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Definitions of Medicare Code Edits

DRAFT ICD-10 VERSION

Software version 27.0 R1 PBL031 September 2011 Manual updated March 2012

Document number September 2011

PBL031

ii Definitions of Medicare Code Edits

September 2011

About this document

HE 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-10-CM and ICD-10-PCS code lists which were published in December 2010. The coding edit information in this manual is effective from 10/01/2010 to 09/30/2011. However it is not intended to be used to process claims as the ICD- 10 code set will not be mandated for use until October 1, 2013.

September 2011

iii

iv Definitions of Medicare Code Edits

September 2011

Contents

Preface Chapter 1

About this document iii Edit code lists


1.3 1.4
1. Invalid diagnosis or procedure code 1.4 2. External causes of morbidity codes as principal diagnosis 3. Duplicate of PDX 1.4 4. Age conflict 1.4 5. Sex conflict 1.58 6. Manifestation code as principal diagnosis 1.161 7. Non-specific principal diagnosis 1.166 8. Questionable admission 1.166 9. Unacceptable principal diagnosis 1.167 10. Non-specific O.R. procedure 1.184 11. Non-covered procedure 1.184 12. Open biopsy check 1.191 13. Bilateral procedure 1.191 14. Invalid age 1.191 15. Invalid sex 1.191 16. Invalid discharge status 1.191 17. Limited coverage 1.192 18. Wrong procedure performed 1.193

Chapter 2

Code list changes

2.3

September 2011

Contents v

vi Definitions of Medicare Code Edits

September 2011

Chapter 1
1

Edit code lists

Contents

Edit code lists

1.3 1.4

1. Invalid diagnosis or procedure code 1.4 2. External causes of morbidity codes as principal diagnosis 3. Duplicate of PDX 1.4 4. Age conflict 1.4 5. Sex conflict 1.58 6. Manifestation code as principal diagnosis 1.161 7. Non-specific principal diagnosis 1.166 8. Questionable admission 1.166 9. Unacceptable principal diagnosis 1.167 10. Non-specific O.R. procedure 1.184 11. Non-covered procedure 1.184 12. Open biopsy check 1.191 13. Bilateral procedure 1.191 14. Invalid age 1.191 15. Invalid sex 1.191 16. Invalid discharge status 1.191 17. Limited coverage 1.192 18. Wrong procedure performed 1.193

1.2 Definitions of Medicare Code Edits

September 2011

Chapter 1

Edit code lists

BELOW IS A LIST of edits described in this chapter.


1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Invalid diagnosis or procedure code External causes of morbidity codes as principal diagnosis Duplicate of PDX Age conflict Sex conflict Manifestation code as principal diagnosis Non-specific principal diagnosis (Discontinued as of 10/01/07) Questionable admission Unacceptable principal diagnosis Non-specific O.R. procedure (Discontinued as of 10/01/07) Non-covered procedure Open biopsy check (Discontinued as of 10/01/10) Bilateral procedure (Discontinued as of 10/01/13) Invalid age Invalid sex Invalid discharge status Limited coverage Wrong procedure performed

September 2011

Edit code lists 1.3

1. Invalid or 1. Invalid diagnosis ordiagnosis procedure code procedure code

The Medicare Code Editor checks each diagnosis including the admitting diagnosis and each procedure against a table of valid ICD-10-CM and ICD-10-PCS codes. If an entered code does not agree with any code on the internal list, it is assumed to be invalid. For a list of all valid ICD-10-CM and ICD-10-PCS codes, see the International Classification of Diseases list.

2. External causes of morbidity codes as 2. External causes of principal diagnosis

morbidity codes as principal diagnosis

External causes of morbidity codes are ICD-10-CM codes beginning with the letter V through Y. 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 external causes of morbidity codes, see the International Classification of Diseases list.

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. The Medicare Code Editor detects inconsistencies between a patients age and any diagnosis on the patients 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 diagnoses in the program:

4. Age conflict

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 017 years inclusive (e.g., Reyes syndrome, routine child health exam). Maternity. Age range is 1255 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication). Adult. Age range is 15124 years inclusive (e.g., senile delirium, mature cataract).

The following pages contain lists of ICD-10-CM diagnosis codes with corresponding English descriptions for each of the age categories described above.

1.4 Definitions of Medicare Code Edits

September 2011

Newborn diagnoses
A33 D807 E71511 E8411 H04531 H04532 H04533 H04539 N470 P000 P001 P002 P003 P004 P005 P006 P007 P0081 P0089 P009 P010 P011 P012 P013 P014 P015 P016 P017 P018 P019 P020 P021 P0220 P0229 P023 P024 P025 P0260 P0269 P027 P028 P029 P030 P031 P032 P033 P034 P035 P036 P03810 P03811 P03819 P0382 P0389 P039 P040 P041 P042 P043 P0441 P0449 P045 P046 P048 P049 Tetanus neonatorum Transient hypogammaglobulinemia of infancy Neonatal adrenoleukodystrophy Meconium ileus in cystic fibrosis Neonatal obstruction of right nasolacrimal duct Neonatal obstruction of left nasolacrimal duct Neonatal obstruction of bilateral nasolacrimal duct Neonatal obstruction of unspecified nasolacrimal duct Adherent prepuce, newborn Newborn affected by maternal hypertensive disorders Newborn aff by maternal renal and urinary tract diseases Newborn affected by maternal infec/parastc diseases Newborn affected by oth maternal circ and resp diseases Newborn affected by maternal nutritional disorders Newborn (suspected to be) affected by maternal injury Newborn affected by surgical procedure on mother Newborn affected by oth medical procedures on mother, NEC Newborn affected by periodontal disease in mother Newborn affected by oth maternal conditions Newborn affected by unsp maternal condition Newborn (suspected to be) affected by incompetent cervix Newborn (suspected to be) affected by premature ROM Newborn (suspected to be) affected by oligohydramnios Newborn (suspected to be) affected by polyhydramnios Newborn (suspected to be) affected by ectopic pregnancy Newborn (suspected to be) affected by multiple pregnancy Newborn (suspected to be) affected by maternal death Newborn affected by malpresentation before labor Newborn affected by oth maternal complications of pregnancy Newborn affected by maternal complication of pregnancy, unsp Newborn (suspected to be) affected by placenta previa Newborn affected by oth placental separation and hemorrhage Newborn aff by unsp morpholog and functn abnlt of placenta Newborn aff by oth morpholog and functn abnlt of placenta Newborn affected by placental transfusion syndromes Newborn (suspected to be) affected by prolapsed cord Newborn affected by oth compression of umbilical cord Newborn affected by unsp conditions of umbilical cord Newborn affected by oth conditions of umbilical cord Newborn (suspected to be) affected by chorioamnionitis Newborn affected by oth abnormalities of membranes Newborn affected by abnormality of membranes, unsp Newborn affected by breech delivery and extraction NB aff by oth malpresent, malpos & disproprtn dur labr & del Newborn (suspected to be) affected by forceps delivery Newborn affected by delivery by vacuum extractor Newborn (suspected to be) affected by Cesarean delivery Newborn (suspected to be) affected by precipitate delivery Newborn affected by abnormal uterine contractions NB aff by abnlt in fetl heart rate or rhythm bef onset labor NB aff by abnlt in fetal heart rate or rhythm during labor NB aff by abnlt in fetl hrt rate or rhythm, unsp time onset Meconium passage during delivery Newborn affected by oth complications of labor and delivery Newborn affected by complication of labor and delivery, unsp NB aff by matern anesth and analgesia in preg, labor and del Newborn affected by oth maternal medication Newborn affected by maternal use of tobacco Newborn affected by maternal use of alcohol Newborn affected by maternal use of cocaine Newborn affected by maternal use of drugs of addiction Newborn aff by maternal use of nutritional chemical substnc Newborn aff by maternal exposure to environ chemical substnc Newborn affected by oth maternal noxious substances Newborn affected by maternal noxious substance, unsp

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Newborn diagnoses

P0500 P0501 P0502 P0503 P0504 P0505 P0506 P0507 P0508 P0510 P0511 P0512 P0513 P0514 P0515 P0516 P0517 P0518 P052 P059 P0700 P0701 P0702 P0703 P0710 P0714 P0715 P0716 P0717 P0718 P0720 P0721 P0722 P0723 P0730 P0731 P0732 P080 P081 P0821 P0822 P09 P100 P101 P102 P103 P104 P108 P109 P110 P111 P112 P113 P114 P115 P119 P120 P121 P122 P123 P124 P1281 P1289 P129 P130 P131 P132 P133

Newborn light for gestational age, unspecified weight Newborn light for gestational age, less than 500 grams Newborn light for gestational age, 500-749 grams Newborn light for gestational age, 750-999 grams Newborn light for gestational age, 1000-1249 grams Newborn light for gestational age, 1250-1499 grams Newborn light for gestational age, 1500-1749 grams Newborn light for gestational age, 1750-1999 grams Newborn light for gestational age, 2000-2499 grams Newborn small for gestational age, unspecified weight Newborn small for gestational age, less than 500 grams Newborn small for gestational age, 500-749 grams Newborn small for gestational age, 750-999 grams Newborn small for gestational age, 1000-1249 grams Newborn small for gestational age, 1250-1499 grams Newborn small for gestational age, 1500-1749 grams Newborn small for gestational age, 1750-1999 grams Newborn small for gestational age, 2000-2499 grams NB aff by fetal malnut not light or small for gestatnl age Newborn affected by slow intrauterine growth, unspecified Extremely low birth weight newborn, unspecified weight Extremely low birth weight newborn, less than 500 grams Extremely low birth weight newborn, 500-749 grams Extremely low birth weight newborn, 750-999 grams Other low birth weight newborn, unspecified weight Other low birth weight newborn, 1000-1249 grams Other low birth weight newborn, 1250-1499 grams Other low birth weight newborn, 1500-1749 grams Other low birth weight newborn, 1750-1999 grams Other low birth weight newborn, 2000-2499 grams Extreme immaturity of newborn, unspecified weeks Extreme immaturity of newborn, less than 24 completed weeks Extreme immaturity of newborn, 24-26 completed weeks Extreme immaturity of newborn, 27 completed weeks Other preterm newborn, unspecified weeks Other preterm newborn, 28-31 completed weeks Other preterm newborn, 32-36 completed weeks Exceptionally large newborn baby Other heavy for gestational age newborn Post-term newborn Prolonged gestation of newborn Abnormal findings on neonatal screening Subdural hemorrhage due to birth injury Cerebral hemorrhage due to birth injury Intraventricular hemorrhage due to birth injury Subarachnoid hemorrhage due to birth injury Tentorial tear due to birth injury Oth intcrn lacerations and hemorrhages due to birth injury Unsp intcrn laceration and hemorrhage due to birth injury Cerebral edema due to birth injury Other specified brain damage due to birth injury Unspecified brain damage due to birth injury Birth injury to facial nerve Birth injury to other cranial nerves Birth injury to spine and spinal cord Birth injury to central nervous system, unspecified Cephalhematoma due to birth injury Chignon (from vacuum extraction) due to birth injury Epicranial subaponeurotic hemorrhage due to birth injury Bruising of scalp due to birth injury Injury of scalp of newborn due to monitoring equipment Caput succedaneum Other birth injuries to scalp Birth injury to scalp, unspecified Fracture of skull due to birth injury Other birth injuries to skull Birth injury to femur Birth injury to other long bones

1.6 Definitions of Medicare Code Edits

September 2011

Newborn diagnoses

P134 P138 P139 P140 P141 P142 P143 P148 P149 P150 P151 P152 P153 P154 P155 P156 P158 P159 P190 P191 P192 P199 P220 P221 P228 P229 P230 P231 P232 P233 P234 P235 P236 P238 P239 P2400 P2401 P2410 P2411 P2420 P2421 P2430 P2431 P2480 P2481 P249 P250 P251 P252 P253 P258 P260 P261 P268 P269 P280 P2810 P2811 P2819 P282 P283 P284 P285 P2881 P2889 P289 P290 P2911

Fracture of clavicle due to birth injury Birth injuries to other parts of skeleton Birth injury to skeleton, unspecified Erb's paralysis due to birth injury Klumpke's paralysis due to birth injury Phrenic nerve paralysis due to birth injury Other brachial plexus birth injuries Birth injuries to other parts of peripheral nervous system Birth injury to peripheral nervous system, unspecified Birth injury to liver Birth injury to spleen Sternomastoid injury due to birth injury Birth injury to eye Birth injury to face Birth injury to external genitalia Subcutaneous fat necrosis due to birth injury Other specified birth injuries Birth injury, unspecified Metabolic acidemia in newborn first noted before onset labor Metabolic acidemia in newborn first noted during labor Metabolic acidemia noted at birth Metabolic acidemia, unspecified Respiratory distress syndrome of newborn Transient tachypnea of newborn Other respiratory distress of newborn Respiratory distress of newborn, unspecified Congenital pneumonia due to viral agent Congenital pneumonia due to Chlamydia Congenital pneumonia due to staphylococcus Congenital pneumonia due to streptococcus, group B Congenital pneumonia due to Escherichia coli Congenital pneumonia due to Pseudomonas Congenital pneumonia due to other bacterial agents Congenital pneumonia due to other organisms Congenital pneumonia, unspecified Meconium aspiration without respiratory symptoms Meconium aspiration with respiratory symptoms Neonatal aspirat of amnio fluid and mucus w/o resp symp Neonatal aspirat of amnio fluid and mucus w resp symp Neonatal aspiration of blood without respiratory symptoms Neonatal aspiration of blood with respiratory symptoms Neonatal aspirat of milk and regurgitated food w/o resp symp Neonatal aspirat of milk and regurgitated food w resp symp Other neonatal aspiration without respiratory symptoms Other neonatal aspiration with respiratory symptoms Neonatal aspiration, unspecified Interstitial emphysema originating in the perinatal period Pneumothorax originating in the perinatal period Pneumomediastinum originating in the perinatal period Pneumopericardium originating in the perinatal period Oth cond rel to interstit emphysema origin in perinat period Tracheobronchial hemorrhage origin in the perinatal period Massive pulmonary hemorrhage origin in the perinatal period Oth pulmonary hemorrhages origin in the perinatal period Unsp pulmonary hemorrhage origin in the perinatal period Primary atelectasis of newborn Unspecified atelectasis of newborn Resorption atelectasis without respiratory distress syndrome Other atelectasis of newborn Cyanotic attacks of newborn Primary sleep apnea of newborn Other apnea of newborn Respiratory failure of newborn Respiratory arrest of newborn Other specified respiratory conditions of newborn Respiratory condition of newborn, unspecified Neonatal cardiac failure Neonatal tachycardia

September 2011

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Newborn diagnoses

P2912 P292 P293 P294 P2981 P2989 P299 P350 P351 P352 P353 P358 P359 P360 P3610 P3619 P362 P3630 P3639 P364 P365 P368 P369 P370 P371 P372 P373 P374 P375 P378 P379 P381 P389 P390 P391 P392 P393 P394 P398 P399 P500 P501 P502 P503 P504 P505 P508 P509 P510 P518 P519 P520 P521 P5221 P5222 P523 P524 P525 P526 P528 P529 P53 P540 P541 P542 P543 P544 P545

Neonatal bradycardia Neonatal hypertension Persistent fetal circulation Transient myocardial ischemia in newborn Cardiac arrest of newborn Oth cardiovasc disorders originating in the perinatal period Cardiovasc disorder origin in the perinatal period, unsp Congenital rubella syndrome Congenital cytomegalovirus infection Congenital herpesviral [herpes simplex] infection Congenital viral hepatitis Other congenital viral diseases Congenital viral disease, unspecified Sepsis of newborn due to streptococcus, group B Sepsis of newborn due to unspecified streptococci Sepsis of newborn due to other streptococci Sepsis of newborn due to Staphylococcus aureus Sepsis of newborn due to unspecified staphylococci Sepsis of newborn due to other staphylococci Sepsis of newborn due to Escherichia coli Sepsis of newborn due to anaerobes Other bacterial sepsis of newborn Bacterial sepsis of newborn, unspecified Congenital tuberculosis Congenital toxoplasmosis Neonatal (disseminated) listeriosis Congenital falciparum malaria Other congenital malaria Neonatal candidiasis Other specified congenital infectious and parasitic diseases Congenital infectious or parasitic disease, unspecified Omphalitis with mild hemorrhage Omphalitis without hemorrhage Neonatal infective mastitis Neonatal conjunctivitis and dacryocystitis Intra-amniotic infection affecting newborn, NEC Neonatal urinary tract infection Neonatal skin infection Other specified infections specific to the perinatal period Infection specific to the perinatal period, unspecified Newborn aff by uterin (fetal) blood loss from vasa previa Newborn aff by uterin (fetal) blood loss from ruptured cord Newborn affected by uterin (fetal) blood loss from placenta Newborn affected by hemorrhage into co-twin Newborn affected by hemorrhage into maternal circulation NB aff by uterin blood loss from cut end of co-twin's cord Newborn affected by other intrauterine (fetal) blood loss Newborn affected by intrauterine (fetal) blood loss, unsp Massive umbilical hemorrhage of newborn Other umbilical hemorrhages of newborn Umbilical hemorrhage of newborn, unspecified Intraventricular (nontraumatic) hemor, grade 1, of newborn Intraventricular (nontraumatic) hemor, grade 2, of newborn Intraventricular (nontraumatic) hemor, grade 3, of newborn Intraventricular (nontraumatic) hemor, grade 4, of newborn Unsp intraventricular (nontraumatic) hemorrhage of newborn Intracerebral (nontraumatic) hemorrhage of newborn Subarachnoid (nontraumatic) hemorrhage of newborn Cereblr (nontraumatic) and posterior fossa hemor of newborn Other intracranial (nontraumatic) hemorrhages of newborn Intracranial (nontraumatic) hemorrhage of newborn, unsp Hemorrhagic disease of newborn Neonatal hematemesis Neonatal melena Neonatal rectal hemorrhage Other neonatal gastrointestinal hemorrhage Neonatal adrenal hemorrhage Neonatal cutaneous hemorrhage

1.8 Definitions of Medicare Code Edits

September 2011

Newborn diagnoses

P546 P548 P549 P550 P551 P558 P559 P560 P5690 P5699 P570 P578 P579 P580 P581 P582 P583 P5841 P5842 P585 P588 P589 P590 P591 P5920 P5929 P593 P598 P599 P60 P610 P611 P612 P613 P614 P615 P616 P618 P619 P700 P701 P702 P703 P704 P708 P709 P710 P711 P712 P713 P714 P718 P719 P720 P721 P722 P728 P729 P740 P741 P742 P743 P744 P745 P746 P748 P749 P760

Neonatal vaginal hemorrhage Other specified neonatal hemorrhages Neonatal hemorrhage, unspecified Rh isoimmunization of newborn ABO isoimmunization of newborn Other hemolytic diseases of newborn Hemolytic disease of newborn, unspecified Hydrops fetalis due to isoimmunization Hydrops fetalis due to unspecified hemolytic disease Hydrops fetalis due to other hemolytic disease Kernicterus due to isoimmunization Other specified kernicterus Kernicterus, unspecified Neonatal jaundice due to bruising Neonatal jaundice due to bleeding Neonatal jaundice due to infection Neonatal jaundice due to polycythemia Neonatal jaundice d/t drugs or toxins transmitd from mother Neonatal jaundice due to drugs or toxins given to newborn Neonatal jaundice due to swallowed maternal blood Neonatal jaundice due to other specified excessive hemolysis Neonatal jaundice due to excessive hemolysis, unspecified Neonatal jaundice associated with preterm delivery Inspissated bile syndrome Neonatal jaundice from unspecified hepatocellular damage Neonatal jaundice from other hepatocellular damage Neonatal jaundice from breast milk inhibitor Neonatal jaundice from other specified causes Neonatal jaundice, unspecified Disseminated intravascular coagulation of newborn Transient neonatal thrombocytopenia Polycythemia neonatorum Anemia of prematurity Congenital anemia from fetal blood loss Other congenital anemias, not elsewhere classified Transient neonatal neutropenia Other transient neonatal disorders of coagulation Other specified perinatal hematological disorders Perinatal hematological disorder, unspecified Syndrome of infant of mother with gestational diabetes Syndrome of infant of a diabetic mother Neonatal diabetes mellitus Iatrogenic neonatal hypoglycemia Other neonatal hypoglycemia Oth transitory disorders of carbohydrate metab of newborn Transitory disorder of carbohydrate metab of newborn, unsp Cow's milk hypocalcemia in newborn Other neonatal hypocalcemia Neonatal hypomagnesemia Neonatal tetany without calcium or magnesium deficiency Transitory neonatal hypoparathyroidism Oth transitory neonatal disord of calcium & magnesium metab Transitory neonatal disord of calcium & magnesium metab,unsp Neonatal goiter, not elsewhere classified Transitory neonatal hyperthyroidism Oth transitory neonatal disorders of thyroid function, NEC Other specified transitory neonatal endocrine disorders Transitory neonatal endocrine disorder, unspecified Late metabolic acidosis of newborn Dehydration of newborn Disturbances of sodium balance of newborn Disturbances of potassium balance of newborn Other transitory electrolyte disturbances of newborn Transitory tyrosinemia of newborn Transitory hyperammonemia of newborn Other transitory metabolic disturbances of newborn Transitory metabolic disturbance of newborn, unspecified Meconium plug syndrome

