invalid point of origin |
Invalid source of admission code in point-of-origin field; effective 1/1/2012 in conjunction with 5010 implementation. |
| TOAf |
Invalid type of admission |
Invalid type of admission code |
