OCE Edit Code

Relation/CHD: Invalid diagnosis code
Non-covered service submitted for verification of denial (condition code 21 from header information on claim)
Non-covered service submitted for FI review (condition code 20 from header information on claim)
Questionable covered service
Additional payment for service not provided by Medicare
Code indicates a site of service not included in OPPS
Service unit out of range for procedure
Multiple bilateral procedures without modifier 50 (see Appendix A)
Multiple bilateral procedures with modifier 50 (see Appendix A)
Inpatient procedure
Mutually exclusive procedure that is not allowed even if appropriate modifier present
Diagnosis and age conflict
Component of a comprehensive procedure that is not allowed even if appropriate modifier present
"Medical visit on same day as a type ""T"" or ""S"" procedure without modifier 25 (see Appendix B)"
;Invalid modifier
Invalid date
Date out of OCE range
Invalid age
Invalid sex
Only incidental services reported
"Code not recognized by Medicare; alternate code for same service available"
;Partial hospitalization service for non-mental health diagnosis
Diagnosis and sex conflict
Insufficient services on day of partial hospitalization
"Partial hospitalization on same day as ECT or type ""T"" procedure"
;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 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 meeting partial hospitalization criteria
Only activity therapy and/or occupational therapy services provided
Extensive mental health services provided on day of ECT or significant procedure
Terminated bilateral procedure or terminated procedure with units greater than one
Inconsistency between implanted device and implantation procedure
Mutually exclusive procedure that would be allowed if appropriate modifier were present
Medicare secondary payer alert
Component of a comprehensive procedure that would be allowed if appropriate modifier were present
Invalid revenue code
Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)
E-code as reason for visit
Invalid procedure code
Procedure and age conflict
Procedure and sex conflict
Nov-covered service