September 2011

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Newborn diagnoses

P761 P762 P768 P769 P771 P772 P773 P779 P780 P781 P782 P783 P7881 P7882 P7883 P7889 P789 P800 P808 P809 P810 P818 P819 P830 P831 P832 P8330 P8339 P834 P836 P838 P839 P84 P90 P910 P911 P912 P913 P914 P915 P9160 P9161 P9162 P9163 P918 P919 P9201 P9209 P921 P922 P923 P924 P925 P926 P928 P929 P930 P938 P940 P941 P942 P948 P949 P95 P960 P961 P962 P963

Transitory ileus of newborn Intestinal obstruction due to inspissated milk Other specified intestinal obstruction of newborn Intestinal obstruction of newborn, unspecified Stage 1 necrotizing enterocolitis in newborn Stage 2 necrotizing enterocolitis in newborn Stage 3 necrotizing enterocolitis in newborn Necrotizing enterocolitis in newborn, unspecified Perinatal intestinal perforation Other neonatal peritonitis Neonatal hematemesis and melena d/t swallowed matern blood Noninfective neonatal diarrhea Congenital cirrhosis (of liver) Peptic ulcer of newborn Newborn esophageal reflux Other specified perinatal digestive system disorders Perinatal digestive system disorder, unspecified Cold injury syndrome Other hypothermia of newborn Hypothermia of newborn, unspecified Environmental hyperthermia of newborn Oth disturbances of temperature regulation of newborn Disturbance of temperature regulation of newborn, unsp Sclerema neonatorum Neonatal erythema toxicum Hydrops fetalis not due to hemolytic disease Unspecified edema specific to newborn Other edema specific to newborn Breast engorgement of newborn Umbilical polyp of newborn Other specified conditions of integument specific to newborn Condition of the integument specific to newborn, unspecified Other problems with newborn Convulsions of newborn Neonatal cerebral ischemia Acquired periventricular cysts of newborn Neonatal cerebral leukomalacia Neonatal cerebral irritability Neonatal cerebral depression Neonatal coma Hypoxic ischemic encephalopathy [HIE], unspecified Mild hypoxic ischemic encephalopathy [HIE] Moderate hypoxic ischemic encephalopathy [HIE] Severe hypoxic ischemic encephalopathy [HIE] Other specified disturbances of cerebral status of newborn Disturbance of cerebral status of newborn, unspecified Bilious vomiting of newborn Other vomiting of newborn Regurgitation and rumination of newborn Slow feeding of newborn Underfeeding of newborn Overfeeding of newborn Neonatal difficulty in feeding at breast Failure to thrive in newborn Other feeding problems of newborn Feeding problem of newborn, unspecified Grey baby syndrome Oth reactions and intoxications d/t drugs administered to NB Transient neonatal myasthenia gravis Congenital hypertonia Congenital hypotonia Other disorders of muscle tone of newborn Disorder of muscle tone of newborn, unspecified Stillbirth Congenital renal failure Neonatal w/drawal symp from matern use of drugs of addiction Withdrawal symptoms from therapeutic use of drugs in newborn Wide cranial sutures of newborn

1.10 Definitions of Medicare Code Edits

September 2011

Newborn diagnoses

P965 P9682 P9683 P9689 P969 Q861 Z00110 Z00111 Z3800 Z3801 Z381 Z382 Z3830 Z3831 Z384 Z385 Z3861 Z3862 Z3863 Z3864 Z3865 Z3866 Z3868 Z3869 Z387 Z388

Comp to newborn due to (fetal) intrauterine procedure Delayed separation of umbilical cord Meconium staining Oth conditions originating in the perinatal period Condition originating in the perinatal period, unspecified Fetal hydantoin syndrome Health examination for newborn under 8 days old Health examination for newborn 8 to 28 days old Single liveborn infant, delivered vaginally Single liveborn infant, delivered by cesarean Single liveborn infant, born outside hospital Single liveborn infant, unspecified as to place of birth Twin liveborn infant, delivered vaginally Twin liveborn infant, delivered by cesarean Twin liveborn infant, born outside hospital Twin liveborn infant, unspecified as to place of birth Triplet liveborn infant, delivered vaginally Triplet liveborn infant, delivered by cesarean Quadruplet liveborn infant, delivered vaginally Quadruplet liveborn infant, delivered by cesarean Quintuplet liveborn infant, delivered vaginally Quintuplet liveborn infant, delivered by cesarean Other multiple liveborn infant, delivered vaginally Other multiple liveborn infant, delivered by cesarean Other multiple liveborn infant, born outside hospital Other multiple liveborn infant, unsp as to place of birth

September 2011

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Pediatric diagnoses (age 0 through 17)


A4851 B0820 B0821 B0822 E301 E308 F642 F843 F930 F938 F939 F941 F942 F948 F949 F9821 F9829 F983 F988 F989 G937 H26001 H26002 H26003 H26009 H26011 H26012 H26013 H26019 H26031 H26032 H26033 H26039 H26041 H26042 H26043 H26049 H26051 H26052 H26053 H26059 H26061 H26062 H26063 H26069 H2609 L122 L2083 L210 L211 L444 L704 N922 R0481 R1083 R620 R6250 R6251 R6252 R6259 R6811 R6812 R6813 R6819 T7402XA Infant botulism Exanthema subitum [sixth disease], unspecified Exanthema subitum [sixth disease] due to human herpesvirus 6 Exanthema subitum [sixth disease] due to human herpesvirus 7 Precocious puberty Other disorders of puberty Gender identity disorder of childhood Other childhood disintegrative disorder Separation anxiety disorder of childhood Other childhood emotional disorders Childhood emotional disorder, unspecified Reactive attachment disorder of childhood Disinhibited attachment disorder of childhood Other childhood disorders of social functioning Childhood disorder of social functioning, unspecified Rumination disorder of infancy Other feeding disorders of infancy and early childhood Pica of infancy and childhood Oth behav/emotn disord w onset usly occur in chldhd and adol Unsp behav/emotn disord w onst usly occur in chldhd and adol Reye's syndrome Unspecified infantile and juvenile cataract, right eye Unspecified infantile and juvenile cataract, left eye Unspecified infantile and juvenile cataract, bilateral Unspecified infantile and juvenile cataract, unspecified eye Infantile and juv cortical/lamellar/zonular cataract, r eye Infantile and juv cortical/lamellar/zonular cataract, l eye Infantile and juv cortical/lamellar/zonular cataract, bi Infantile & juv cortical/lamellar/zonular cataract, unsp eye Infantile and juvenile nuclear cataract, right eye Infantile and juvenile nuclear cataract, left eye Infantile and juvenile nuclear cataract, bilateral Infantile and juvenile nuclear cataract, unspecified eye Ant subcapsular polar infantile and juvenile cataract, r eye Ant subcapsular polar infantile and juv cataract, left eye Ant subcapsular polar infantile and juvenile cataract, bi Ant subcapsular polar infantile and juv cataract, unsp eye Post subcapsular polar infantile and juv cataract, r eye Post subcapsular polar infantile and juv cataract, left eye Post subcapsular polar infantile and juvenile cataract, bi Post subcapsular polar infantile and juv cataract, unsp eye Combined forms of infantile and juvenile cataract, right eye Combined forms of infantile and juvenile cataract, left eye Combined forms of infantile and juvenile cataract, bilateral Combined forms of infantile and juvenile cataract, unsp eye Other infantile and juvenile cataract Chronic bullous disease of childhood Infantile (acute) (chronic) eczema Seborrhea capitis Seborrheic infantile dermatitis Infantile papular acrodermatitis [Gianotti-Crosti] Infantile acne Excessive menstruation at puberty Acute idiopathic pulmonary hemorrhage in infants Colic Delayed milestone in childhood Unsp lack of expected normal physiol dev in childhood Failure to thrive (child) Short stature (child) Oth lack of expected normal physiol development in childhood Excessive crying of infant (baby) Fussy infant (baby) Apparent life threatening event in infant (ALTE) Other nonspecific symptoms peculiar to infancy Child neglect or abandonment, confirmed, initial encounter

1.12 Definitions of Medicare Code Edits

September 2011

Pediatric diagnoses (age 0 through 17)

T7402XD T7402XS T7412XA T7412XD T7412XS T7422XA T7422XD T7422XS T7432XA T7432XD T7432XS T744XXA T744XXD T744XXS T7492XA T7492XD T7492XS T7602XA T7602XD T7602XS T7612XA T7612XD T7612XS T7622XA T7622XD T7622XS T7632XA T7632XD T7632XS T7692XA T7692XD T7692XS Y936A Z00121 Z00129 Z002 Z003 Z0070 Z0071 Z0442 Z0472 Z134 Z6221 Z623 Z6851 Z6852 Z6853 Z6854 Z69010 Z69020 Z72810 Z73810 Z73811 Z73812 Z73819 Z762

Child neglect or abandonment, confirmed, subs encntr Child neglect or abandonment, confirmed, sequela Child physical abuse, confirmed, initial encounter Child physical abuse, confirmed, subsequent encounter Child physical abuse, confirmed, sequela Child sexual abuse, confirmed, initial encounter Child sexual abuse, confirmed, subsequent encounter Child sexual abuse, confirmed, sequela Child psychological abuse, confirmed, initial encounter Child psychological abuse, confirmed, subsequent encounter Child psychological abuse, confirmed, sequela Shaken infant syndrome, initial encounter Shaken infant syndrome, subsequent encounter Shaken infant syndrome, sequela Unspecified child maltreatment, confirmed, initial encounter Unspecified child maltreatment, confirmed, subs encntr Unspecified child maltreatment, confirmed, sequela Child neglect or abandonment, suspected, initial encounter Child neglect or abandonment, suspected, subs encntr Child neglect or abandonment, suspected, sequela Child physical abuse, suspected, initial encounter Child physical abuse, suspected, subsequent encounter Child physical abuse, suspected, sequela Child sexual abuse, suspected, initial encounter Child sexual abuse, suspected, subsequent encounter Child sexual abuse, suspected, sequela Child psychological abuse, suspected, initial encounter Child psychological abuse, suspected, subsequent encounter Child psychological abuse, suspected, sequela Unspecified child maltreatment, suspected, initial encounter Unspecified child maltreatment, suspected, subs encntr Unspecified child maltreatment, suspected, sequela Actvty,physcl games assoc w school recess, sumr camp & child Encounter for routine child health exam w abnormal findings Encntr for routine child health exam w/o abnormal findings Encounter for exam for period of rapid growth in childhood Encounter for examination for adolescent development state Encntr for exam for delay growth in chldhd w/o abn findings Encntr for exam for delay growth in chldhd w abn findings Encounter for exam and obs following alleged child rape Encntr for exam and obs fol alleged child physical abuse Encntr screen for certain developmental disorders in chldhd Child in welfare custody Hostility towards and scapegoating of child BMI pediatric, less than 5th percentile for age BMI pediatric, 5th percentile to less than 85% for age BMI pediatric, 85% to less than 95th percentile for age BMI pediatric, greater than or equal to 95% for age Encntr for mental hlth serv for victim of prntl child abuse Encntr for mntl hlth serv for vctm of non-prntl child abuse Child and adolescent antisocial behavior Behavioral insomnia of childhood, sleep-onset assoc type Behavioral insomnia of childhood, limit setting type Behavioral insomnia of childhood, combined type Behavioral insomnia of childhood, unspecified type Encntr for hlth suprvsn and care of healthy infant and child

September 2011

Edit code lists 1.13

Maternity diagnoses (age 12 through 55)


A34 M830 O000 O001 O002 O008 O009 O010 O011 O019 O020 O021 O028 O029 O030 O031 O032 O0330 O0331 O0332 O0333 O0334 O0335 O0336 O0337 O0338 O0339 O034 O035 O036 O037 O0380 O0381 O0382 O0383 O0384 O0385 O0386 O0387 O0388 O0389 O039 O045 O046 O047 O0480 O0481 O0482 O0483 O0484 O0485 O0486 O0487 O0488 O0489 O070 O071 O072 O0730 O0731 O0732 O0733 O0734 O0735 O0736 Obstetrical tetanus Puerperal osteomalacia Abdominal pregnancy Tubal pregnancy Ovarian pregnancy Other ectopic pregnancy Ectopic pregnancy, unspecified Classical hydatidiform mole Incomplete and partial hydatidiform mole Hydatidiform mole, unspecified Blighted ovum and nonhydatidiform mole Missed abortion Other specified abnormal products of conception Abnormal product of conception, unspecified Genitl trct and pelvic infection fol incmpl spon abortion Delayed or excessive hemor following incmpl spon abortion Embolism following incomplete spontaneous abortion Unsp complication following incomplete spontaneous abortion Shock following incomplete spontaneous abortion Renal failure following incomplete spontaneous abortion Metabolic disorder following incomplete spontaneous abortion Damage to pelvic organs following incomplete spon abortion Oth venous comp following incomplete spontaneous abortion Cardiac arrest following incomplete spontaneous abortion Sepsis following incomplete spontaneous abortion Urinary tract infection following incomplete spon abortion Incomplete spontaneous abortion with other complications Incomplete spontaneous abortion without complication Genitl trct and pelvic infct fol complete or unsp spon abort Delayed or excess hemor fol complete or unsp spon abortion Embolism following complete or unsp spontaneous abortion Unsp comp following complete or unsp spontaneous abortion Shock following complete or unspecified spontaneous abortion Renal failure following complete or unsp spon abortion Metabolic disorder following complete or unsp spon abortion Damage to pelvic organs fol complete or unsp spon abortion Oth venous comp following complete or unsp spon abortion Cardiac arrest following complete or unsp spon abortion Sepsis following complete or unsp spontaneous abortion Urinary tract infection fol complete or unsp spon abortion Complete or unsp spontaneous abortion with oth complications Complete or unsp spontaneous abortion without complication Genitl trct and pelvic infct fol (induced) term of pregnancy Delayed or excess hemor fol (induced) term of pregnancy Embolism following (induced) termination of pregnancy (Induced) termination of pregnancy with unsp complications Shock following (induced) termination of pregnancy Renal failure following (induced) termination of pregnancy Metabolic disorder following (induced) term of pregnancy Damage to pelvic organs fol (induced) term of pregnancy Oth venous comp following (induced) termination of pregnancy Cardiac arrest following (induced) termination of pregnancy Sepsis following (induced) termination of pregnancy Urinary tract infection fol (induced) term of pregnancy (Induced) termination of pregnancy with other complications Genitl trct and pelvic infct fol failed attempt term of preg Delayed or excess hemor fol failed attempt term of pregnancy Embolism following failed attempted termination of pregnancy Failed attempted termination of pregnancy w unsp comp Shock following failed attempted termination of pregnancy Renal failure following failed attempted term of pregnancy Metabolic disorder fol failed attempt term of pregnancy Damage to pelvic organs fol failed attempt term of pregnancy Oth venous comp following failed attempted term of pregnancy Cardiac arrest following failed attempted term of pregnancy

1.14 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O09829 O09891 O09892 O09893 O09899 O0990 O0991 O0992 O0993 O10011 O10012 O10013 O10019 O1002 O1003 O10111 O10112 O10113 O10119 O1012 O1013 O10211 O10212 O10213 O10219 O1022 O1023 O10311 O10312 O10313 O10319 O1032 O1033 O10411 O10412 O10413 O10419 O1042 O1043 O10911 O10912 O10913 O10919 O1092 O1093 O111 O112 O113 O119 O1200 O1201 O1202 O1203 O1210 O1211 O1212 O1213 O1220 O1221 O1222 O1223 O131 O132 O133 O139 O1400 O1402 O1403

Suprvsn of preg w hx of in utero proc dur prev preg,unsp tri Supervision of other high risk pregnancies, first trimester Supervision of other high risk pregnancies, second trimester Supervision of other high risk pregnancies, third trimester Supervision of other high risk pregnancies, unsp trimester Supervision of high risk pregnancy, unsp, unsp trimester Supervision of high risk pregnancy, unsp, first trimester Supervision of high risk pregnancy, unsp, second trimester Supervision of high risk pregnancy, unsp, third trimester Pre-existing essential htn comp pregnancy, first trimester Pre-existing essential htn comp pregnancy, second trimester Pre-existing essential htn comp pregnancy, third trimester Pre-existing essential htn comp pregnancy, unsp trimester Pre-existing essential hypertension complicating childbirth Pre-existing essential hypertension comp the puerperium Pre-exist hyp heart disease comp pregnancy, first trimester Pre-exist hyp heart disease comp pregnancy, second trimester Pre-exist hyp heart disease comp pregnancy, third trimester Pre-exist hyp heart disease comp pregnancy, unsp trimester Pre-existing hypertensive heart disease comp childbirth Pre-existing hypertensive heart disease comp the puerperium Pre-exist hyp chronic kidney disease comp preg, first tri Pre-exist hyp chronic kidney disease comp preg, second tri Pre-exist hyp chronic kidney disease comp preg, third tri Pre-exist hyp chronic kidney disease comp preg, unsp tri Pre-existing hyp chronic kidney disease comp childbirth Pre-existing hyp chronic kidney disease comp the puerperium Pre-exist hyp heart and chr kidney dis comp preg, first tri Pre-exist hyp heart and chr kidney dis comp preg, second tri Pre-exist hyp heart and chr kidney dis comp preg, third tri Pre-exist hyp heart and chr kidney dis comp preg, unsp tri Pre-exist hyp heart and chronic kidney disease comp chldbrth Pre-exist hyp heart and chr kidney disease comp the puerp Pre-existing secondary htn comp pregnancy, first trimester Pre-existing secondary htn comp pregnancy, second trimester Pre-existing secondary htn comp pregnancy, third trimester Pre-existing secondary htn comp pregnancy, unsp trimester Pre-existing secondary hypertension complicating childbirth Pre-existing secondary hypertension comp the puerperium Unsp pre-existing htn comp pregnancy, first trimester Unsp pre-existing htn comp pregnancy, second trimester Unsp pre-existing htn comp pregnancy, third trimester Unsp pre-existing htn comp pregnancy, unsp trimester Unsp pre-existing hypertension complicating childbirth Unsp pre-existing hypertension complicating the puerperium Pre-existing hypertension w pre-eclampsia, first trimester Pre-existing hypertension w pre-eclampsia, second trimester Pre-existing hypertension w pre-eclampsia, third trimester Pre-existing hypertension with pre-eclampsia, unsp trimester Gestational edema, unspecified trimester Gestational edema, first trimester Gestational edema, second trimester Gestational edema, third trimester Gestational proteinuria, unspecified trimester Gestational proteinuria, first trimester Gestational proteinuria, second trimester Gestational proteinuria, third trimester Gestational edema with proteinuria, unspecified trimester Gestational edema with proteinuria, first trimester Gestational edema with proteinuria, second trimester Gestational edema with proteinuria, third trimester Gestational htn w/o significant proteinuria, first trimester Gestatnl htn w/o significant proteinuria, second trimester Gestational htn w/o significant proteinuria, third trimester Gestational htn w/o significant proteinuria, unsp trimester Mild to moderate pre-eclampsia, unspecified trimester Mild to moderate pre-eclampsia, second trimester Mild to moderate pre-eclampsia, third trimester

September 2011

Edit code lists 1.15

Maternity diagnoses (age 12 through 55)

O0737 O0738 O0739 O074 O080 O081 O082 O083 O084 O085 O086 O087 O0881 O0882 O0883 O0889 O089 O0900 O0901 O0902 O0903 O0910 O0911 O0912 O0913 O09211 O09212 O09213 O09219 O09291 O09292 O09293 O09299 O0930 O0931 O0932 O0933 O0940 O0941 O0942 O0943 O09511 O09512 O09513 O09519 O09521 O09522 O09523 O09529 O09611 O09612 O09613 O09619 O09621 O09622 O09623 O09629 O0970 O0971 O0972 O0973 O09811 O09812 O09813 O09819 O09821 O09822 O09823

