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Preliminary 08/25/09 Definitions of Medicare Code Edits PBL–011 October 2009 08/25/09 Preliminary Document number PBL–011 October 2009 ii Definitions of Medicare Code Edits October 2009 Preliminary 08/25/09 About this document THE MEDICARE CODE EDITOR (MCE) detects and reports errors in the coding claims data. This manual contains a description of each coding edit with corresponding ICD-9-CM code lists. The coding edit information in this manual is effective from 10/01/2009 to 09/30/2010. October 2009 iii 08/25/09 Preliminary iv Definitions of Medicare Code Edits October 2009 Preliminary 08/25/09 Contents Preface About this document iii Chapter 1 Edit code lists 1.3 1. Invalid diagnosis or procedure code 1.4 2. E-code as principal diagnosis 1.4 3. Duplicate of PDX 1.4 4. Age conflict 1.4 5. Sex conflict 1.19 6. Manifestation code as principal diagnosis 1.38 7. Non-specific principal diagnosis 1.41 8. Questionable admission 1.41 9. Unacceptable principal diagnosis 1.42 10. Non-specific O.R. procedure 1.50 11. Non-covered procedure 1.50 12. Open biopsy check 1.53 13. Bilateral procedure 1.54 14. Invalid age 1.55 15. Invalid sex 1.55 16. Invalid discharge status 1.55 17. Limited coverage 1.56 18. Wrong procedure performed 1.57 Chapter 2 Code list changes 2.3 Changes to existing edits 2.3 New edit 2.13 Index I.1 October 2009 Contents v 08/25/09 Preliminary vi Definitions of Medicare Code Edits October 2009 Chapter 1 1Edit code lists Contents Edit code lists 1.3 1. Invalid diagnosis or procedure code 1.4 2. E-code as principal diagnosis 1.4 3. Duplicate of PDX 1.4 4. Age conflict 1.4 5. Sex conflict 1.19 6. Manifestation code as principal diagnosis 1.38 7. Non-specific principal diagnosis 1.41 8. Questionable admission 1.41 9. Unacceptable principal diagnosis 1.42 10. Non-specific O.R. procedure 1.50 11. Non-covered procedure 1.50 12. Open biopsy check 1.53 13. Bilateral procedure 1.54 14. Invalid age 1.55 15. Invalid sex 1.55 16. Invalid discharge status 1.55 17. Limited coverage 1.56 18. Wrong procedure performed 1.57 1.2 Definitions of Medicare Code Edits October 2009 Chapter 1 Edit code lists BELOW IS A LIST of current edits described in this chapter. 1. Invalid diagnosis or procedure code 2. E-code as principal diagnosis 3. Duplicate of PDX 4. Age conflict 5. Sex conflict 6. Manifestation code as principal diagnosis 7. Non-specific principal diagnosis (Discontinued as of 10/01/07) 8. Questionable admission 9. Unacceptable principal diagnosis 10. Non-specific O.R. procedure (Discontinued as of 10/01/07) 11. Non-covered procedure 12. Open biopsy check 13. Bilateral procedure 14. Invalid age 15. Invalid sex 16. Invalid discharge status 17. Limited coverage 18. Wrong procedure performed October 2009 Edit code lists 1.3 1. Invalid1. diagnosis Invalid or diagnosis procedure code or The Medicare Code Editor checks each diagnosis including the admit- procedure code ting diagnosis and each procedure against a table of valid ICD-9-CM codes. If an entered code does not agree with any code on the internal list, it is assumed to be invalid or that the 4th or 5th digit of the code is invalid or missing. 2. 