Sepsis following failed attempted termination of pregnancy Urinary tract infection fol failed attempt term of pregnancy Failed attempted termination of pregnancy w oth comp Failed attempted termination of pregnancy w/o complication Genitl trct and pelvic infct fol ectopic and molar pregnancy Delayed or excess hemor fol ectopic and molar pregnancy Embolism following ectopic and molar pregnancy Shock following ectopic and molar pregnancy Renal failure following ectopic and molar pregnancy Metabolic disorders following an ectopic and molar pregnancy Damage to pelvic organs and tiss fol an ect and molar preg Oth venous comp following an ectopic and molar pregnancy Cardiac arrest following an ectopic and molar pregnancy Sepsis following ectopic and molar pregnancy Urinary tract infection fol an ectopic and molar pregnancy Other complications following an ectopic and molar pregnancy Unsp complication following an ectopic and molar pregnancy Suprvsn of preg w history of infertility, unsp trimester Suprvsn of preg w history of infertility, first trimester Suprvsn of preg w history of infertility, second trimester Suprvsn of preg w history of infertility, third trimester Suprvsn of preg w history of ectopic or molar preg, unsp tri Suprvsn of preg w history of ect or molar preg, first tri Suprvsn of preg w history of ect or molar preg, second tri Suprvsn of preg w history of ect or molar preg, third tri Suprvsn of preg w history of pre-term labor, first trimester Suprvsn of preg w history of pre-term labor, second tri Suprvsn of preg w history of pre-term labor, third trimester Suprvsn of preg w history of pre-term labor, unsp trimester Suprvsn of preg w poor reprodctv or obstet hx, first tri Suprvsn of preg w poor reprodctv or obstet hx, second tri Suprvsn of preg w poor reprodctv or obstet hx, third tri Suprvsn of preg w poor reprodctv or obstet history, unsp tri Suprvsn of preg w insufficient antenat care, unsp trimester Suprvsn of preg w insufficient antenat care, first trimester Suprvsn of preg w insufficient antenat care, second tri Suprvsn of preg w insufficient antenat care, third trimester Supervision of pregnancy w grand multiparity, unsp trimester Suprvsn of pregnancy w grand multiparity, first trimester Suprvsn of pregnancy w grand multiparity, second trimester Suprvsn of pregnancy w grand multiparity, third trimester Supervision of elderly primigravida, first trimester Supervision of elderly primigravida, second trimester Supervision of elderly primigravida, third trimester Supervision of elderly primigravida, unspecified trimester Supervision of elderly multigravida, first trimester Supervision of elderly multigravida, second trimester Supervision of elderly multigravida, third trimester Supervision of elderly multigravida, unspecified trimester Supervision of young primigravida, first trimester Supervision of young primigravida, second trimester Supervision of young primigravida, third trimester Supervision of young primigravida, unspecified trimester Supervision of young multigravida, first trimester Supervision of young multigravida, second trimester Supervision of young multigravida, third trimester Supervision of young multigravida, unspecified trimester Suprvsn of high risk preg due to social problems, unsp tri Suprvsn of high risk preg due to social problems, first tri Suprvsn of high risk preg due to social problems, second tri Suprvsn of high risk preg due to social problems, third tri Suprvsn of preg rslt from assisted reprodctv tech, first tri Suprvsn of preg rslt from assist reprodctv tech, second tri Suprvsn of preg rslt from assisted reprodctv tech, third tri Suprvsn of preg rslt from assisted reprodctv tech, unsp tri Suprvsn of preg w hx of in utero proc dur prev preg, 1st tri Suprvsn of preg w hx of in utero proc dur prev preg, 2nd tri Suprvsn of preg w hx of in utero proc dur prev preg, 3rd tri

1.16 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O1410 O1412 O1413 O1420 O1422 O1423 O1490 O1492 O1493 O1500 O1502 O1503 O151 O152 O159 O161 O162 O163 O169 O200 O208 O209 O210 O211 O212 O218 O219 O2200 O2201 O2202 O2203 O2210 O2211 O2212 O2213 O2220 O2221 O2222 O2223 O2230 O2231 O2232 O2233 O2240 O2241 O2242 O2243 O2250 O2251 O2252 O2253 O228X1 O228X2 O228X3 O228X9 O2290 O2291 O2292 O2293 O2300 O2301 O2302 O2303 O2310 O2311 O2312 O2313 O2320

Severe pre-eclampsia, unspecified trimester Severe pre-eclampsia, second trimester Severe pre-eclampsia, third trimester HELLP syndrome (HELLP), unspecified trimester HELLP syndrome (HELLP), second trimester HELLP syndrome (HELLP), third trimester Unspecified pre-eclampsia, unspecified trimester Unspecified pre-eclampsia, second trimester Unspecified pre-eclampsia, third trimester Eclampsia in pregnancy, unspecified trimester Eclampsia in pregnancy, second trimester Eclampsia in pregnancy, third trimester Eclampsia in labor Eclampsia in the puerperium Eclampsia, unspecified as to time period Unspecified maternal hypertension, first trimester Unspecified maternal hypertension, second trimester Unspecified maternal hypertension, third trimester Unspecified maternal hypertension, unspecified trimester Threatened abortion Other hemorrhage in early pregnancy Hemorrhage in early pregnancy, unspecified Mild hyperemesis gravidarum Hyperemesis gravidarum with metabolic disturbance Late vomiting of pregnancy Other vomiting complicating pregnancy Vomiting of pregnancy, unspecified Varicose veins of low extrm in pregnancy, unsp trimester Varicose veins of low extrm in pregnancy, first trimester Varicose veins of low extrm in pregnancy, second trimester Varicose veins of low extrm in pregnancy, third trimester Genital varices in pregnancy, unspecified trimester Genital varices in pregnancy, first trimester Genital varices in pregnancy, second trimester Genital varices in pregnancy, third trimester Superficial thrombophlebitis in pregnancy, unsp trimester Superficial thrombophlebitis in pregnancy, first trimester Superficial thrombophlebitis in pregnancy, second trimester Superficial thrombophlebitis in pregnancy, third trimester Deep phlebothrombosis in pregnancy, unspecified trimester Deep phlebothrombosis in pregnancy, first trimester Deep phlebothrombosis in pregnancy, second trimester Deep phlebothrombosis in pregnancy, third trimester Hemorrhoids in pregnancy, unspecified trimester Hemorrhoids in pregnancy, first trimester Hemorrhoids in pregnancy, second trimester Hemorrhoids in pregnancy, third trimester Cerebral venous thrombosis in pregnancy, unsp trimester Cerebral venous thrombosis in pregnancy, first trimester Cerebral venous thrombosis in pregnancy, second trimester Cerebral venous thrombosis in pregnancy, third trimester Other venous complications in pregnancy, first trimester Other venous complications in pregnancy, second trimester Other venous complications in pregnancy, third trimester Other venous complications in pregnancy, unsp trimester Venous complication in pregnancy, unsp, unsp trimester Venous complication in pregnancy, unsp, first trimester Venous complication in pregnancy, unsp, second trimester Venous complication in pregnancy, unsp, third trimester Infections of kidney in pregnancy, unspecified trimester Infections of kidney in pregnancy, first trimester Infections of kidney in pregnancy, second trimester Infections of kidney in pregnancy, third trimester Infections of bladder in pregnancy, unspecified trimester Infections of bladder in pregnancy, first trimester Infections of bladder in pregnancy, second trimester Infections of bladder in pregnancy, third trimester Infections of urethra in pregnancy, unspecified trimester

September 2011

Edit code lists 1.17

Maternity diagnoses (age 12 through 55)

O2321 O2322 O2323 O2330 O2331 O2332 O2333 O2340 O2341 O2342 O2343 O23511 O23512 O23513 O23519 O23521 O23522 O23523 O23529 O23591 O23592 O23593 O23599 O2390 O2391 O2392 O2393 O24011 O24012 O24013 O24019 O2402 O2403 O24111 O24112 O24113 O24119 O2412 O2413 O24311 O24312 O24313 O24319 O2432 O2433 O24410 O24414 O24419 O24420 O24424 O24429 O24430 O24434 O24439 O24811 O24812 O24813 O24819 O2482 O2483 O24911 O24912 O24913 O24919 O2492 O2493 O2510 O2511

Infections of urethra in pregnancy, first trimester Infections of urethra in pregnancy, second trimester Infections of urethra in pregnancy, third trimester Infections of prt urinary tract in pregnancy, unsp trimester Infect of prt urinary tract in pregnancy, first trimester Infect of prt urinary tract in pregnancy, second trimester Infect of prt urinary tract in pregnancy, third trimester Unsp infection of urinary tract in pregnancy, unsp trimester Unsp infct of urinary tract in pregnancy, first trimester Unsp infct of urinary tract in pregnancy, second trimester Unsp infct of urinary tract in pregnancy, third trimester Infections of cervix in pregnancy, first trimester Infections of cervix in pregnancy, second trimester Infections of cervix in pregnancy, third trimester Infections of cervix in pregnancy, unspecified trimester Salpingo-oophoritis in pregnancy, first trimester Salpingo-oophoritis in pregnancy, second trimester Salpingo-oophoritis in pregnancy, third trimester Salpingo-oophoritis in pregnancy, unspecified trimester Infection oth prt genitl trct in pregnancy, first trimester Infection oth prt genitl trct in pregnancy, second trimester Infection oth prt genitl trct in pregnancy, third trimester Infection oth prt genital tract in pregnancy, unsp trimester Unsp GU tract infection in pregnancy, unsp trimester Unsp GU tract infection in pregnancy, first trimester Unsp GU tract infection in pregnancy, second trimester Unsp GU tract infection in pregnancy, third trimester Pre-existing diabetes, type 1, in pregnancy, first trimester Pre-exist diabetes, type 1, in pregnancy, second trimester Pre-existing diabetes, type 1, in pregnancy, third trimester Pre-existing diabetes, type 1, in pregnancy, unsp trimester Pre-existing diabetes mellitus, type 1, in childbirth Pre-existing diabetes mellitus, type 1, in the puerperium Pre-existing diabetes, type 2, in pregnancy, first trimester Pre-exist diabetes, type 2, in pregnancy, second trimester Pre-existing diabetes, type 2, in pregnancy, third trimester Pre-existing diabetes, type 2, in pregnancy, unsp trimester Pre-existing diabetes mellitus, type 2, in childbirth Pre-existing diabetes mellitus, type 2, in the puerperium Unsp pre-existing diabetes in pregnancy, first trimester Unsp pre-existing diabetes in pregnancy, second trimester Unsp pre-existing diabetes in pregnancy, third trimester Unsp pre-existing diabetes in pregnancy, unsp trimester Unspecified pre-existing diabetes mellitus in childbirth Unspecified pre-existing diabetes mellitus in the puerperium Gestational diabetes mellitus in pregnancy, diet controlled Gestational diabetes in pregnancy, insulin controlled Gestational diabetes mellitus in pregnancy, unsp control Gestational diabetes mellitus in childbirth, diet controlled Gestational diabetes in childbirth, insulin controlled Gestational diabetes mellitus in childbirth, unsp control Gestational diabetes in the puerperium, diet controlled Gestational diabetes in the puerperium, insulin controlled Gestational diabetes in the puerperium, unsp control Oth pre-existing diabetes in pregnancy, first trimester Oth pre-existing diabetes in pregnancy, second trimester Oth pre-existing diabetes in pregnancy, third trimester Oth pre-existing diabetes in pregnancy, unsp trimester Other pre-existing diabetes mellitus in childbirth Other pre-existing diabetes mellitus in the puerperium Unspecified diabetes mellitus in pregnancy, first trimester Unspecified diabetes mellitus in pregnancy, second trimester Unspecified diabetes mellitus in pregnancy, third trimester Unsp diabetes mellitus in pregnancy, unspecified trimester Unspecified diabetes mellitus in childbirth Unspecified diabetes mellitus in the puerperium Malnutrition in pregnancy, unspecified trimester Malnutrition in pregnancy, first trimester

1.18 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O2512 O2513 O252 O253 O2600 O2601 O2602 O2603 O2610 O2611 O2612 O2613 O2620 O2621 O2622 O2623 O2630 O2631 O2632 O2633 O2640 O2641 O2642 O2643 O2650 O2651 O2652 O2653 O26611 O26612 O26613 O26619 O2662 O2663 O26711 O26712 O26713 O26719 O2672 O2673 O26811 O26812 O26813 O26819 O26821 O26822 O26823 O26829 O26831 O26832 O26833 O26839 O26841 O26842 O26843 O26849 O26851 O26852 O26853 O26859 O2686 O26872 O26873 O26879 O26891 O26892 O26893 O26899

Malnutrition in pregnancy, second trimester Malnutrition in pregnancy, third trimester Malnutrition in childbirth Malnutrition in the puerperium Excessive weight gain in pregnancy, unspecified trimester Excessive weight gain in pregnancy, first trimester Excessive weight gain in pregnancy, second trimester Excessive weight gain in pregnancy, third trimester Low weight gain in pregnancy, unspecified trimester Low weight gain in pregnancy, first trimester Low weight gain in pregnancy, second trimester Low weight gain in pregnancy, third trimester Preg care for patient w recurrent preg loss, unsp trimester Preg care for patient w recurrent preg loss, first trimester Preg care for patient w recur preg loss, second trimester Preg care for patient w recurrent preg loss, third trimester Retained uterin contracep dev in pregnancy, unsp trimester Retained uterin contracep dev in pregnancy, first trimester Retained uterin contracep dev in pregnancy, second trimester Retained uterin contracep dev in pregnancy, third trimester Herpes gestationis, unspecified trimester Herpes gestationis, first trimester Herpes gestationis, second trimester Herpes gestationis, third trimester Maternal hypotension syndrome, unspecified trimester Maternal hypotension syndrome, first trimester Maternal hypotension syndrome, second trimester Maternal hypotension syndrome, third trimester Liver disorders in pregnancy, first trimester Liver disorders in pregnancy, second trimester Liver disorders in pregnancy, third trimester Liver disorders in pregnancy, unspecified trimester Liver disorders in childbirth Liver disorders in the puerperium Sublux of symphysis (pubis) in pregnancy, first trimester Sublux of symphysis (pubis) in pregnancy, second trimester Sublux of symphysis (pubis) in pregnancy, third trimester Sublux of symphysis (pubis) in pregnancy, unsp trimester Subluxation of symphysis (pubis) in childbirth Subluxation of symphysis (pubis) in the puerperium Pregnancy related exhaustion and fatigue, first trimester Pregnancy related exhaustion and fatigue, second trimester Pregnancy related exhaustion and fatigue, third trimester Pregnancy related exhaustion and fatigue, unsp trimester Pregnancy related peripheral neuritis, first trimester Pregnancy related peripheral neuritis, second trimester Pregnancy related peripheral neuritis, third trimester Pregnancy related peripheral neuritis, unspecified trimester Pregnancy related renal disease, first trimester Pregnancy related renal disease, second trimester Pregnancy related renal disease, third trimester Pregnancy related renal disease, unspecified trimester Uterine size-date discrepancy, first trimester Uterine size-date discrepancy, second trimester Uterine size-date discrepancy, third trimester Uterine size-date discrepancy, unspecified trimester Spotting complicating pregnancy, first trimester Spotting complicating pregnancy, second trimester Spotting complicating pregnancy, third trimester Spotting complicating pregnancy, unspecified trimester Pruritic urticarial papules and plaques of pregnancy (PUPPP) Cervical shortening, second trimester Cervical shortening, third trimester Cervical shortening, unspecified trimester Oth pregnancy related conditions, first trimester Oth pregnancy related conditions, second trimester Oth pregnancy related conditions, third trimester Oth pregnancy related conditions, unspecified trimester

September 2011

Edit code lists 1.19

Maternity diagnoses (age 12 through 55)

O2690 O2691 O2692 O2693 O280 O281 O282 O283 O284 O285 O288 O289 O29011 O29012 O29013 O29019 O29021 O29022 O29023 O29029 O29091 O29092 O29093 O29099 O29111 O29112 O29113 O29119 O29121 O29122 O29123 O29129 O29191 O29192 O29193 O29199 O29211 O29212 O29213 O29219 O29291 O29292 O29293 O29299 O293X1 O293X2 O293X3 O293X9 O2940 O2941 O2942 O2943 O295X1 O295X2 O295X3 O295X9 O2960 O2961 O2962 O2963 O298X1 O298X2 O298X3 O298X9 O2990 O2991 O2992 O2993

Pregnancy related conditions, unsp, unspecified trimester Pregnancy related conditions, unspecified, first trimester Pregnancy related conditions, unspecified, second trimester Pregnancy related conditions, unspecified, third trimester Abnormal hematolog finding on antenatal screening of mother Abnormal biochemical finding on antenat screening of mother Abnormal cytolog finding on antenatal screening of mother Abnormal ultrasonic finding on antenatal screening of mother Abnormal radiolog finding on antenatal screening of mother Abn chromsoml and genetic find on antenat screen of mother Other abnormal findings on antenatal screening of mother Unsp abnormal findings on antenatal screening of mother Aspirat pneumonitis due to anesth during preg, first tri Aspirat pneumonitis due to anesth during preg, second tri Aspirat pneumonitis due to anesth during preg, third tri Aspirat pneumonitis due to anesth during preg, unsp tri Pressr collapse of lung due to anesth during preg, first tri Pressr collapse of lung d/t anesth during preg, second tri Pressr collapse of lung due to anesth during preg, third tri Pressr collapse of lung due to anesth during preg, unsp tri Oth pulmonary comp of anesth during preg, first trimester Oth pulmonary comp of anesth during preg, second trimester Oth pulmonary comp of anesth during preg, third trimester Oth pulmonary comp of anesth during preg, unsp trimester Cardiac arrest due to anesth during preg, first trimester Cardiac arrest due to anesth during preg, second trimester Cardiac arrest due to anesth during preg, third trimester Cardiac arrest due to anesth during preg, unsp trimester Cardiac failure due to anesth during preg, first trimester Cardiac failure due to anesth during preg, second trimester Cardiac failure due to anesth during preg, third trimester Cardiac failure due to anesth during preg, unsp trimester Oth cardiac comp of anesth during pregnancy, first trimester Oth cardiac comp of anesth during preg, second trimester Oth cardiac comp of anesth during pregnancy, third trimester Oth cardiac comp of anesth during pregnancy, unsp trimester Cerebral anoxia due to anesth during preg, first trimester Cerebral anoxia due to anesth during preg, second trimester Cerebral anoxia due to anesth during preg, third trimester Cerebral anoxia due to anesth during preg, unsp trimester Oth cnsl comp of anesth during pregnancy, first trimester Oth cnsl comp of anesth during pregnancy, second trimester Oth cnsl comp of anesth during pregnancy, third trimester Oth cnsl comp of anesthesia during pregnancy, unsp trimester Toxic reaction to local anesth during preg, first trimester Toxic reaction to local anesth during preg, second trimester Toxic reaction to local anesth during preg, third trimester Toxic reaction to local anesth during preg, unsp trimester Spinal and epidur anesth induce hdache during preg, unsp tri Spinal and epidur anesth induce hdache dur preg, first tri Spinal and epidur anesth induce hdache dur preg, second tri Spinal and epidur anesth induce hdache dur preg, third tri Oth comp of spinal and epidur anesth during preg, first tri Oth comp of spinal and epidur anesth during preg, second tri Oth comp of spinal and epidur anesth during preg, third tri Oth comp of spinal and epidural anesth during preg, unsp tri Failed or difficult intubation for anesth dur preg, unsp tri Fail or difficult intubation for anesth dur preg, first tri Fail or difficult intubation for anesth dur preg, second tri Fail or difficult intubation for anesth dur preg, third tri Oth comp of anesthesia during pregnancy, first trimester Oth comp of anesthesia during pregnancy, second trimester Oth comp of anesthesia during pregnancy, third trimester Oth comp of anesthesia during pregnancy, unsp trimester Unsp comp of anesthesia during pregnancy, unsp trimester Unsp comp of anesthesia during pregnancy, first trimester Unsp comp of anesthesia during pregnancy, second trimester Unsp comp of anesthesia during pregnancy, third trimester

1.20 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O30001 O30002 O30003 O30009 O30011 O30012 O30013 O30019 O30021 O30022 O30023 O30029 O30031 O30032 O30033 O30039 O30041 O30042 O30043 O30049 O30091 O30092 O30093 O30099 O30101 O30102 O30103 O30109 O30111 O30112 O30113 O30119 O30121 O30122 O30123 O30129 O30191 O30192 O30193 O30199 O30201 O30202 O30203 O30209 O30211 O30212 O30213 O30219 O30221 O30222 O30223 O30229 O30291 O30292 O30293 O30299 O30801 O30802 O30803 O30809 O30811 O30812 O30813 O30819 O30821 O30822 O30823 O30829

Twin preg, unsp num plcnta & amnio sacs, first trimester Twin preg, unsp num plcnta & amnio sacs, second trimester Twin preg, unsp num plcnta & amnio sacs, third trimester Twin pregnancy, unsp num plcnta & amnio sacs, unsp trimester Twin pregnancy, monochorionic/monoamniotic, first trimester Twin pregnancy, monochorionic/monoamniotic, second trimester Twin pregnancy, monochorionic/monoamniotic, third trimester Twin pregnancy, monochorionic/monoamniotic, unsp trimester Conjoined twins, first trimester Conjoined twins, second trimester Conjoined twins, third trimester Conjoined twins, unspecified trimester Twin pregnancy, monochorionic/diamniotic, first trimester Twin pregnancy, monochorionic/diamniotic, second trimester Twin pregnancy, monochorionic/diamniotic, third trimester Twin pregnancy, monochorionic/diamniotic, unsp trimester Twin pregnancy, dichorionic/diamniotic, first trimester Twin pregnancy, dichorionic/diamniotic, second trimester Twin pregnancy, dichorionic/diamniotic, third trimester Twin pregnancy, dichorionic/diamniotic, unsp trimester Twin preg, unable to dtrm num plcnta & amnio sacs, first tri Twin preg, unable to dtrm num plcnta & amnio sacs, 2nd tri Twin preg, unable to dtrm num plcnta & amnio sacs, third tri Twin preg, unable to dtrm num plcnta & amnio sacs, unsp tri Triplet preg, unsp num plcnta & amnio sacs, first trimester Triplet preg, unsp num plcnta & amnio sacs, second trimester Triplet preg, unsp num plcnta & amnio sacs, third trimester Triplet preg, unsp num plcnta & amnio sacs, unsp trimester Triplet preg w two or more monochorionic fetuses, first tri Triplet preg w two or more monochorionic fetuses, second tri Triplet preg w two or more monochorionic fetuses, third tri Triplet preg w two or more monochorionic fetuses, unsp tri Triplet preg w two or more monoamnio fetuses, first tri Triplet preg w two or more monoamnio fetuses, second tri Triplet preg w two or more monoamnio fetuses, third tri Triplet preg w two or more monoamnio fetuses, unsp trimester Trp preg, unable to dtrm num plcnta & amnio sacs, first tri Trp preg, unable to dtrm num plcnta & amnio sacs, second tri Trp preg, unable to dtrm num plcnta & amnio sacs, third tri Trp preg, unable to dtrm num plcnta & amnio sacs, unsp tri Quad preg, unsp num plcnta & amnio sacs, first trimester Quad preg, unsp num plcnta & amnio sacs, second trimester Quad preg, unsp num plcnta & amnio sacs, third trimester Quad pregnancy, unsp num plcnta & amnio sacs, unsp trimester Quad preg w two or more monochorionic fetuses, first tri Quad preg w two or more monochorionic fetuses, second tri Quad preg w two or more monochorionic fetuses, third tri Quad preg w two or more monochorionic fetuses, unsp tri Quad preg w two or more monoamnio fetuses, first trimester Quad preg w two or more monoamnio fetuses, second trimester Quad preg w two or more monoamnio fetuses, third trimester Quad preg w two or more monoamnio fetuses, unsp trimester Quad preg, unable to dtrm num plcnta & amnio sacs, first tri Quad preg, unable to dtrm num plcnta & amnio sacs, 2nd tri Quad preg, unable to dtrm num plcnta & amnio sacs, third tri Quad preg, unable to dtrm num plcnta & amnio sacs, unsp tri Oth multiple gest, unsp num plcnta & amnio sacs, first tri Oth multiple gest, unsp num plcnta & amnio sacs, second tri Oth multiple gest, unsp num plcnta & amnio sacs, third tri Oth multiple gest, unsp num plcnta & amnio sacs, unsp tri Oth mult gest w two or more monochorionic fetuses, first tri Oth mult gest w two or more monochorionic fetuses, 2nd tri Oth mult gest w two or more monochorionic fetuses, third tri Oth mult gest w two or more monochorionic fetuses, unsp tri Oth multiple gest w two or more monoamnio fetuses, first tri Oth mult gest w two or more monoamnio fetuses, second tri Oth multiple gest w two or more monoamnio fetuses, third tri Oth multiple gest w two or more monoamnio fetuses, unsp tri

September 2011

Edit code lists 1.21

Maternity diagnoses (age 12 through 55)

O30891 O30892 O30893 O30899 O3090 O3091 O3092 O3093 O3100X0 O3100X1 O3100X2 O3100X3 O3100X4 O3100X5 O3100X9 O3101X0 O3101X1 O3101X2 O3101X3 O3101X4 O3101X5 O3101X9 O3102X0 O3102X1 O3102X2 O3102X3 O3102X4 O3102X5 O3102X9 O3103X0 O3103X1 O3103X2 O3103X3 O3103X4 O3103X5 O3103X9 O3110X0 O3110X1 O3110X2 O3110X3 O3110X4 O3110X5 O3110X9 O3111X0 O3111X1 O3111X2 O3111X3 O3111X4 O3111X5 O3111X9 O3112X0 O3112X1 O3112X2 O3112X3 O3112X4 O3112X5 O3112X9 O3113X0 O3113X1 O3113X2 O3113X3 O3113X4 O3113X5 O3113X9 O3120X0 O3120X1 O3120X2 O3120X3

Oth mult gest, unab to dtrm num plcnta & amnio sacs, 1st tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 2nd tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 3rd tri Oth mult gest,unab to dtrm num plcnta & amnio sacs, unsp tri Multiple gestation, unspecified, unspecified trimester Multiple gestation, unspecified, first trimester Multiple gestation, unspecified, second trimester Multiple gestation, unspecified, third trimester Papyraceous fetus, unsp trimester, not applicable or unsp Papyraceous fetus, unspecified trimester, fetus 1 Papyraceous fetus, unspecified trimester, fetus 2 Papyraceous fetus, unspecified trimester, fetus 3 Papyraceous fetus, unspecified trimester, fetus 4 Papyraceous fetus, unspecified trimester, fetus 5 Papyraceous fetus, unspecified trimester, other fetus Papyraceous fetus, first trimester, not applicable or unsp Papyraceous fetus, first trimester, fetus 1 Papyraceous fetus, first trimester, fetus 2 Papyraceous fetus, first trimester, fetus 3 Papyraceous fetus, first trimester, fetus 4 Papyraceous fetus, first trimester, fetus 5 Papyraceous fetus, first trimester, other fetus Papyraceous fetus, second trimester, not applicable or unsp Papyraceous fetus, second trimester, fetus 1 Papyraceous fetus, second trimester, fetus 2 Papyraceous fetus, second trimester, fetus 3 Papyraceous fetus, second trimester, fetus 4 Papyraceous fetus, second trimester, fetus 5 Papyraceous fetus, second trimester, other fetus Papyraceous fetus, third trimester, not applicable or unsp Papyraceous fetus, third trimester, fetus 1 Papyraceous fetus, third trimester, fetus 2 Papyraceous fetus, third trimester, fetus 3 Papyraceous fetus, third trimester, fetus 4 Papyraceous fetus, third trimester, fetus 5 Papyraceous fetus, third trimester, other fetus Cont preg aft spon abort of one fts or more, unsp tri, unsp Cont preg aft spon abort of one fts or more, unsp tri, fts1 Cont preg aft spon abort of one fts or more, unsp tri, fts2 Cont preg aft spon abort of one fts or more, unsp tri, fts3 Cont preg aft spon abort of one fts or more, unsp tri, fts4 Cont preg aft spon abort of one fts or more, unsp tri, fts5 Cont preg aft spon abort of one fetus or more, unsp tri, oth Cont preg aft spon abort of one fts or more, first tri, unsp Cont preg aft spon abort of one fts or more, first tri, fts1 Cont preg aft spon abort of one fts or more, first tri, fts2 Cont preg aft spon abort of one fts or more, first tri, fts3 Cont preg aft spon abort of one fts or more, first tri, fts4 Cont preg aft spon abort of one fts or more, first tri, fts5 Cont preg aft spon abort of one fts or more, first tri, oth Cont preg aft spon abort of one fetus or more, 2nd tri, unsp Cont preg aft spon abort of one fetus or more, 2nd tri, fts1 Cont preg aft spon abort of one fetus or more, 2nd tri, fts2 Cont preg aft spon abort of one fetus or more, 2nd tri, fts3 Cont preg aft spon abort of one fetus or more, 2nd tri, fts4 Cont preg aft spon abort of one fetus or more, 2nd tri, fts5 Cont preg aft spon abort of one fetus or more, 2nd tri, oth Cont preg aft spon abort of one fts or more, third tri, unsp Cont preg aft spon abort of one fts or more, third tri, fts1 Cont preg aft spon abort of one fts or more, third tri, fts2 Cont preg aft spon abort of one fts or more, third tri, fts3 Cont preg aft spon abort of one fts or more, third tri, fts4 Cont preg aft spon abort of one fts or more, third tri, fts5 Cont preg aft spon abort of one fts or more, third tri, oth Cont preg aft uterin dth of one fts or more, unsp tri, unsp Cont preg aft uterin dth of one fts or more, unsp tri, fts1 Cont preg aft uterin dth of one fts or more, unsp tri, fts2 Cont preg aft uterin dth of one fts or more, unsp tri, fts3

1.22 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O3120X4 O3120X5 O3120X9 O3121X0 O3121X1 O3121X2 O3121X3 O3121X4 O3121X5 O3121X9 O3122X0 O3122X1 O3122X2 O3122X3 O3122X4 O3122X5 O3122X9 O3123X0 O3123X1 O3123X2 O3123X3 O3123X4 O3123X5 O3123X9 O3130X0 O3130X1 O3130X2 O3130X3 O3130X4 O3130X5 O3130X9 O3131X0 O3131X1 O3131X2 O3131X3 O3131X4 O3131X5 O3131X9 O3132X0 O3132X1 O3132X2 O3132X3 O3132X4 O3132X5 O3132X9 O3133X0 O3133X1 O3133X2 O3133X3 O3133X4 O3133X5 O3133X9 O318X10 O318X11 O318X12 O318X13 O318X14 O318X15 O318X19 O318X20 O318X21 O318X22 O318X23 O318X24 O318X25 O318X29 O318X30 O318X31

Cont preg aft uterin dth of one fts or more, unsp tri, fts4 Cont preg aft uterin dth of one fts or more, unsp tri, fts5 Cont preg aft uterin dth of one fetus or more, unsp tri, oth Cont preg aft uterin dth of one fts or more, first tri, unsp Cont preg aft uterin dth of one fts or more, first tri, fts1 Cont preg aft uterin dth of one fts or more, first tri, fts2 Cont preg aft uterin dth of one fts or more, first tri, fts3 Cont preg aft uterin dth of one fts or more, first tri, fts4 Cont preg aft uterin dth of one fts or more, first tri, fts5 Cont preg aft uterin dth of one fts or more, first tri, oth Cont preg aft uterin dth of one fetus or more, 2nd tri, unsp Cont preg aft uterin dth of one fetus or more, 2nd tri, fts1 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts2 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts3 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts4 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts5 Cont preg aft uterin dth of one fetus or more, 2nd tri, oth Cont preg aft uterin dth of one fts or more, third tri, unsp Cont preg aft uterin dth of one fts or more, third tri, fts1 Cont preg aft uterin dth of one fts or more, third tri, fts2 Cont preg aft uterin dth of one fts or more, third tri, fts3 Cont preg aft uterin dth of one fts or more, third tri, fts4 Cont preg aft uterin dth of one fts or more, third tri, fts5 Cont preg aft uterin dth of one fts or more, third tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,unsp Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts1 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts2 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts3 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts4 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts5 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, unsp Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts1 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts2 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts3 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts4 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts5 Cont preg aft elctv fetl rdct of 1 fts or more, 1st tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, unsp Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts1 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts2 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts3 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts4 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts5 Cont preg aft elctv fetl rdct of 1 fts or more, 2nd tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, unsp Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts1 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts2 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts3 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts4 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts5 Cont preg aft elctv fetl rdct of 1 fts or more, 3rd tri, oth Oth comp specific to multiple gest, first trimester, unsp Oth comp specific to multiple gest, first trimester, fetus 1 Oth comp specific to multiple gest, first trimester, fetus 2 Oth comp specific to multiple gest, first trimester, fetus 3 Oth comp specific to multiple gest, first trimester, fetus 4 Oth comp specific to multiple gest, first trimester, fetus 5 Oth comp specific to multiple gest, first trimester, oth Oth comp specific to multiple gest, second trimester, unsp Oth comp specific to multiple gest, second tri, fetus 1 Oth comp specific to multiple gest, second tri, fetus 2 Oth comp specific to multiple gest, second tri, fetus 3 Oth comp specific to multiple gest, second tri, fetus 4 Oth comp specific to multiple gest, second tri, fetus 5 Oth comp specific to multiple gest, second trimester, oth Oth comp specific to multiple gest, third trimester, unsp Oth comp specific to multiple gest, third trimester, fetus 1

September 2011

Edit code lists 1.23

Maternity diagnoses (age 12 through 55)

O318X32 O318X33 O318X34 O318X35 O318X39 O318X90 O318X91 O318X92 O318X93 O318X94 O318X95 O318X99 O320XX0 O320XX1 O320XX2 O320XX3 O320XX4 O320XX5 O320XX9 O321XX0 O321XX1 O321XX2 O321XX3 O321XX4 O321XX5 O321XX9 O322XX0 O322XX1 O322XX2 O322XX3 O322XX4 O322XX5 O322XX9 O323XX0 O323XX1 O323XX2 O323XX3 O323XX4 O323XX5 O323XX9 O324XX0 O324XX1 O324XX2 O324XX3 O324XX4 O324XX5 O324XX9 O326XX0 O326XX1 O326XX2 O326XX3 O326XX4 O326XX5 O326XX9 O328XX0 O328XX1 O328XX2 O328XX3 O328XX4 O328XX5 O328XX9 O329XX0 O329XX1 O329XX2 O329XX3 O329XX4 O329XX5 O329XX9

Oth comp specific to multiple gest, third trimester, fetus 2 Oth comp specific to multiple gest, third trimester, fetus 3 Oth comp specific to multiple gest, third trimester, fetus 4 Oth comp specific to multiple gest, third trimester, fetus 5 Oth comp specific to multiple gest, third trimester, oth Oth comp specific to multiple gest, unsp trimester, unsp Oth comp specific to multiple gest, unsp trimester, fetus 1 Oth comp specific to multiple gest, unsp trimester, fetus 2 Oth comp specific to multiple gest, unsp trimester, fetus 3 Oth comp specific to multiple gest, unsp trimester, fetus 4 Oth comp specific to multiple gest, unsp trimester, fetus 5 Oth comp specific to multiple gestation, unsp trimester, oth Maternal care for unstable lie, not applicable or unsp Maternal care for unstable lie, fetus 1 Maternal care for unstable lie, fetus 2 Maternal care for unstable lie, fetus 3 Maternal care for unstable lie, fetus 4 Maternal care for unstable lie, fetus 5 Maternal care for unstable lie, other fetus Maternal care for breech presentation, unsp Maternal care for breech presentation, fetus 1 Maternal care for breech presentation, fetus 2 Maternal care for breech presentation, fetus 3 Maternal care for breech presentation, fetus 4 Maternal care for breech presentation, fetus 5 Maternal care for breech presentation, other fetus Maternal care for transverse and oblique lie, unsp Maternal care for transverse and oblique lie, fetus 1 Maternal care for transverse and oblique lie, fetus 2 Maternal care for transverse and oblique lie, fetus 3 Maternal care for transverse and oblique lie, fetus 4 Maternal care for transverse and oblique lie, fetus 5 Maternal care for transverse and oblique lie, other fetus Maternal care for face, brow and chin presentation, unsp Maternal care for face, brow and chin presentation, fetus 1 Maternal care for face, brow and chin presentation, fetus 2 Maternal care for face, brow and chin presentation, fetus 3 Maternal care for face, brow and chin presentation, fetus 4 Maternal care for face, brow and chin presentation, fetus 5 Maternal care for face, brow and chin presentation, oth Maternal care for high head at term, not applicable or unsp Maternal care for high head at term, fetus 1 Maternal care for high head at term, fetus 2 Maternal care for high head at term, fetus 3 Maternal care for high head at term, fetus 4 Maternal care for high head at term, fetus 5 Maternal care for high head at term, other fetus Maternal care for compound presentation, unsp Maternal care for compound presentation, fetus 1 Maternal care for compound presentation, fetus 2 Maternal care for compound presentation, fetus 3 Maternal care for compound presentation, fetus 4 Maternal care for compound presentation, fetus 5 Maternal care for compound presentation, other fetus Maternal care for oth malpresentation of fetus, unsp Maternal care for other malpresentation of fetus, fetus 1 Maternal care for other malpresentation of fetus, fetus 2 Maternal care for other malpresentation of fetus, fetus 3 Maternal care for other malpresentation of fetus, fetus 4 Maternal care for other malpresentation of fetus, fetus 5 Maternal care for oth malpresentation of fetus, other fetus Maternal care for malpresentation of fetus, unsp, unsp Maternal care for malpresentation of fetus, unsp, fetus 1 Maternal care for malpresentation of fetus, unsp, fetus 2 Maternal care for malpresentation of fetus, unsp, fetus 3 Maternal care for malpresentation of fetus, unsp, fetus 4 Maternal care for malpresentation of fetus, unsp, fetus 5 Maternal care for malpresentation of fetus, unsp, oth fetus

1.24 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O330 O331 O332 O333XX0 O333XX1 O333XX2 O333XX3 O333XX4 O333XX5 O333XX9 O334XX0 O334XX1 O334XX2 O334XX3 O334XX4 O334XX5 O334XX9 O335XX0 O335XX1 O335XX2 O335XX3 O335XX4 O335XX5 O335XX9 O336XX0 O336XX1 O336XX2 O336XX3 O336XX4 O336XX5 O336XX9 O337 O338 O339 O3400 O3401 O3402 O3403 O3410 O3411 O3412 O3413 O3421 O3429 O3430 O3431 O3432 O3433 O3440 O3441 O3442 O3443 O34511 O34512 O34513 O34519 O34521 O34522 O34523 O34529 O34531 O34532 O34533 O34539 O34591 O34592 O34593 O34599

Matern care for disproprtn d/t deformity of matern pelv bone Matern care for disproprtn d/t generally contracted pelvis Maternal care for disproprtn due to inlet contrctn of pelvis Matern care for disproprtn d/t outlet contrctn of pelv, unsp Matern care for disproprtn d/t outlet contrctn of pelv, fts1 Matern care for disproprtn d/t outlet contrctn of pelv, fts2 Matern care for disproprtn d/t outlet contrctn of pelv, fts3 Matern care for disproprtn d/t outlet contrctn of pelv, fts4 Matern care for disproprtn d/t outlet contrctn of pelv, fts5 Matern care for disproprtn d/t outlet contrctn of pelv, oth Matern care for disproprtn of mix matern & fetl origin, unsp Matern care for disproprtn of mix matern & fetl origin, fts1 Matern care for disproprtn of mix matern & fetl origin, fts2 Matern care for disproprtn of mix matern & fetl origin, fts3 Matern care for disproprtn of mix matern & fetl origin, fts4 Matern care for disproprtn of mix matern & fetl origin, fts5 Matern care for disproprtn of mix matern & fetl origin, oth Matern care for disproprtn d/t unusually large fetus, unsp Matern care for disproprtn d/t unusually large fetus, fts1 Matern care for disproprtn d/t unusually large fetus, fts2 Matern care for disproprtn d/t unusually large fetus, fts3 Matern care for disproprtn d/t unusually large fetus, fts4 Matern care for disproprtn d/t unusually large fetus, fts5 Matern care for disproprtn due to unusually large fetus, oth Matern care for disproprtn due to hydrocephalic fetus, unsp Matern care for disproprtn due to hydrocephalic fetus, fts1 Matern care for disproprtn due to hydrocephalic fetus, fts2 Matern care for disproprtn due to hydrocephalic fetus, fts3 Matern care for disproprtn due to hydrocephalic fetus, fts4 Matern care for disproprtn due to hydrocephalic fetus, fts5 Maternal care for disproprtn due to hydrocephalic fetus, oth Maternal care for disproportion due to oth fetal deformities Maternal care for disproportion of other origin Maternal care for disproportion, unspecified Maternal care for unsp congen malform of uterus, unsp tri Maternal care for unsp congen malform of uterus, first tri Maternal care for unsp congen malform of uterus, second tri Maternal care for unsp congen malform of uterus, third tri Maternal care for benign tumor of corpus uteri, unsp tri Maternal care for benign tumor of corpus uteri, first tri Maternal care for benign tumor of corpus uteri, second tri Maternal care for benign tumor of corpus uteri, third tri Maternal care for scar from previous cesarean delivery Maternal care due to uterine scar from oth previous surgery Maternal care for cervical incompetence, unsp trimester Maternal care for cervical incompetence, first trimester Maternal care for cervical incompetence, second trimester Maternal care for cervical incompetence, third trimester Maternal care for oth abnlt of cervix, unsp trimester Maternal care for oth abnlt of cervix, first trimester Maternal care for oth abnlt of cervix, second trimester Maternal care for oth abnlt of cervix, third trimester Maternal care for incarceration of gravid uterus, first tri Maternal care for incarceration of gravid uterus, second tri Maternal care for incarceration of gravid uterus, third tri Maternal care for incarceration of gravid uterus, unsp tri Maternal care for prolapse of gravid uterus, first trimester Maternal care for prolapse of gravid uterus, second tri Maternal care for prolapse of gravid uterus, third trimester Maternal care for prolapse of gravid uterus, unsp trimester Maternal care for retroversion of gravid uterus, first tri Maternal care for retroversion of gravid uterus, second tri Maternal care for retroversion of gravid uterus, third tri Maternal care for retroversion of gravid uterus, unsp tri Maternal care for oth abnlt of gravid uterus, first tri Maternal care for oth abnlt of gravid uterus, second tri Maternal care for oth abnlt of gravid uterus, third tri Maternal care for oth abnlt of gravid uterus, unsp trimester