2.E-code E-code as principal as principal diagnosis For a list of all valid ICD-9-CM codes, see volumes 2 (diseases) and 3 diagnosis (procedures) of the International Classification of Diseases, 9th Revi- sion, Fourth Edition, Clinical Modification (ICD-9-CM). E-codes are ICD-9-CM codes beginning with the letter E. They describe the circumstance causing an injury, not the nature of the injury, and therefore should not be used as a principal diagnosis. For a list of all E-codes, see volume 2 (diseases) of the International Classification of Diseases, 9th Revision, Fourth Edition, Clinical Modification (ICD-9-CM). 3. Duplicate of PDX Whenever a secondary diagnosis is coded the same as the principal diagnosis, the secondary diagnosis is identified as a duplicate of the principal diagnosis. 4. Age conflict The Medicare Code Editor detects inconsistencies between a patient’s age and any diagnosis on the patient’s record. For example, a five-year-old patient with benign prostatic hypertrophy or a 78-year-old patient coded with a delivery. In the above cases, the diagnosis is clinically and virtually impossible in a patient of the stated age. Therefore, either the diagnosis or the age is presumed to be incorrect. There are four age categories for diag- noses in the program: ◆ Newborn. Age of 0 years; a subset of diagnoses intended only for newborns and neonates (e.g., fetal distress, perinatal jaundice). ◆ Pediatric. Age range is 0–17 years inclusive (e.g., Reye’s syn- drome, routine child health exam). ◆ Maternity. Age range is 12–55 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication). ◆ Adult. Age range is 15–124 years inclusive (e.g., senile delirium, mature cataract). The following pages contain lists of ICD-9-CM diagnosis codes with corresponding English descriptions for each of the age categories described above. 1.4 Definitions of Medicare Code Edits October 2009 Newborn diagnoses 27701 Cystic fibrosis w ileus 76497 Fet grwth ret 1750-1999g 74783 Persistent fetal circ 76498 Fet grwth ret 2000-2499g 76077 Mat anticonv aff NB/fet 76499 Fet growth ret 2500+g 76078 Mat antimetabol aff NB 76500 Extreme immatur wtNOS 7620 Placenta previa aff NB 76501 Extreme immatur <500g 7621 Placenta hem NEC aff NB 76502 Extreme immatur 500-749g 7622 Abn plac NEC/NOS aff NB 76503 Extreme immatur 750-999g 7623 Placent transfusion syn 76504 Extreme immat 1000-1249g 7624 Prolapsed cord aff NB 76505 Extreme immat 1250-1499g 7625 Oth umbil cord compress 76506 Extreme immat 1500-1749g 7626 Umbil cond NEC aff NB 76507 Extreme immat 1750-1999g 7627 Chorioamnionitis aff NB 76508 Extreme immat 2000-2499g 7628 Abn amnion NEC aff NB 76509 Extreme immat 2500+g 7629 Abn amnion NOS aff NB 76510 Preterm infant NEC wtNOS 7630 Breech del/extrac aff NB 76511 Preterm NEC <500g 7631 Malpos/dispro NEC aff NB 76512 Preterm NEC 500-749g 7632 Forceps delivery aff NB 76513 Preterm NEC 750-999g 7633 Vacuum extrac del aff NB 76514 Preterm NEC 1000-1249g 7634 Cesarean delivery aff NB 76515 Preterm NEC 1250-1499g 7635 Mat anesth/analg aff NB 76516 Preterm NEC 1500-1749g 7636 Precipitate del aff NB 76517 Preterm NEC 1750-1999g 7637 Abn uterine contr aff NB 76518 Preterm NEC 2000-2499g 76381 Ab ftl hrt rt/rh b/f lab 76519 Preterm NEC 2500+g 