September 2011

Edit code lists 1.25

Maternity diagnoses (age 12 through 55)

O3460 O3461 O3462 O3463 O3470 O3471 O3472 O3473 O3480 O3481 O3482 O3483 O3490 O3491 O3492 O3493 O350XX0 O350XX1 O350XX2 O350XX3 O350XX4 O350XX5 O350XX9 O351XX0 O351XX1 O351XX2 O351XX3 O351XX4 O351XX5 O351XX9 O352XX0 O352XX1 O352XX2 O352XX3 O352XX4 O352XX5 O352XX9 O353XX0 O353XX1 O353XX2 O353XX3 O353XX4 O353XX5 O353XX9 O354XX0 O354XX1 O354XX2 O354XX3 O354XX4 O354XX5 O354XX9 O355XX0 O355XX1 O355XX2 O355XX3 O355XX4 O355XX5 O355XX9 O356XX0 O356XX1 O356XX2 O356XX3 O356XX4 O356XX5 O356XX9 O357XX0 O357XX1 O357XX2

Maternal care for abnormality of vagina, unsp trimester Maternal care for abnormality of vagina, first trimester Maternal care for abnormality of vagina, second trimester Maternal care for abnormality of vagina, third trimester Maternal care for abnlt of vulva and perineum, unsp tri Maternal care for abnlt of vulva and perineum, first tri Maternal care for abnlt of vulva and perineum, second tri Maternal care for abnlt of vulva and perineum, third tri Maternal care for oth abnlt of pelvic organs, unsp trimester Maternal care for oth abnlt of pelvic organs, first tri Maternal care for oth abnlt of pelvic organs, second tri Maternal care for oth abnlt of pelvic organs, third tri Maternal care for abnlt of pelvic organ, unsp, unsp tri Maternal care for abnlt of pelvic organ, unsp, first tri Maternal care for abnlt of pelvic organ, unsp, second tri Maternal care for abnlt of pelvic organ, unsp, third tri Maternal care for (suspected) cnsl malform in fetus, unsp Maternal care for (suspected) cnsl malform in fetus, fetus 1 Maternal care for (suspected) cnsl malform in fetus, fetus 2 Maternal care for (suspected) cnsl malform in fetus, fetus 3 Maternal care for (suspected) cnsl malform in fetus, fetus 4 Maternal care for (suspected) cnsl malform in fetus, fetus 5 Maternal care for (suspected) cnsl malform in fetus, oth Maternal care for chromosomal abnormality in fetus, unsp Maternal care for chromosomal abnormality in fetus, fetus 1 Maternal care for chromosomal abnormality in fetus, fetus 2 Maternal care for chromosomal abnormality in fetus, fetus 3 Maternal care for chromosomal abnormality in fetus, fetus 4 Maternal care for chromosomal abnormality in fetus, fetus 5 Maternal care for chromosomal abnormality in fetus, oth Maternal care for hereditary disease in fetus, unsp Maternal care for hereditary disease in fetus, fetus 1 Maternal care for hereditary disease in fetus, fetus 2 Maternal care for hereditary disease in fetus, fetus 3 Maternal care for hereditary disease in fetus, fetus 4 Maternal care for hereditary disease in fetus, fetus 5 Maternal care for hereditary disease in fetus, oth Matern care for damag to fts from viral dis in mother, unsp Matern care for damag to fts from viral dis in mother, fts1 Matern care for damag to fts from viral dis in mother, fts2 Matern care for damag to fts from viral dis in mother, fts3 Matern care for damag to fts from viral dis in mother, fts4 Matern care for damag to fts from viral dis in mother, fts5 Matern care for damag to fetus from viral dis in mother, oth Maternal care for damage to fetus from alcohol, unsp Maternal care for damage to fetus from alcohol, fetus 1 Maternal care for damage to fetus from alcohol, fetus 2 Maternal care for damage to fetus from alcohol, fetus 3 Maternal care for damage to fetus from alcohol, fetus 4 Maternal care for damage to fetus from alcohol, fetus 5 Maternal care for damage to fetus from alcohol, oth Maternal care for (suspected) damage to fetus by drugs, unsp Maternal care for damage to fetus by drugs, fetus 1 Maternal care for damage to fetus by drugs, fetus 2 Maternal care for damage to fetus by drugs, fetus 3 Maternal care for damage to fetus by drugs, fetus 4 Maternal care for damage to fetus by drugs, fetus 5 Maternal care for (suspected) damage to fetus by drugs, oth Maternal care for damage to fetus by radiation, unsp Maternal care for damage to fetus by radiation, fetus 1 Maternal care for damage to fetus by radiation, fetus 2 Maternal care for damage to fetus by radiation, fetus 3 Maternal care for damage to fetus by radiation, fetus 4 Maternal care for damage to fetus by radiation, fetus 5 Maternal care for damage to fetus by radiation, oth Maternal care for damage to fetus by oth medical proc, unsp Matern care for damage to fetus by oth medical proc, fetus 1 Matern care for damage to fetus by oth medical proc, fetus 2

1.26 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O357XX3 O357XX4 O357XX5 O357XX9 O358XX0 O358XX1 O358XX2 O358XX3 O358XX4 O358XX5 O358XX9 O359XX0 O359XX1 O359XX2 O359XX3 O359XX4 O359XX5 O359XX9 O360110 O360111 O360112 O360113 O360114 O360115 O360119 O360120 O360121 O360122 O360123 O360124 O360125 O360129 O360130 O360131 O360132 O360133 O360134 O360135 O360139 O360190 O360191 O360192 O360193 O360194 O360195 O360199 O360910 O360911 O360912 O360913 O360914 O360915 O360919 O360920 O360921 O360922 O360923 O360924 O360925 O360929 O360930 O360931 O360932 O360933 O360934 O360935 O360939 O360990

Matern care for damage to fetus by oth medical proc, fetus 3 Matern care for damage to fetus by oth medical proc, fetus 4 Matern care for damage to fetus by oth medical proc, fetus 5 Maternal care for damage to fetus by oth medical proc, oth Maternal care for oth fetal abnormality and damage, unsp Maternal care for oth fetal abnormality and damage, fetus 1 Maternal care for oth fetal abnormality and damage, fetus 2 Maternal care for oth fetal abnormality and damage, fetus 3 Maternal care for oth fetal abnormality and damage, fetus 4 Maternal care for oth fetal abnormality and damage, fetus 5 Maternal care for oth fetal abnormality and damage, oth Maternal care for fetal abnormality and damage, unsp, unsp Maternal care for fetal abnlt and damage, unsp, fetus 1 Maternal care for fetal abnlt and damage, unsp, fetus 2 Maternal care for fetal abnlt and damage, unsp, fetus 3 Maternal care for fetal abnlt and damage, unsp, fetus 4 Maternal care for fetal abnlt and damage, unsp, fetus 5 Maternal care for fetal abnormality and damage, unsp, oth Maternal care for anti-D antibodies, first trimester, unsp Maternal care for anti-D antibodies, first tri, fetus 1 Maternal care for anti-D antibodies, first tri, fetus 2 Maternal care for anti-D antibodies, first tri, fetus 3 Maternal care for anti-D antibodies, first tri, fetus 4 Maternal care for anti-D antibodies, first tri, fetus 5 Maternal care for anti-D antibodies, first trimester, oth Maternal care for anti-D antibodies, second trimester, unsp Maternal care for anti-D antibodies, second tri, fetus 1 Maternal care for anti-D antibodies, second tri, fetus 2 Maternal care for anti-D antibodies, second tri, fetus 3 Maternal care for anti-D antibodies, second tri, fetus 4 Maternal care for anti-D antibodies, second tri, fetus 5 Maternal care for anti-D antibodies, second trimester, oth Maternal care for anti-D antibodies, third trimester, unsp Maternal care for anti-D antibodies, third tri, fetus 1 Maternal care for anti-D antibodies, third tri, fetus 2 Maternal care for anti-D antibodies, third tri, fetus 3 Maternal care for anti-D antibodies, third tri, fetus 4 Maternal care for anti-D antibodies, third tri, fetus 5 Maternal care for anti-D antibodies, third trimester, oth Maternal care for anti-D antibodies, unsp trimester, unsp Maternal care for anti-D antibodies, unsp trimester, fetus 1 Maternal care for anti-D antibodies, unsp trimester, fetus 2 Maternal care for anti-D antibodies, unsp trimester, fetus 3 Maternal care for anti-D antibodies, unsp trimester, fetus 4 Maternal care for anti-D antibodies, unsp trimester, fetus 5 Maternal care for anti-D antibodies, unsp trimester, oth Maternal care for oth rhesus isoimmun, first trimester, unsp Maternal care for oth rhesus isoimmun, first tri, fetus 1 Maternal care for oth rhesus isoimmun, first tri, fetus 2 Maternal care for oth rhesus isoimmun, first tri, fetus 3 Maternal care for oth rhesus isoimmun, first tri, fetus 4 Maternal care for oth rhesus isoimmun, first tri, fetus 5 Maternal care for oth rhesus isoimmun, first trimester, oth Maternal care for oth rhesus isoimmun, second tri, unsp Maternal care for oth rhesus isoimmun, second tri, fetus 1 Maternal care for oth rhesus isoimmun, second tri, fetus 2 Maternal care for oth rhesus isoimmun, second tri, fetus 3 Maternal care for oth rhesus isoimmun, second tri, fetus 4 Maternal care for oth rhesus isoimmun, second tri, fetus 5 Maternal care for oth rhesus isoimmun, second trimester, oth Maternal care for oth rhesus isoimmun, third trimester, unsp Maternal care for oth rhesus isoimmun, third tri, fetus 1 Maternal care for oth rhesus isoimmun, third tri, fetus 2 Maternal care for oth rhesus isoimmun, third tri, fetus 3 Maternal care for oth rhesus isoimmun, third tri, fetus 4 Maternal care for oth rhesus isoimmun, third tri, fetus 5 Maternal care for oth rhesus isoimmun, third trimester, oth Maternal care for oth rhesus isoimmun, unsp trimester, unsp

September 2011

Edit code lists 1.27

Maternity diagnoses (age 12 through 55)

O360991 O360992 O360993 O360994 O360995 O360999 O361110 O361111 O361112 O361113 O361114 O361115 O361119 O361120 O361121 O361122 O361123 O361124 O361125 O361129 O361130 O361131 O361132 O361133 O361134 O361135 O361139 O361190 O361191 O361192 O361193 O361194 O361195 O361199 O361910 O361911 O361912 O361913 O361914 O361915 O361919 O361920 O361921 O361922 O361923 O361924 O361925 O361929 O361930 O361931 O361932 O361933 O361934 O361935 O361939 O361990 O361991 O361992 O361993 O361994 O361995 O361999 O3620X0 O3620X1 O3620X2 O3620X3 O3620X4 O3620X5

Maternal care for oth rhesus isoimmun, unsp tri, fetus 1 Maternal care for oth rhesus isoimmun, unsp tri, fetus 2 Maternal care for oth rhesus isoimmun, unsp tri, fetus 3 Maternal care for oth rhesus isoimmun, unsp tri, fetus 4 Maternal care for oth rhesus isoimmun, unsp tri, fetus 5 Maternal care for oth rhesus isoimmun, unsp trimester, oth Maternal care for Anti-A sensitization, first tri, unsp Maternal care for Anti-A sensitization, first tri, fetus 1 Maternal care for Anti-A sensitization, first tri, fetus 2 Maternal care for Anti-A sensitization, first tri, fetus 3 Maternal care for Anti-A sensitization, first tri, fetus 4 Maternal care for Anti-A sensitization, first tri, fetus 5 Maternal care for Anti-A sensitization, first trimester, oth Maternal care for Anti-A sensitization, second tri, unsp Maternal care for Anti-A sensitization, second tri, fetus 1 Maternal care for Anti-A sensitization, second tri, fetus 2 Maternal care for Anti-A sensitization, second tri, fetus 3 Maternal care for Anti-A sensitization, second tri, fetus 4 Maternal care for Anti-A sensitization, second tri, fetus 5 Maternal care for Anti-A sensitization, second tri, oth Maternal care for Anti-A sensitization, third tri, unsp Maternal care for Anti-A sensitization, third tri, fetus 1 Maternal care for Anti-A sensitization, third tri, fetus 2 Maternal care for Anti-A sensitization, third tri, fetus 3 Maternal care for Anti-A sensitization, third tri, fetus 4 Maternal care for Anti-A sensitization, third tri, fetus 5 Maternal care for Anti-A sensitization, third trimester, oth Maternal care for Anti-A sensitization, unsp trimester, unsp Maternal care for Anti-A sensitization, unsp tri, fetus 1 Maternal care for Anti-A sensitization, unsp tri, fetus 2 Maternal care for Anti-A sensitization, unsp tri, fetus 3 Maternal care for Anti-A sensitization, unsp tri, fetus 4 Maternal care for Anti-A sensitization, unsp tri, fetus 5 Maternal care for Anti-A sensitization, unsp trimester, oth Maternal care for oth isoimmunization, first trimester, unsp Maternal care for oth isoimmun, first trimester, fetus 1 Maternal care for oth isoimmun, first trimester, fetus 2 Maternal care for oth isoimmun, first trimester, fetus 3 Maternal care for oth isoimmun, first trimester, fetus 4 Maternal care for oth isoimmun, first trimester, fetus 5 Maternal care for oth isoimmunization, first trimester, oth Maternal care for oth isoimmun, second trimester, unsp Maternal care for oth isoimmun, second trimester, fetus 1 Maternal care for oth isoimmun, second trimester, fetus 2 Maternal care for oth isoimmun, second trimester, fetus 3 Maternal care for oth isoimmun, second trimester, fetus 4 Maternal care for oth isoimmun, second trimester, fetus 5 Maternal care for oth isoimmunization, second trimester, oth Maternal care for oth isoimmunization, third trimester, unsp Maternal care for oth isoimmun, third trimester, fetus 1 Maternal care for oth isoimmun, third trimester, fetus 2 Maternal care for oth isoimmun, third trimester, fetus 3 Maternal care for oth isoimmun, third trimester, fetus 4 Maternal care for oth isoimmun, third trimester, fetus 5 Maternal care for oth isoimmunization, third trimester, oth Maternal care for oth isoimmunization, unsp trimester, unsp Maternal care for oth isoimmun, unsp trimester, fetus 1 Maternal care for oth isoimmun, unsp trimester, fetus 2 Maternal care for oth isoimmun, unsp trimester, fetus 3 Maternal care for oth isoimmun, unsp trimester, fetus 4 Maternal care for oth isoimmun, unsp trimester, fetus 5 Maternal care for oth isoimmunization, unsp trimester, oth Maternal care for hydrops fetalis, unsp trimester, unsp Maternal care for hydrops fetalis, unsp trimester, fetus 1 Maternal care for hydrops fetalis, unsp trimester, fetus 2 Maternal care for hydrops fetalis, unsp trimester, fetus 3 Maternal care for hydrops fetalis, unsp trimester, fetus 4 Maternal care for hydrops fetalis, unsp trimester, fetus 5

1.28 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O3620X9 O3621X0 O3621X1 O3621X2 O3621X3 O3621X4 O3621X5 O3621X9 O3622X0 O3622X1 O3622X2 O3622X3 O3622X4 O3622X5 O3622X9 O3623X0 O3623X1 O3623X2 O3623X3 O3623X4 O3623X5 O3623X9 O364XX0 O364XX1 O364XX2 O364XX3 O364XX4 O364XX5 O364XX9 O365110 O365111 O365112 O365113 O365114 O365115 O365119 O365120 O365121 O365122 O365123 O365124 O365125 O365129 O365130 O365131 O365132 O365133 O365134 O365135 O365139 O365190 O365191 O365192 O365193 O365194 O365195 O365199 O365910 O365911 O365912 O365913 O365914 O365915 O365919 O365920 O365921 O365922 O365923

Maternal care for hydrops fetalis, unsp trimester, oth fetus Maternal care for hydrops fetalis, first trimester, unsp Maternal care for hydrops fetalis, first trimester, fetus 1 Maternal care for hydrops fetalis, first trimester, fetus 2 Maternal care for hydrops fetalis, first trimester, fetus 3 Maternal care for hydrops fetalis, first trimester, fetus 4 Maternal care for hydrops fetalis, first trimester, fetus 5 Maternal care for hydrops fetalis, first trimester, oth Maternal care for hydrops fetalis, second trimester, unsp Maternal care for hydrops fetalis, second trimester, fetus 1 Maternal care for hydrops fetalis, second trimester, fetus 2 Maternal care for hydrops fetalis, second trimester, fetus 3 Maternal care for hydrops fetalis, second trimester, fetus 4 Maternal care for hydrops fetalis, second trimester, fetus 5 Maternal care for hydrops fetalis, second trimester, oth Maternal care for hydrops fetalis, third trimester, unsp Maternal care for hydrops fetalis, third trimester, fetus 1 Maternal care for hydrops fetalis, third trimester, fetus 2 Maternal care for hydrops fetalis, third trimester, fetus 3 Maternal care for hydrops fetalis, third trimester, fetus 4 Maternal care for hydrops fetalis, third trimester, fetus 5 Maternal care for hydrops fetalis, third trimester, oth Maternal care for intrauterine death, not applicable or unsp Maternal care for intrauterine death, fetus 1 Maternal care for intrauterine death, fetus 2 Maternal care for intrauterine death, fetus 3 Maternal care for intrauterine death, fetus 4 Maternal care for intrauterine death, fetus 5 Maternal care for intrauterine death, other fetus Matern care for known or susp placntl insuff, 1st tri, unsp Matern care for known or susp placntl insuff, 1st tri, fts1 Matern care for known or susp placntl insuff, 1st tri, fts2 Matern care for known or susp placntl insuff, 1st tri, fts3 Matern care for known or susp placntl insuff, 1st tri, fts4 Matern care for known or susp placntl insuff, 1st tri, fts5 Matern care for known or susp placntl insuff, first tri, oth Matern care for known or susp placntl insuff, 2nd tri, unsp Matern care for known or susp placntl insuff, 2nd tri, fts1 Matern care for known or susp placntl insuff, 2nd tri, fts2 Matern care for known or susp placntl insuff, 2nd tri, fts3 Matern care for known or susp placntl insuff, 2nd tri, fts4 Matern care for known or susp placntl insuff, 2nd tri, fts5 Matern care for known or susp placntl insuff, 2nd tri, oth Matern care for or susp placntl insuff, third tri, unsp Matern care for or susp placntl insuff, third tri, fts1 Matern care for or susp placntl insuff, third tri, fts2 Matern care for or susp placntl insuff, third tri, fts3 Matern care for or susp placntl insuff, third tri, fts4 Matern care for or susp placntl insuff, third tri, fts5 Matern care for known or susp placntl insuff, third tri, oth Matern care for known or susp placntl insuff, unsp tri, unsp Matern care for known or susp placntl insuff, unsp tri, fts1 Matern care for known or susp placntl insuff, unsp tri, fts2 Matern care for known or susp placntl insuff, unsp tri, fts3 Matern care for known or susp placntl insuff, unsp tri, fts4 Matern care for known or susp placntl insuff, unsp tri, fts5 Matern care for known or susp placntl insuff, unsp tri, oth Matern care for oth or susp poor fetl grth, 1st tri, unsp Matern care for oth or susp poor fetl grth, 1st tri, fts1 Matern care for oth or susp poor fetl grth, 1st tri, fts2 Matern care for oth or susp poor fetl grth, 1st tri, fts3 Matern care for oth or susp poor fetl grth, 1st tri, fts4 Matern care for oth or susp poor fetl grth, 1st tri, fts5 Matern care for oth or susp poor fetl grth, 1st tri, oth Matern care for oth or susp poor fetl grth, 2nd tri, unsp Matern care for oth or susp poor fetl grth, 2nd tri, fts1 Matern care for oth or susp poor fetl grth, 2nd tri, fts2 Matern care for oth or susp poor fetl grth, 2nd tri, fts3

September 2011

Edit code lists 1.29

Maternity diagnoses (age 12 through 55)

O365924 O365925 O365929 O365930 O365931 O365932 O365933 O365934 O365935 O365939 O365990 O365991 O365992 O365993 O365994 O365995 O365999 O3660X0 O3660X1 O3660X2 O3660X3 O3660X4 O3660X5 O3660X9 O3661X0 O3661X1 O3661X2 O3661X3 O3661X4 O3661X5 O3661X9 O3662X0 O3662X1 O3662X2 O3662X3 O3662X4 O3662X5 O3662X9 O3663X0 O3663X1 O3663X2 O3663X3 O3663X4 O3663X5 O3663X9 O3670X0 O3670X1 O3670X2 O3670X3 O3670X4 O3670X5 O3670X9 O3671X0 O3671X1 O3671X2 O3671X3 O3671X4 O3671X5 O3671X9 O3672X0 O3672X1 O3672X2 O3672X3 O3672X4 O3672X5 O3672X9 O3673X0 O3673X1

Matern care for oth or susp poor fetl grth, 2nd tri, fts4 Matern care for oth or susp poor fetl grth, 2nd tri, fts5 Matern care for oth or susp poor fetl grth, 2nd tri, oth Matern care for oth or susp poor fetl grth, third tri, unsp Matern care for oth or susp poor fetl grth, third tri, fts1 Matern care for oth or susp poor fetl grth, third tri, fts2 Matern care for oth or susp poor fetl grth, third tri, fts3 Matern care for oth or susp poor fetl grth, third tri, fts4 Matern care for oth or susp poor fetl grth, third tri, fts5 Matern care for oth or susp poor fetl grth, third tri, oth Matern care for oth or susp poor fetl grth, unsp tri, unsp Matern care for oth or susp poor fetl grth, unsp tri, fts1 Matern care for oth or susp poor fetl grth, unsp tri, fts2 Matern care for oth or susp poor fetl grth, unsp tri, fts3 Matern care for oth or susp poor fetl grth, unsp tri, fts4 Matern care for oth or susp poor fetl grth, unsp tri, fts5 Matern care for oth or susp poor fetl grth, unsp tri, oth Maternal care for excess fetal growth, unsp trimester, unsp Maternal care for excess fetal growth, unsp tri, fetus 1 Maternal care for excess fetal growth, unsp tri, fetus 2 Maternal care for excess fetal growth, unsp tri, fetus 3 Maternal care for excess fetal growth, unsp tri, fetus 4 Maternal care for excess fetal growth, unsp tri, fetus 5 Maternal care for excess fetal growth, unsp trimester, oth Maternal care for excess fetal growth, first trimester, unsp Maternal care for excess fetal growth, first tri, fetus 1 Maternal care for excess fetal growth, first tri, fetus 2 Maternal care for excess fetal growth, first tri, fetus 3 Maternal care for excess fetal growth, first tri, fetus 4 Maternal care for excess fetal growth, first tri, fetus 5 Maternal care for excess fetal growth, first trimester, oth Maternal care for excess fetal growth, second tri, unsp Maternal care for excess fetal growth, second tri, fetus 1 Maternal care for excess fetal growth, second tri, fetus 2 Maternal care for excess fetal growth, second tri, fetus 3 Maternal care for excess fetal growth, second tri, fetus 4 Maternal care for excess fetal growth, second tri, fetus 5 Maternal care for excess fetal growth, second trimester, oth Maternal care for excess fetal growth, third trimester, unsp Maternal care for excess fetal growth, third tri, fetus 1 Maternal care for excess fetal growth, third tri, fetus 2 Maternal care for excess fetal growth, third tri, fetus 3 Maternal care for excess fetal growth, third tri, fetus 4 Maternal care for excess fetal growth, third tri, fetus 5 Maternal care for excess fetal growth, third trimester, oth Maternal care for viable fetus in abd preg, unsp tri, unsp Matern care for viable fetus in abd preg, unsp tri, fetus 1 Matern care for viable fetus in abd preg, unsp tri, fetus 2 Matern care for viable fetus in abd preg, unsp tri, fetus 3 Matern care for viable fetus in abd preg, unsp tri, fetus 4 Matern care for viable fetus in abd preg, unsp tri, fetus 5 Maternal care for viable fetus in abd preg, unsp tri, oth Maternal care for viable fetus in abd preg, first tri, unsp Matern care for viable fetus in abd preg, first tri, fetus 1 Matern care for viable fetus in abd preg, first tri, fetus 2 Matern care for viable fetus in abd preg, first tri, fetus 3 Matern care for viable fetus in abd preg, first tri, fetus 4 Matern care for viable fetus in abd preg, first tri, fetus 5 Maternal care for viable fetus in abd preg, first tri, oth Maternal care for viable fetus in abd preg, second tri, unsp Matern care for viable fetus in abd preg, second tri, fts1 Matern care for viable fetus in abd preg, second tri, fts2 Matern care for viable fetus in abd preg, second tri, fts3 Matern care for viable fetus in abd preg, second tri, fts4 Matern care for viable fetus in abd preg, second tri, fts5 Maternal care for viable fetus in abd preg, second tri, oth Maternal care for viable fetus in abd preg, third tri, unsp Matern care for viable fetus in abd preg, third tri, fetus 1

1.30 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O3673X2 O3673X3 O3673X4 O3673X5 O3673X9 O368120 O368121 O368122 O368123 O368124 O368125 O368129 O368130 O368131 O368132 O368133 O368134 O368135 O368139 O368190 O368191 O368192 O368193 O368194 O368195 O368199 O368210 O368211 O368212 O368213 O368214 O368215 O368219 O368220 O368221 O368222 O368223 O368224 O368225 O368229 O368230 O368231 O368232 O368233 O368234 O368235 O368239 O368290 O368291 O368292 O368293 O368294 O368295 O368299 O368910 O368911 O368912 O368913 O368914 O368915 O368919 O368920 O368921 O368922 O368923 O368924 O368925 O368929

Matern care for viable fetus in abd preg, third tri, fetus 2 Matern care for viable fetus in abd preg, third tri, fetus 3 Matern care for viable fetus in abd preg, third tri, fetus 4 Matern care for viable fetus in abd preg, third tri, fetus 5 Maternal care for viable fetus in abd preg, third tri, oth Decreased fetal movements, second trimester, unsp Decreased fetal movements, second trimester, fetus 1 Decreased fetal movements, second trimester, fetus 2 Decreased fetal movements, second trimester, fetus 3 Decreased fetal movements, second trimester, fetus 4 Decreased fetal movements, second trimester, fetus 5 Decreased fetal movements, second trimester, other fetus Decreased fetal movements, third trimester, unsp Decreased fetal movements, third trimester, fetus 1 Decreased fetal movements, third trimester, fetus 2 Decreased fetal movements, third trimester, fetus 3 Decreased fetal movements, third trimester, fetus 4 Decreased fetal movements, third trimester, fetus 5 Decreased fetal movements, third trimester, other fetus Decreased fetal movements, unsp trimester, unsp Decreased fetal movements, unspecified trimester, fetus 1 Decreased fetal movements, unspecified trimester, fetus 2 Decreased fetal movements, unspecified trimester, fetus 3 Decreased fetal movements, unspecified trimester, fetus 4 Decreased fetal movements, unspecified trimester, fetus 5 Decreased fetal movements, unsp trimester, other fetus Fetal anemia and thrombocytopenia, first trimester, unsp Fetal anemia and thrombocytopenia, first trimester, fetus 1 Fetal anemia and thrombocytopenia, first trimester, fetus 2 Fetal anemia and thrombocytopenia, first trimester, fetus 3 Fetal anemia and thrombocytopenia, first trimester, fetus 4 Fetal anemia and thrombocytopenia, first trimester, fetus 5 Fetal anemia and thrombocytopenia, first trimester, oth Fetal anemia and thrombocytopenia, second trimester, unsp Fetal anemia and thrombocytopenia, second trimester, fetus 1 Fetal anemia and thrombocytopenia, second trimester, fetus 2 Fetal anemia and thrombocytopenia, second trimester, fetus 3 Fetal anemia and thrombocytopenia, second trimester, fetus 4 Fetal anemia and thrombocytopenia, second trimester, fetus 5 Fetal anemia and thrombocytopenia, second trimester, oth Fetal anemia and thrombocytopenia, third trimester, unsp Fetal anemia and thrombocytopenia, third trimester, fetus 1 Fetal anemia and thrombocytopenia, third trimester, fetus 2 Fetal anemia and thrombocytopenia, third trimester, fetus 3 Fetal anemia and thrombocytopenia, third trimester, fetus 4 Fetal anemia and thrombocytopenia, third trimester, fetus 5 Fetal anemia and thrombocytopenia, third trimester, oth Fetal anemia and thrombocytopenia, unsp trimester, unsp Fetal anemia and thrombocytopenia, unsp trimester, fetus 1 Fetal anemia and thrombocytopenia, unsp trimester, fetus 2 Fetal anemia and thrombocytopenia, unsp trimester, fetus 3 Fetal anemia and thrombocytopenia, unsp trimester, fetus 4 Fetal anemia and thrombocytopenia, unsp trimester, fetus 5 Fetal anemia and thrombocytopenia, unsp trimester, oth fetus Maternal care for oth fetal problems, first trimester, unsp Maternal care for oth fetal problems, first tri, fetus 1 Maternal care for oth fetal problems, first tri, fetus 2 Maternal care for oth fetal problems, first tri, fetus 3 Maternal care for oth fetal problems, first tri, fetus 4 Maternal care for oth fetal problems, first tri, fetus 5 Maternal care for oth fetal problems, first trimester, oth Maternal care for oth fetal problems, second trimester, unsp Maternal care for oth fetal problems, second tri, fetus 1 Maternal care for oth fetal problems, second tri, fetus 2 Maternal care for oth fetal problems, second tri, fetus 3 Maternal care for oth fetal problems, second tri, fetus 4 Maternal care for oth fetal problems, second tri, fetus 5 Maternal care for oth fetal problems, second trimester, oth

September 2011

Edit code lists 1.31

Maternity diagnoses (age 12 through 55)

O368930 O368931 O368932 O368933 O368934 O368935 O368939 O368990 O368991 O368992 O368993 O368994 O368995 O368999 O3690X0 O3690X1 O3690X2 O3690X3 O3690X4 O3690X5 O3690X9 O3691X0 O3691X1 O3691X2 O3691X3 O3691X4 O3691X5 O3691X9 O3692X0 O3692X1 O3692X2 O3692X3 O3692X4 O3692X5 O3692X9 O3693X0 O3693X1 O3693X2 O3693X3 O3693X4 O3693X5 O3693X9 O401XX0 O401XX1 O401XX2 O401XX3 O401XX4 O401XX5 O401XX9 O402XX0 O402XX1 O402XX2 O402XX3 O402XX4 O402XX5 O402XX9 O403XX0 O403XX1 O403XX2 O403XX3 O403XX4 O403XX5 O403XX9 O409XX0 O409XX1 O409XX2 O409XX3 O409XX4

Maternal care for oth fetal problems, third trimester, unsp Maternal care for oth fetal problems, third tri, fetus 1 Maternal care for oth fetal problems, third tri, fetus 2 Maternal care for oth fetal problems, third tri, fetus 3 Maternal care for oth fetal problems, third tri, fetus 4 Maternal care for oth fetal problems, third tri, fetus 5 Maternal care for oth fetal problems, third trimester, oth Maternal care for oth fetal problems, unsp trimester, unsp Maternal care for oth fetal problems, unsp tri, fetus 1 Maternal care for oth fetal problems, unsp tri, fetus 2 Maternal care for oth fetal problems, unsp tri, fetus 3 Maternal care for oth fetal problems, unsp tri, fetus 4 Maternal care for oth fetal problems, unsp tri, fetus 5 Maternal care for oth fetal problems, unsp trimester, oth Maternal care for fetal problem, unsp, unsp trimester, unsp Maternal care for fetal problem, unsp, unsp tri, fetus 1 Maternal care for fetal problem, unsp, unsp tri, fetus 2 Maternal care for fetal problem, unsp, unsp tri, fetus 3 Maternal care for fetal problem, unsp, unsp tri, fetus 4 Maternal care for fetal problem, unsp, unsp tri, fetus 5 Maternal care for fetal problem, unsp, unsp trimester, oth Maternal care for fetal problem, unsp, first trimester, unsp Maternal care for fetal problem, unsp, first tri, fetus 1 Maternal care for fetal problem, unsp, first tri, fetus 2 Maternal care for fetal problem, unsp, first tri, fetus 3 Maternal care for fetal problem, unsp, first tri, fetus 4 Maternal care for fetal problem, unsp, first tri, fetus 5 Maternal care for fetal problem, unsp, first trimester, oth Maternal care for fetal problem, unsp, second tri, unsp Maternal care for fetal problem, unsp, second tri, fetus 1 Maternal care for fetal problem, unsp, second tri, fetus 2 Maternal care for fetal problem, unsp, second tri, fetus 3 Maternal care for fetal problem, unsp, second tri, fetus 4 Maternal care for fetal problem, unsp, second tri, fetus 5 Maternal care for fetal problem, unsp, second trimester, oth Maternal care for fetal problem, unsp, third trimester, unsp Maternal care for fetal problem, unsp, third tri, fetus 1 Maternal care for fetal problem, unsp, third tri, fetus 2 Maternal care for fetal problem, unsp, third tri, fetus 3 Maternal care for fetal problem, unsp, third tri, fetus 4 Maternal care for fetal problem, unsp, third tri, fetus 5 Maternal care for fetal problem, unsp, third trimester, oth Polyhydramnios, first trimester, not applicable or unsp Polyhydramnios, first trimester, fetus 1 Polyhydramnios, first trimester, fetus 2 Polyhydramnios, first trimester, fetus 3 Polyhydramnios, first trimester, fetus 4 Polyhydramnios, first trimester, fetus 5 Polyhydramnios, first trimester, other fetus Polyhydramnios, second trimester, not applicable or unsp Polyhydramnios, second trimester, fetus 1 Polyhydramnios, second trimester, fetus 2 Polyhydramnios, second trimester, fetus 3 Polyhydramnios, second trimester, fetus 4 Polyhydramnios, second trimester, fetus 5 Polyhydramnios, second trimester, other fetus Polyhydramnios, third trimester, not applicable or unsp Polyhydramnios, third trimester, fetus 1 Polyhydramnios, third trimester, fetus 2 Polyhydramnios, third trimester, fetus 3 Polyhydramnios, third trimester, fetus 4 Polyhydramnios, third trimester, fetus 5 Polyhydramnios, third trimester, other fetus Polyhydramnios, unsp trimester, not applicable or unsp Polyhydramnios, unspecified trimester, fetus 1 Polyhydramnios, unspecified trimester, fetus 2 Polyhydramnios, unspecified trimester, fetus 3 Polyhydramnios, unspecified trimester, fetus 4

1.32 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O409XX5 O409XX9 O4100X0 O4100X1 O4100X2 O4100X3 O4100X4 O4100X5 O4100X9 O4101X0 O4101X1 O4101X2 O4101X3 O4101X4 O4101X5 O4101X9 O4102X0 O4102X1 O4102X2 O4102X3 O4102X4 O4102X5 O4102X9 O4103X0 O4103X1 O4103X2 O4103X3 O4103X4 O4103X5 O4103X9 O411010 O411011 O411012 O411013 O411014 O411015 O411019 O411020 O411021 O411022 O411023 O411024 O411025 O411029 O411030 O411031 O411032 O411033 O411034 O411035 O411039 O411090 O411091 O411092 O411093 O411094 O411095 O411099 O411210 O411211 O411212 O411213 O411214 O411215 O411219 O411220 O411221 O411222

Polyhydramnios, unspecified trimester, fetus 5 Polyhydramnios, unspecified trimester, other fetus Oligohydramnios, unsp trimester, not applicable or unsp Oligohydramnios, unspecified trimester, fetus 1 Oligohydramnios, unspecified trimester, fetus 2 Oligohydramnios, unspecified trimester, fetus 3 Oligohydramnios, unspecified trimester, fetus 4 Oligohydramnios, unspecified trimester, fetus 5 Oligohydramnios, unspecified trimester, other fetus Oligohydramnios, first trimester, not applicable or unsp Oligohydramnios, first trimester, fetus 1 Oligohydramnios, first trimester, fetus 2 Oligohydramnios, first trimester, fetus 3 Oligohydramnios, first trimester, fetus 4 Oligohydramnios, first trimester, fetus 5 Oligohydramnios, first trimester, other fetus Oligohydramnios, second trimester, not applicable or unsp Oligohydramnios, second trimester, fetus 1 Oligohydramnios, second trimester, fetus 2 Oligohydramnios, second trimester, fetus 3 Oligohydramnios, second trimester, fetus 4 Oligohydramnios, second trimester, fetus 5 Oligohydramnios, second trimester, other fetus Oligohydramnios, third trimester, not applicable or unsp Oligohydramnios, third trimester, fetus 1 Oligohydramnios, third trimester, fetus 2 Oligohydramnios, third trimester, fetus 3 Oligohydramnios, third trimester, fetus 4 Oligohydramnios, third trimester, fetus 5 Oligohydramnios, third trimester, other fetus Infct of amniotic sac and membrns, unsp, first tri, unsp Infct of amniotic sac and membrns, unsp, first tri, fetus 1 Infct of amniotic sac and membrns, unsp, first tri, fetus 2 Infct of amniotic sac and membrns, unsp, first tri, fetus 3 Infct of amniotic sac and membrns, unsp, first tri, fetus 4 Infct of amniotic sac and membrns, unsp, first tri, fetus 5 Infct of amniotic sac and membrns, unsp, first tri, oth Infct of amniotic sac and membrns, unsp, second tri, unsp Infct of amniotic sac and membrns, unsp, second tri, fetus 1 Infct of amniotic sac and membrns, unsp, second tri, fetus 2 Infct of amniotic sac and membrns, unsp, second tri, fetus 3 Infct of amniotic sac and membrns, unsp, second tri, fetus 4 Infct of amniotic sac and membrns, unsp, second tri, fetus 5 Infct of amniotic sac and membrns, unsp, second tri, oth Infct of amniotic sac and membrns, unsp, third tri, unsp Infct of amniotic sac and membrns, unsp, third tri, fetus 1 Infct of amniotic sac and membrns, unsp, third tri, fetus 2 Infct of amniotic sac and membrns, unsp, third tri, fetus 3 Infct of amniotic sac and membrns, unsp, third tri, fetus 4 Infct of amniotic sac and membrns, unsp, third tri, fetus 5 Infct of amniotic sac and membrns, unsp, third tri, oth Infct of amniotic sac and membrns, unsp, unsp tri, unsp Infct of amniotic sac and membrns, unsp, unsp tri, fetus 1 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 2 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 3 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 4 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 5 Infct of amniotic sac and membrns, unsp, unsp trimester, oth Chorioamnionitis, first trimester, not applicable or unsp Chorioamnionitis, first trimester, fetus 1 Chorioamnionitis, first trimester, fetus 2 Chorioamnionitis, first trimester, fetus 3 Chorioamnionitis, first trimester, fetus 4 Chorioamnionitis, first trimester, fetus 5 Chorioamnionitis, first trimester, other fetus Chorioamnionitis, second trimester, not applicable or unsp Chorioamnionitis, second trimester, fetus 1 Chorioamnionitis, second trimester, fetus 2

September 2011

Edit code lists 1.33

Maternity diagnoses (age 12 through 55)

O411223 O411224 O411225 O411229 O411230 O411231 O411232 O411233 O411234 O411235 O411239 O411290 O411291 O411292 O411293 O411294 O411295 O411299 O411410 O411411 O411412 O411413 O411414 O411415 O411419 O411420 O411421 O411422 O411423 O411424 O411425 O411429 O411430 O411431 O411432 O411433 O411434 O411435 O411439 O411490 O411491 O411492 O411493 O411494 O411495 O411499 O418X10 O418X11 O418X12 O418X13 O418X14 O418X15 O418X19 O418X20 O418X21 O418X22 O418X23 O418X24 O418X25 O418X29 O418X30 O418X31 O418X32 O418X33 O418X34 O418X35 O418X39 O418X90