76382 Ab ftl hrt rt/rh dur lab 76520 Weeks of gestation NOS 76383 Ab ftl hrt rt/rhy NOS 76521 <24 comp wks gestation 76384 Meconium dur del aff NB 76522 24 comp weeks gestation 76389 Compl del NEC aff NB 76523 25-26 comp wks gestation 7639 Compl deliv NOS aff NB 76524 27-28 comp wks gestation 76400 Light-for-dates wtNOS 76525 29-30 comp wks gestation 76401 Light-for-dates <500g 76526 31-32 comp wks gestation 76402 Lt-for-dates 500-749g 76527 33-34 comp wks gestation 76403 Lt-for-dates 750-999g 76528 35-36 comp wks gestation 76404 Lt-for-dates 1000-1249g 76529 37+ comp wks gestation 76405 Lt-for-dates 1250-1499g 7660 Exceptionally large baby 76406 Lt-for-dates 1500-1749g 7661 Heavy-for-date infan NEC 76407 Lt-for-dates 1750-1999g 76621 Post-term infant 76408 Lt-for-dates 2000-2499g 76622 Prolong gestation-infant 76409 Lt-for-dates 2500+g 7670 Cerebral hem at birth 76410 Lt-for-date w/mal wtNOS 76711 Epicranial subapo hemorr 76411 Lt-for-date w/mal <500g 76719 Injuries to scalp NEC 76412 Lt-date w/mal 500-749g 7672 Clavicle fx at birth 76413 Lt-date w/mal 750-999g 7673 Bone injury NEC at birth 76414 Lt-date w/mal 1000-1249g 7674 Spinal cord inj at birth 76415 Lt-date w/mal 1250-1499g 7675 Facial nerve inj-birth 76416 Lt-date w/mal 1500-1749g 7676 Brach plexus inj-birth 76417 Lt-date w/mal 1750-1999g 7677 Nerve inj NEC at birth 76418 Lt-date w/mal 2000-2499g 7678 Birth trauma NEC 76419 Lt-for-date w/mal 2500+g 7679 Birth trauma NOS 76420 Fetal malnutrition wtNOS 7680 Fetal death-anoxia NOS 76421 Fetal malnutrition <500g 7681 Fet death-anoxia dur lab 76422 Fetal malnutr 500-749g 7682 Fet distress befor labor 76423 Fetal mal 750-999g 7683 Fetal distrs dur lab/del 76424 Fetal mal 1000-1249g 7684 Fetal distress NOS 76425 Fetal mal 1250-1499g 7685 Severe birth asphyxia 76426 Fetal mal 1500-1749g 7686 Mild/mod birth asphyxia 76427 Fetal malnutr 1750-1999g 76870 Hypoxc-ischem enceph NOS 76428 Fetal malnutr 2000-2499g 76871 Mild hypox-ischem enceph 76429 Fetal malnutr 2500+g 76872 Mod hypox-ischem enceph 76490 Fet growth retard wtNOS 76873 Sev hypox-ischem enceph 76491 Fet growth retard <500g 7689 Birth asphyxia NOS 76492 Fet growth ret 500-749g 769 Respiratory distress syn 76493 Fet growth ret 750-999g 7700 Congenital pneumonia 76494 Fet grwth ret 1000-1249g 77010 Fetal & newborn asp NOS 76495 Fet grwth ret 1250-1499g 77011 Meconium asp wo resp sym 76496 Fet grwth ret 1500-1749g 77012 Meconium asp w resp symp October 2009 Edit code lists 1.5 Newborn diagnoses 77013 Amniotc asp w/o resp sym 7756 Neonatal hypoglycemia 77014 Amniotic asp w resp sym 7757 Late metab acidosis NB 77015 Blood asp w/o resp sympt 77581 NB acidosis NEC 77016 Blood asp w resp sympt 77589 Neonat endo/met dis NEC 77017 NB asp w/o resp symp NEC 7759 Transient met dis NB NOS 77018 NB asp w resp symp NEC 7760 NB hemorrhagic disease 7702 NB interstit emphysema 7761 Neonatal thrombocytopen 7703 NB pulmonary hemorrhage 7762 Dissem intravasc coag NB 7704 Primary atelectasis 7763 Oth neonatal coag dis 7705 NB atelectasis NEC/NOS 7764 Polycythemia neonatorum 7706 NB transitory tachypnea 7765 Congenital anemia 77081 Primary apnea of newborn 7766 Anemia of prematurity
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