Chorioamnionitis, second trimester, fetus 3 Chorioamnionitis, second trimester, fetus 4 Chorioamnionitis, second trimester, fetus 5 Chorioamnionitis, second trimester, other fetus Chorioamnionitis, third trimester, not applicable or unsp Chorioamnionitis, third trimester, fetus 1 Chorioamnionitis, third trimester, fetus 2 Chorioamnionitis, third trimester, fetus 3 Chorioamnionitis, third trimester, fetus 4 Chorioamnionitis, third trimester, fetus 5 Chorioamnionitis, third trimester, other fetus Chorioamnionitis, unsp trimester, not applicable or unsp Chorioamnionitis, unspecified trimester, fetus 1 Chorioamnionitis, unspecified trimester, fetus 2 Chorioamnionitis, unspecified trimester, fetus 3 Chorioamnionitis, unspecified trimester, fetus 4 Chorioamnionitis, unspecified trimester, fetus 5 Chorioamnionitis, unspecified trimester, other fetus Placentitis, first trimester, not applicable or unspecified Placentitis, first trimester, fetus 1 Placentitis, first trimester, fetus 2 Placentitis, first trimester, fetus 3 Placentitis, first trimester, fetus 4 Placentitis, first trimester, fetus 5 Placentitis, first trimester, other fetus Placentitis, second trimester, not applicable or unspecified Placentitis, second trimester, fetus 1 Placentitis, second trimester, fetus 2 Placentitis, second trimester, fetus 3 Placentitis, second trimester, fetus 4 Placentitis, second trimester, fetus 5 Placentitis, second trimester, other fetus Placentitis, third trimester, not applicable or unspecified Placentitis, third trimester, fetus 1 Placentitis, third trimester, fetus 2 Placentitis, third trimester, fetus 3 Placentitis, third trimester, fetus 4 Placentitis, third trimester, fetus 5 Placentitis, third trimester, other fetus Placentitis, unsp trimester, not applicable or unspecified Placentitis, unspecified trimester, fetus 1 Placentitis, unspecified trimester, fetus 2 Placentitis, unspecified trimester, fetus 3 Placentitis, unspecified trimester, fetus 4 Placentitis, unspecified trimester, fetus 5 Placentitis, unspecified trimester, other fetus Oth disrd of amniotic fluid and membrns, first tri, unsp Oth disrd of amniotic fluid and membrns, first tri, fetus 1 Oth disrd of amniotic fluid and membrns, first tri, fetus 2 Oth disrd of amniotic fluid and membrns, first tri, fetus 3 Oth disrd of amniotic fluid and membrns, first tri, fetus 4 Oth disrd of amniotic fluid and membrns, first tri, fetus 5 Oth disrd of amniotic fluid and membrns, first tri, oth Oth disrd of amniotic fluid and membrns, second tri, unsp Oth disrd of amniotic fluid and membrns, second tri, fetus 1 Oth disrd of amniotic fluid and membrns, second tri, fetus 2 Oth disrd of amniotic fluid and membrns, second tri, fetus 3 Oth disrd of amniotic fluid and membrns, second tri, fetus 4 Oth disrd of amniotic fluid and membrns, second tri, fetus 5 Oth disrd of amniotic fluid and membrns, second tri, oth Oth disrd of amniotic fluid and membrns, third tri, unsp Oth disrd of amniotic fluid and membrns, third tri, fetus 1 Oth disrd of amniotic fluid and membrns, third tri, fetus 2 Oth disrd of amniotic fluid and membrns, third tri, fetus 3 Oth disrd of amniotic fluid and membrns, third tri, fetus 4 Oth disrd of amniotic fluid and membrns, third tri, fetus 5 Oth disrd of amniotic fluid and membrns, third tri, oth Oth disrd of amniotic fluid and membrns, unsp tri, unsp

1.34 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O418X91 O418X92 O418X93 O418X94 O418X95 O418X99 O4190X0 O4190X1 O4190X2 O4190X3 O4190X4 O4190X5 O4190X9 O4191X0 O4191X1 O4191X2 O4191X3 O4191X4 O4191X5 O4191X9 O4192X0 O4192X1 O4192X2 O4192X3 O4192X4 O4192X5 O4192X9 O4193X0 O4193X1 O4193X2 O4193X3 O4193X4 O4193X5 O4193X9 O4200 O42011 O42012 O42013 O42019 O4202 O4210 O42111 O42112 O42113 O42119 O4212 O4290 O42911 O42912 O42913 O42919 O4292 O43011 O43012 O43013 O43019 O43021 O43022 O43023 O43029 O43101 O43102 O43103 O43109 O43111 O43112 O43113 O43119

Oth disrd of amniotic fluid and membrns, unsp tri, fetus 1 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 2 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 3 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 4 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 5 Oth disrd of amniotic fluid and membrns, unsp trimester, oth Disorder of amniotic fluid and membrns, unsp, unsp tri, unsp Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 1 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 2 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 3 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 4 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 5 Disorder of amniotic fluid and membrns, unsp, unsp tri, oth Disorder of amnio fluid and membrns, unsp, first tri, unsp Disord of amnio fluid and membrns, unsp, first tri, fetus 1 Disord of amnio fluid and membrns, unsp, first tri, fetus 2 Disord of amnio fluid and membrns, unsp, first tri, fetus 3 Disord of amnio fluid and membrns, unsp, first tri, fetus 4 Disord of amnio fluid and membrns, unsp, first tri, fetus 5 Disorder of amniotic fluid and membrns, unsp, first tri, oth Disorder of amnio fluid and membrns, unsp, second tri, unsp Disord of amnio fluid and membrns, unsp, second tri, fetus 1 Disord of amnio fluid and membrns, unsp, second tri, fetus 2 Disord of amnio fluid and membrns, unsp, second tri, fetus 3 Disord of amnio fluid and membrns, unsp, second tri, fetus 4 Disord of amnio fluid and membrns, unsp, second tri, fetus 5 Disorder of amnio fluid and membrns, unsp, second tri, oth Disorder of amnio fluid and membrns, unsp, third tri, unsp Disord of amnio fluid and membrns, unsp, third tri, fetus 1 Disord of amnio fluid and membrns, unsp, third tri, fetus 2 Disord of amnio fluid and membrns, unsp, third tri, fetus 3 Disord of amnio fluid and membrns, unsp, third tri, fetus 4 Disord of amnio fluid and membrns, unsp, third tri, fetus 5 Disorder of amniotic fluid and membrns, unsp, third tri, oth Prem ROM, onset labor w/n 24 hr of rupt, unsp weeks of gest Pretrm prem ROM, onset labor w/n 24 hours of rupt, first tri Pretrm prem ROM, onset labor w/n 24 hours of rupt, 2nd tri Pretrm prem ROM, onset labor w/n 24 hours of rupt, third tri Pretrm prem ROM, onset labor w/n 24 hours of rupt, unsp tri Full-term prem ROM, onset labor within 24 hours of rupture Prem ROM, onset labor > 24 hr fol rupt, unsp weeks of gest Pretrm prem ROM, onset labor > 24 hours fol rupt, first tri Pretrm prem ROM, onset labor > 24 hours fol rupt, second tri Pretrm prem ROM, onset labor > 24 hours fol rupt, third tri Pretrm prem ROM, onset labor > 24 hours fol rupt, unsp tri Full-term premature ROM, onset labor > 24 hours fol rupture Prem ROM, 7th0 betw rupt & onst labr, unsp weeks of gest Pretrm prem ROM, unsp time betw rupt and onset labr, 1st tri Pretrm prem ROM, unsp time betw rupt and onset labr, 2nd tri Pretrm prem ROM, unsp time betw rupt and onst labr, 3rd tri Pretrm prem ROM, unsp time betw rupt and onst labr, unsp tri Full-term prem ROM, unsp time betw rupture and onset labor Fetomaternal placental transfusion syndrome, first trimester Fetomaternal placental transfuse syndrome, second trimester Fetomaternal placental transfusion syndrome, third trimester Fetomaternal placental transfusion syndrome, unsp trimester Fetus-to-fetus placental transfuse syndrome, first trimester Fetus-to-fetus placntl transfuse syndrome, second trimester Fetus-to-fetus placental transfuse syndrome, third trimester Fetus-to-fetus placental transfuse syndrome, unsp trimester Malformation of placenta, unspecified, first trimester Malformation of placenta, unspecified, second trimester Malformation of placenta, unspecified, third trimester Malformation of placenta, unspecified, unspecified trimester Circumvallate placenta, first trimester Circumvallate placenta, second trimester Circumvallate placenta, third trimester Circumvallate placenta, unspecified trimester

September 2011

Edit code lists 1.35

Maternity diagnoses (age 12 through 55)

O43121 O43122 O43123 O43129 O43191 O43192 O43193 O43199 O43211 O43212 O43213 O43219 O43221 O43222 O43223 O43229 O43231 O43232 O43233 O43239 O43811 O43812 O43813 O43819 O43891 O43892 O43893 O43899 O4390 O4391 O4392 O4393 O4400 O4401 O4402 O4403 O4410 O4411 O4412 O4413 O45001 O45002 O45003 O45009 O45011 O45012 O45013 O45019 O45021 O45022 O45023 O45029 O45091 O45092 O45093 O45099 O458X1 O458X2 O458X3 O458X9 O4590 O4591 O4592 O4593 O46001 O46002 O46003 O46009

Velamentous insertion of umbilical cord, first trimester Velamentous insertion of umbilical cord, second trimester Velamentous insertion of umbilical cord, third trimester Velamentous insertion of umbilical cord, unsp trimester Other malformation of placenta, first trimester Other malformation of placenta, second trimester Other malformation of placenta, third trimester Other malformation of placenta, unspecified trimester Placenta accreta, first trimester Placenta accreta, second trimester Placenta accreta, third trimester Placenta accreta, unspecified trimester Placenta increta, first trimester Placenta increta, second trimester Placenta increta, third trimester Placenta increta, unspecified trimester Placenta percreta, first trimester Placenta percreta, second trimester Placenta percreta, third trimester Placenta percreta, unspecified trimester Placental infarction, first trimester Placental infarction, second trimester Placental infarction, third trimester Placental infarction, unspecified trimester Other placental disorders, first trimester Other placental disorders, second trimester Other placental disorders, third trimester Other placental disorders, unspecified trimester Unspecified placental disorder, unspecified trimester Unspecified placental disorder, first trimester Unspecified placental disorder, second trimester Unspecified placental disorder, third trimester Placenta previa specified as w/o hemorrhage, unsp trimester Placenta previa specified as w/o hemorrhage, first trimester Placenta previa specified as w/o hemor, second trimester Placenta previa specified as w/o hemorrhage, third trimester Placenta previa with hemorrhage, unspecified trimester Placenta previa with hemorrhage, first trimester Placenta previa with hemorrhage, second trimester Placenta previa with hemorrhage, third trimester Prem separtn of placenta w coag defect, unsp, first tri Prem separtn of placenta w coag defect, unsp, second tri Prem separtn of placenta w coag defect, unsp, third tri Prem separtn of placenta w coag defect, unsp, unsp trimester Prem separtn of placenta w afibrinogenemia, first trimester Prem separtn of placenta w afibrinogenemia, second trimester Prem separtn of placenta w afibrinogenemia, third trimester Prem separtn of placenta w afibrinogenemia, unsp trimester Prem separtn of placenta w dissem intravasc coag, first tri Prem separtn of placenta w dissem intravasc coag, second tri Prem separtn of placenta w dissem intravasc coag, third tri Prem separtn of placenta w dissem intravasc coag, unsp tri Prem separtn of placenta w oth coag defect, first trimester Prem separtn of placenta w oth coag defect, second trimester Prem separtn of placenta w oth coag defect, third trimester Prem separtn of placenta w oth coag defect, unsp trimester Other premature separation of placenta, first trimester Other premature separation of placenta, second trimester Other premature separation of placenta, third trimester Other premature separation of placenta, unsp trimester Premature separation of placenta, unsp, unsp trimester Premature separation of placenta, unsp, first trimester Premature separation of placenta, unsp, second trimester Premature separation of placenta, unsp, third trimester Antepartum hemorrhage w coag defect, unsp, first trimester Antepartum hemorrhage w coag defect, unsp, second trimester Antepartum hemorrhage w coag defect, unsp, third trimester Antepartum hemorrhage w coag defect, unsp, unsp trimester

1.36 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O46011 O46012 O46013 O46019 O46021 O46022 O46023 O46029 O46091 O46092 O46093 O46099 O468X1 O468X2 O468X3 O468X9 O4690 O4691 O4692 O4693 O4700 O4702 O4703 O471 O479 O480 O481 O6000 O6002 O6003 O6010X0 O6010X1 O6010X2 O6010X3 O6010X4 O6010X5 O6010X9 O6012X0 O6012X1 O6012X2 O6012X3 O6012X4 O6012X5 O6012X9 O6013X0 O6013X1 O6013X2 O6013X3 O6013X4 O6013X5 O6013X9 O6014X0 O6014X1 O6014X2 O6014X3 O6014X4 O6014X5 O6014X9 O6020X0 O6020X1 O6020X2 O6020X3 O6020X4 O6020X5 O6020X9 O6022X0 O6022X1 O6022X2

Antepartum hemorrhage with afibrinogenemia, first trimester Antepartum hemorrhage with afibrinogenemia, second trimester Antepartum hemorrhage with afibrinogenemia, third trimester Antepartum hemorrhage with afibrinogenemia, unsp trimester Antepart hemorrhage w dissem intravasc coag, first trimester Antepart hemor w dissem intravasc coag, second trimester Antepart hemorrhage w dissem intravasc coag, third trimester Antepart hemorrhage w dissem intravasc coag, unsp trimester Antepartum hemorrhage w oth coag defect, first trimester Antepartum hemorrhage w oth coag defect, second trimester Antepartum hemorrhage w oth coag defect, third trimester Antepartum hemorrhage w oth coag defect, unsp trimester Other antepartum hemorrhage, first trimester Other antepartum hemorrhage, second trimester Other antepartum hemorrhage, third trimester Other antepartum hemorrhage, unspecified trimester Antepartum hemorrhage, unspecified, unspecified trimester Antepartum hemorrhage, unspecified, first trimester Antepartum hemorrhage, unspecified, second trimester Antepartum hemorrhage, unspecified, third trimester False labor before 37 completed weeks of gest, unsp tri False labor before 37 completed weeks of gest, second tri False labor before 37 completed weeks of gest, third tri False labor at or after 37 completed weeks of gestation False labor, unspecified Post-term pregnancy Prolonged pregnancy Preterm labor without delivery, unspecified trimester Preterm labor without delivery, second trimester Preterm labor without delivery, third trimester Preterm labor w preterm delivery, unsp trimester, unsp Preterm labor with preterm delivery, unsp trimester, fetus 1 Preterm labor with preterm delivery, unsp trimester, fetus 2 Preterm labor with preterm delivery, unsp trimester, fetus 3 Preterm labor with preterm delivery, unsp trimester, fetus 4 Preterm labor with preterm delivery, unsp trimester, fetus 5 Preterm labor w preterm delivery, unsp trimester, oth fetus Preterm labor second tri w preterm delivery second tri, unsp Preterm labor second tri w preterm del second tri, fetus 1 Preterm labor second tri w preterm del second tri, fetus 2 Preterm labor second tri w preterm del second tri, fetus 3 Preterm labor second tri w preterm del second tri, fetus 4 Preterm labor second tri w preterm del second tri, fetus 5 Preterm labor second tri w preterm delivery second tri, oth Preterm labor second tri w preterm delivery third tri, unsp Preterm labor second tri w preterm del third tri, fetus 1 Preterm labor second tri w preterm del third tri, fetus 2 Preterm labor second tri w preterm del third tri, fetus 3 Preterm labor second tri w preterm del third tri, fetus 4 Preterm labor second tri w preterm del third tri, fetus 5 Preterm labor second tri w preterm delivery third tri, oth Preterm labor third tri w preterm delivery third tri, unsp Preterm labor third tri w preterm del third tri, fetus 1 Preterm labor third tri w preterm del third tri, fetus 2 Preterm labor third tri w preterm del third tri, fetus 3 Preterm labor third tri w preterm del third tri, fetus 4 Preterm labor third tri w preterm del third tri, fetus 5 Preterm labor third tri w preterm delivery third tri, oth Term delivery w preterm labor, unsp trimester, unsp Term delivery with preterm labor, unsp trimester, fetus 1 Term delivery with preterm labor, unsp trimester, fetus 2 Term delivery with preterm labor, unsp trimester, fetus 3 Term delivery with preterm labor, unsp trimester, fetus 4 Term delivery with preterm labor, unsp trimester, fetus 5 Term delivery with preterm labor, unsp trimester, oth fetus Term delivery w preterm labor, second trimester, unsp Term delivery with preterm labor, second trimester, fetus 1 Term delivery with preterm labor, second trimester, fetus 2

September 2011

Edit code lists 1.37

Maternity diagnoses (age 12 through 55)

O6022X3 O6022X4 O6022X5 O6022X9 O6023X0 O6023X1 O6023X2 O6023X3 O6023X4 O6023X5 O6023X9 O610 O611 O618 O619 O620 O621 O622 O623 O624 O628 O629 O630 O631 O632 O639 O640XX0 O640XX1 O640XX2 O640XX3 O640XX4 O640XX5 O640XX9 O641XX0 O641XX1 O641XX2 O641XX3 O641XX4 O641XX5 O641XX9 O642XX0 O642XX1 O642XX2 O642XX3 O642XX4 O642XX5 O642XX9 O643XX0 O643XX1 O643XX2 O643XX3 O643XX4 O643XX5 O643XX9 O644XX0 O644XX1 O644XX2 O644XX3 O644XX4 O644XX5 O644XX9 O645XX0 O645XX1 O645XX2 O645XX3 O645XX4 O645XX5 O645XX9

Term delivery with preterm labor, second trimester, fetus 3 Term delivery with preterm labor, second trimester, fetus 4 Term delivery with preterm labor, second trimester, fetus 5 Term delivery w preterm labor, second trimester, oth fetus Term delivery w preterm labor, third trimester, unsp Term delivery with preterm labor, third trimester, fetus 1 Term delivery with preterm labor, third trimester, fetus 2 Term delivery with preterm labor, third trimester, fetus 3 Term delivery with preterm labor, third trimester, fetus 4 Term delivery with preterm labor, third trimester, fetus 5 Term delivery with preterm labor, third trimester, oth fetus Failed medical induction of labor Failed instrumental induction of labor Other failed induction of labor Failed induction of labor, unspecified Primary inadequate contractions Secondary uterine inertia Other uterine inertia Precipitate labor Hypertonic, incoordinate, and prolonged uterine contractions Other abnormalities of forces of labor Abnormality of forces of labor, unspecified Prolonged first stage (of labor) Prolonged second stage (of labor) Delayed delivery of second twin, triplet, etc. Long labor, unspecified Obstructed labor due to incmpl rotation of fetal head, unsp Obst labor due to incmpl rotation of fetal head, fetus 1 Obst labor due to incmpl rotation of fetal head, fetus 2 Obst labor due to incmpl rotation of fetal head, fetus 3 Obst labor due to incmpl rotation of fetal head, fetus 4 Obst labor due to incmpl rotation of fetal head, fetus 5 Obstructed labor due to incmpl rotation of fetal head, oth Obstructed labor due to breech presentation, unsp Obstructed labor due to breech presentation, fetus 1 Obstructed labor due to breech presentation, fetus 2 Obstructed labor due to breech presentation, fetus 3 Obstructed labor due to breech presentation, fetus 4 Obstructed labor due to breech presentation, fetus 5 Obstructed labor due to breech presentation, other fetus Obstructed labor due to face presentation, unsp Obstructed labor due to face presentation, fetus 1 Obstructed labor due to face presentation, fetus 2 Obstructed labor due to face presentation, fetus 3 Obstructed labor due to face presentation, fetus 4 Obstructed labor due to face presentation, fetus 5 Obstructed labor due to face presentation, other fetus Obstructed labor due to brow presentation, unsp Obstructed labor due to brow presentation, fetus 1 Obstructed labor due to brow presentation, fetus 2 Obstructed labor due to brow presentation, fetus 3 Obstructed labor due to brow presentation, fetus 4 Obstructed labor due to brow presentation, fetus 5 Obstructed labor due to brow presentation, other fetus Obstructed labor due to shoulder presentation, unsp Obstructed labor due to shoulder presentation, fetus 1 Obstructed labor due to shoulder presentation, fetus 2 Obstructed labor due to shoulder presentation, fetus 3 Obstructed labor due to shoulder presentation, fetus 4 Obstructed labor due to shoulder presentation, fetus 5 Obstructed labor due to shoulder presentation, other fetus Obstructed labor due to compound presentation, unsp Obstructed labor due to compound presentation, fetus 1 Obstructed labor due to compound presentation, fetus 2 Obstructed labor due to compound presentation, fetus 3 Obstructed labor due to compound presentation, fetus 4 Obstructed labor due to compound presentation, fetus 5 Obstructed labor due to compound presentation, other fetus

1.38 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O648XX0 O648XX1 O648XX2 O648XX3 O648XX4 O648XX5 O648XX9 O649XX0 O649XX1 O649XX2 O649XX3 O649XX4 O649XX5 O649XX9 O650 O651 O652 O653 O654 O655 O658 O659 O660 O661 O662 O663 O6640 O6641 O665 O666 O668 O669 O670 O678 O679 O68 O690XX0 O690XX1 O690XX2 O690XX3 O690XX4 O690XX5 O690XX9 O691XX0 O691XX1 O691XX2 O691XX3 O691XX4 O691XX5 O691XX9 O692XX0 O692XX1 O692XX2 O692XX3 O692XX4 O692XX5 O692XX9 O693XX0 O693XX1 O693XX2 O693XX3 O693XX4 O693XX5 O693XX9 O694XX0 O694XX1 O694XX2 O694XX3

Obstructed labor due to oth malposition and malpresent, unsp Obstructed labor due to oth malpos and malpresent, fetus 1 Obstructed labor due to oth malpos and malpresent, fetus 2 Obstructed labor due to oth malpos and malpresent, fetus 3 Obstructed labor due to oth malpos and malpresent, fetus 4 Obstructed labor due to oth malpos and malpresent, fetus 5 Obstructed labor due to oth malposition and malpresent, oth Obstructed labor due to malpos and malpresent, unsp, unsp Obstructed labor due to malpos and malpresent, unsp, fetus 1 Obstructed labor due to malpos and malpresent, unsp, fetus 2 Obstructed labor due to malpos and malpresent, unsp, fetus 3 Obstructed labor due to malpos and malpresent, unsp, fetus 4 Obstructed labor due to malpos and malpresent, unsp, fetus 5 Obstructed labor due to malpos and malpresent, unsp, oth Obstructed labor due to deformed pelvis Obstructed labor due to generally contracted pelvis Obstructed labor due to pelvic inlet contraction Obst labor due to pelvic outlet and mid-cavity contrctn Obstructed labor due to fetopelvic disproportion, unsp Obstructed labor due to abnlt of maternal pelvic organs Obstructed labor due to other maternal pelvic abnormalities Obstructed labor due to maternal pelvic abnormality, unsp Obstructed labor due to shoulder dystocia Obstructed labor due to locked twins Obstructed labor due to unusually large fetus Obstructed labor due to other abnormalities of fetus Failed trial of labor, unspecified Failed attempt vaginal birth after previous cesarean del Attempted application of vacuum extractor and forceps Obstructed labor due to other multiple fetuses Other specified obstructed labor Obstructed labor, unspecified Intrapartum hemorrhage with coagulation defect Other intrapartum hemorrhage Intrapartum hemorrhage, unspecified Labor and delivery comp by abnlt of fetal acid-base balance Labor and delivery complicated by prolapse of cord, unsp Labor and delivery complicated by prolapse of cord, fetus 1 Labor and delivery complicated by prolapse of cord, fetus 2 Labor and delivery complicated by prolapse of cord, fetus 3 Labor and delivery complicated by prolapse of cord, fetus 4 Labor and delivery complicated by prolapse of cord, fetus 5 Labor and delivery complicated by prolapse of cord, oth Labor and delivery comp by cord around neck, w comprsn, unsp Labor and del comp by cord around neck, w comprsn, fetus 1 Labor and del comp by cord around neck, w comprsn, fetus 2 Labor and del comp by cord around neck, w comprsn, fetus 3 Labor and del comp by cord around neck, w comprsn, fetus 4 Labor and del comp by cord around neck, w comprsn, fetus 5 Labor and delivery comp by cord around neck, w comprsn, oth Labor and del comp by oth cord entangle, w comprsn, unsp Labor and del comp by oth cord entangle, w comprsn, fetus 1 Labor and del comp by oth cord entangle, w comprsn, fetus 2 Labor and del comp by oth cord entangle, w comprsn, fetus 3 Labor and del comp by oth cord entangle, w comprsn, fetus 4 Labor and del comp by oth cord entangle, w comprsn, fetus 5 Labor and delivery comp by oth cord entangle, w comprsn, oth Labor and delivery complicated by short cord, unsp Labor and delivery complicated by short cord, fetus 1 Labor and delivery complicated by short cord, fetus 2 Labor and delivery complicated by short cord, fetus 3 Labor and delivery complicated by short cord, fetus 4 Labor and delivery complicated by short cord, fetus 5 Labor and delivery complicated by short cord, other fetus Labor and delivery complicated by vasa previa, unsp Labor and delivery complicated by vasa previa, fetus 1 Labor and delivery complicated by vasa previa, fetus 2 Labor and delivery complicated by vasa previa, fetus 3

September 2011

Edit code lists 1.39

Maternity diagnoses (age 12 through 55)

O694XX4 O694XX5 O694XX9 O695XX0 O695XX1 O695XX2 O695XX3 O695XX4 O695XX5 O695XX9 O6981X0 O6981X1 O6981X2 O6981X3 O6981X4 O6981X5 O6981X9 O6982X0 O6982X1 O6982X2 O6982X3 O6982X4 O6982X5 O6982X9 O6989X0 O6989X1 O6989X2 O6989X3 O6989X4 O6989X5 O6989X9 O699XX0 O699XX1 O699XX2 O699XX3 O699XX4 O699XX5 O699XX9 O700 O701 O702 O703 O704 O709 O7100 O7102 O7103 O711 O712 O713 O714 O715 O716 O717 O7181 O7182 O7189 O719 O720 O721 O722 O723 O730 O731 O740 O741 O742 O743

Labor and delivery complicated by vasa previa, fetus 4 Labor and delivery complicated by vasa previa, fetus 5 Labor and delivery complicated by vasa previa, other fetus Labor and delivery comp by vascular lesion of cord, unsp Labor and delivery comp by vascular lesion of cord, fetus 1 Labor and delivery comp by vascular lesion of cord, fetus 2 Labor and delivery comp by vascular lesion of cord, fetus 3 Labor and delivery comp by vascular lesion of cord, fetus 4 Labor and delivery comp by vascular lesion of cord, fetus 5 Labor and delivery comp by vascular lesion of cord, oth Labor and del comp by cord around neck, w/o comprsn, unsp Labor and del comp by cord around neck, w/o comprsn, fetus 1 Labor and del comp by cord around neck, w/o comprsn, fetus 2 Labor and del comp by cord around neck, w/o comprsn, fetus 3 Labor and del comp by cord around neck, w/o comprsn, fetus 4 Labor and del comp by cord around neck, w/o comprsn, fetus 5 Labor and del comp by cord around neck, w/o comprsn, oth Labor and del comp by oth cord entangle, w/o comprsn, unsp Labor and del comp by oth cord entangle, w/o comprsn, fts1 Labor and del comp by oth cord entangle, w/o comprsn, fts2 Labor and del comp by oth cord entangle, w/o comprsn, fts3 Labor and del comp by oth cord entangle, w/o comprsn, fts4 Labor and del comp by oth cord entangle, w/o comprsn, fts5 Labor and del comp by oth cord entangle, w/o comprsn, oth Labor and delivery complicated by oth cord comp, unsp Labor and delivery complicated by oth cord comp, fetus 1 Labor and delivery complicated by oth cord comp, fetus 2 Labor and delivery complicated by oth cord comp, fetus 3 Labor and delivery complicated by oth cord comp, fetus 4 Labor and delivery complicated by oth cord comp, fetus 5 Labor and delivery complicated by oth cord comp, oth Labor and delivery complicated by cord comp, unsp, unsp Labor and delivery complicated by cord comp, unsp, fetus 1 Labor and delivery complicated by cord comp, unsp, fetus 2 Labor and delivery complicated by cord comp, unsp, fetus 3 Labor and delivery complicated by cord comp, unsp, fetus 4 Labor and delivery complicated by cord comp, unsp, fetus 5 Labor and delivery complicated by cord comp, unsp, oth First degree perineal laceration during delivery Second degree perineal laceration during delivery Third degree perineal laceration during delivery Fourth degree perineal laceration during delivery Anal sphincter tear comp del, not assoc w third degree lac Perineal laceration during delivery, unspecified Rupture of uterus before onset of labor, unsp trimester Rupture of uterus before onset of labor, second trimester Rupture of uterus before onset of labor, third trimester Rupture of uterus during labor Postpartum inversion of uterus Obstetric laceration of cervix Obstetric high vaginal laceration alone Other obstetric injury to pelvic organs Obstetric damage to pelvic joints and ligaments Obstetric hematoma of pelvis Laceration of uterus, not elsewhere classified Other specified trauma to perineum and vulva Other specified obstetric trauma Obstetric trauma, unspecified Third-stage hemorrhage Other immediate postpartum hemorrhage Delayed and secondary postpartum hemorrhage Postpartum coagulation defects Retained placenta without hemorrhage Retained portions of placenta and membranes, w/o hemorrhage Aspirat pneumonitis due to anesth during labor and delivery Oth pulmonary comp of anesthesia during labor and delivery Cardiac comp of anesthesia during labor and delivery Cnsl complications of anesthesia during labor and delivery

1.40 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O744 O745 O746 O747 O748 O749 O750 O751 O752 O753 O754 O755 O7581 O7589 O759 O76 O770 O771 O778 O779 O80 O82 O85 O860 O8611 O8612 O8613 O8619 O8620 O8621 O8622 O8629 O864 O8681 O8689 O870 O871 O872 O873 O874 O878 O879 O88011 O88012 O88013 O88019 O8802 O8803 O88111 O88112 O88113 O88119 O8812 O8813 O88211 O88212 O88213 O88219 O8822 O8823 O88311 O88312 O88313 O88319 O8832 O8833 O88811 O88812

Toxic reaction to local anesthesia during labor and delivery Spinal and epidur anesthesia-induced hdache dur labr and del Oth comp of spinal and epidural anesth during labor and del Failed or difficult intubation for anesth dur labor and del Other complications of anesthesia during labor and delivery Complication of anesthesia during labor and delivery, unsp Maternal distress during labor and delivery Shock during or following labor and delivery Pyrexia during labor, not elsewhere classified Other infection during labor Other complications of obstetric surgery and procedures Delayed delivery after artificial rupture of membranes Maternal exhaustion complicating labor and delivery Other specified complications of labor and delivery Complication of labor and delivery, unspecified Abnlt in fetal heart rate and rhythm comp labor and delivery Labor and delivery complicated by meconium in amniotic fluid Fetal stress in labor or delivery due to drug administration Labor and delivery comp by oth evidence of fetal stress Labor and delivery complicated by fetal stress, unspecified Encounter for full-term uncomplicated delivery Encounter for cesarean delivery without indication Puerperal sepsis Infection of obstetric surgical wound Cervicitis following delivery Endometritis following delivery Vaginitis following delivery Other infection of genital tract following delivery Urinary tract infection following delivery, unspecified Infection of kidney following delivery Infection of bladder following delivery Other urinary tract infection following delivery Pyrexia of unknown origin following delivery Puerperal septic thrombophlebitis Other specified puerperal infections Superficial thrombophlebitis in the puerperium Deep phlebothrombosis in the puerperium Hemorrhoids in the puerperium Cerebral venous thrombosis in the puerperium Varicose veins of lower extremity in the puerperium Other venous complications in the puerperium Venous complication in the puerperium, unspecified Air embolism in pregnancy, first trimester Air embolism in pregnancy, second trimester Air embolism in pregnancy, third trimester Air embolism in pregnancy, unspecified trimester Air embolism in childbirth Air embolism in the puerperium Amniotic fluid embolism in pregnancy, first trimester Amniotic fluid embolism in pregnancy, second trimester Amniotic fluid embolism in pregnancy, third trimester Amniotic fluid embolism in pregnancy, unspecified trimester Amniotic fluid embolism in childbirth Amniotic fluid embolism in the puerperium Thromboembolism in pregnancy, first trimester Thromboembolism in pregnancy, second trimester Thromboembolism in pregnancy, third trimester Thromboembolism in pregnancy, unspecified trimester Thromboembolism in childbirth Thromboembolism in the puerperium Pyemic and septic embolism in pregnancy, first trimester Pyemic and septic embolism in pregnancy, second trimester Pyemic and septic embolism in pregnancy, third trimester Pyemic and septic embolism in pregnancy, unsp trimester Pyemic and septic embolism in childbirth Pyemic and septic embolism in the puerperium Other embolism in pregnancy, first trimester Other embolism in pregnancy, second trimester

September 2011

Edit code lists 1.41

Maternity diagnoses (age 12 through 55)

O88813 O88819 O8882 O8883 O8901 O8909 O891 O892 O893 O894 O895 O896 O898 O899 O900 O901 O902 O903 O904 O905 O906 O9081 O9089 O909 O91011 O91012 O91013 O91019 O9102 O9103 O91111 O91112 O91113 O91119 O9112 O9113 O91211 O91212 O91213 O91219 O9122 O9123 O92011 O92012 O92013 O92019 O9202 O9203 O92111 O92112 O92113 O92119 O9212 O9213 O9220 O9229 O923 O924 O925 O926 O9270 O9279 O94 O98011 O98012 O98013 O98019 O9802

Other embolism in pregnancy, third trimester Other embolism in pregnancy, unspecified trimester Other embolism in childbirth Other embolism in the puerperium Aspiration pneumonitis due to anesth during the puerperium Oth pulmonary comp of anesthesia during the puerperium Cardiac complications of anesthesia during the puerperium Cnsl complications of anesthesia during the puerperium Toxic reaction to local anesthesia during the puerperium Spinal and epidur anesthesia-induced hdache during the puerp Oth comp of spinal and epidural anesth during the puerperium Failed or difficult intubation for anesth during the puerp Other complications of anesthesia during the puerperium Complication of anesthesia during the puerperium, unsp Disruption of cesarean delivery wound Disruption of perineal obstetric wound Hematoma of obstetric wound Peripartum cardiomyopathy Postpartum acute kidney failure Postpartum thyroiditis Postpartum mood disturbance Anemia of the puerperium Oth complications of the puerperium, NEC Complication of the puerperium, unspecified Infection of nipple associated w pregnancy, first trimester Infection of nipple associated w pregnancy, second trimester Infection of nipple associated w pregnancy, third trimester Infection of nipple associated w pregnancy, unsp trimester Infection of nipple associated with the puerperium Infection of nipple associated with lactation Abscess of breast associated with pregnancy, first trimester Abscess of breast associated w pregnancy, second trimester Abscess of breast associated with pregnancy, third trimester Abscess of breast associated with pregnancy, unsp trimester Abscess of breast associated with the puerperium Abscess of breast associated with lactation Nonpurulent mastitis associated w pregnancy, first trimester Nonpurulent mastitis assoc w pregnancy, second trimester Nonpurulent mastitis associated w pregnancy, third trimester Nonpurulent mastitis associated w pregnancy, unsp trimester Nonpurulent mastitis associated with the puerperium Nonpurulent mastitis associated with lactation Retracted nipple associated with pregnancy, first trimester Retracted nipple associated with pregnancy, second trimester Retracted nipple associated with pregnancy, third trimester Retracted nipple associated with pregnancy, unsp trimester Retracted nipple associated with the puerperium Retracted nipple associated with lactation Cracked nipple associated with pregnancy, first trimester Cracked nipple associated with pregnancy, second trimester Cracked nipple associated with pregnancy, third trimester Cracked nipple associated with pregnancy, unsp trimester Cracked nipple associated with the puerperium Cracked nipple associated with lactation Unsp disorder of breast assoc w pregnancy and the puerperium Oth disorders of breast assoc w pregnancy and the puerperium Agalactia Hypogalactia Suppressed lactation Galactorrhea Unspecified disorders of lactation Other disorders of lactation Sequelae of comp of pregnancy, chldbrth, and the puerperium Tuberculosis complicating pregnancy, first trimester Tuberculosis complicating pregnancy, second trimester Tuberculosis complicating pregnancy, third trimester Tuberculosis complicating pregnancy, unspecified trimester Tuberculosis complicating childbirth

1.42 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O9803 O98111 O98112 O98113 O98119 O9812 O9813 O98211 O98212 O98213 O98219 O9822 O9823 O98311 O98312 O98313 O98319 O9832 O9833 O98411 O98412 O98413 O98419 O9842 O9843 O98511 O98512 O98513 O98519 O9852 O9853 O98611 O98612 O98613 O98619 O9862 O9863 O98711 O98712 O98713 O98719 O9872 O9873 O98811 O98812 O98813 O98819 O9882 O9883 O98911 O98912 O98913 O98919 O9892 O9893 O99011 O99012 O99013 O99019 O9902 O9903 O99111 O99112 O99113 O99119 O9912 O9913 O99210

Tuberculosis complicating the puerperium Syphilis complicating pregnancy, first trimester Syphilis complicating pregnancy, second trimester Syphilis complicating pregnancy, third trimester Syphilis complicating pregnancy, unspecified trimester Syphilis complicating childbirth Syphilis complicating the puerperium Gonorrhea complicating pregnancy, first trimester Gonorrhea complicating pregnancy, second trimester Gonorrhea complicating pregnancy, third trimester Gonorrhea complicating pregnancy, unspecified trimester Gonorrhea complicating childbirth Gonorrhea complicating the puerperium Oth infect w sexl mode of transmiss comp preg, first tri Oth infect w sexl mode of transmiss comp preg, second tri Oth infect w sexl mode of transmiss comp preg, third tri Oth infect w sexl mode of transmiss comp preg, unsp tri Oth infections w sexl mode of transmiss comp childbirth Oth infections w sexl mode of transmiss comp the puerperium Viral hepatitis complicating pregnancy, first trimester Viral hepatitis complicating pregnancy, second trimester Viral hepatitis complicating pregnancy, third trimester Viral hepatitis complicating pregnancy, unsp trimester Viral hepatitis complicating childbirth Viral hepatitis complicating the puerperium Other viral diseases complicating pregnancy, first trimester Oth viral diseases complicating pregnancy, second trimester Other viral diseases complicating pregnancy, third trimester Other viral diseases complicating pregnancy, unsp trimester Other viral diseases complicating childbirth Other viral diseases complicating the puerperium Protozoal diseases complicating pregnancy, first trimester Protozoal diseases complicating pregnancy, second trimester Protozoal diseases complicating pregnancy, third trimester Protozoal diseases complicating pregnancy, unsp trimester Protozoal diseases complicating childbirth Protozoal diseases complicating the puerperium Human immunodef disease comp pregnancy, first trimester Human immunodef disease comp pregnancy, second trimester Human immunodef disease comp pregnancy, third trimester Human immunodef disease comp pregnancy, unsp trimester Human immunodeficiency [HIV] disease complicating childbirth Human immunodeficiency disease complicating the puerperium Oth maternal infec/parastc diseases comp preg, first tri Oth maternal infec/parastc diseases comp preg, second tri Oth maternal infec/parastc diseases comp preg, third tri Oth maternal infec/parastc diseases comp preg, unsp tri Oth maternal infec/parastc diseases complicating childbirth Oth maternal infec/parastc diseases comp the puerperium Unsp maternal infec/parastc disease comp preg, first tri Unsp maternal infec/parastc disease comp preg, second tri Unsp maternal infec/parastc disease comp preg, third tri Unsp maternal infec/parastc disease comp preg, unsp tri Unsp maternal infec/parastc disease complicating childbirth Unsp maternal infec/parastc disease comp the puerperium Anemia complicating pregnancy, first trimester Anemia complicating pregnancy, second trimester Anemia complicating pregnancy, third trimester Anemia complicating pregnancy, unspecified trimester Anemia complicating childbirth Anemia complicating the puerperium Oth dis of bld/bld-form org/immun mechnsm comp preg, 1st tri Oth dis of bld/bld-form org/immun mechnsm comp preg, 2nd tri Oth dis of bld/bld-form org/immun mechnsm comp preg, 3rd tri Oth dis of bld/bld-form org/immun mechnsm comp preg,unsp tri Oth dis of the bld/bld-form org/immun mechnsm comp chldbrth Oth dis of the bld/bld-form org/immun mechnsm comp the puerp Obesity complicating pregnancy, unspecified trimester

September 2011

Edit code lists 1.43

Maternity diagnoses (age 12 through 55)

O99211 O99212 O99213 O99214 O99215 O99280 O99281 O99282 O99283 O99284 O99285 O99310 O99311 O99312 O99313 O99314 O99315 O99320 O99321 O99322 O99323 O99324 O99325 O99330 O99331 O99332 O99333 O99334 O99335 O99340 O99341 O99342 O99343 O99344 O99345 O99350 O99351 O99352 O99353 O99354 O99355 O99411 O99412 O99413 O99419 O9942 O9943 O99511 O99512 O99513 O99519 O9952 O9953 O99611 O99612 O99613 O99619 O9962 O9963 O99711 O99712 O99713 O99719 O9972 O9973 O99810 O99814 O99815

Obesity complicating pregnancy, first trimester Obesity complicating pregnancy, second trimester Obesity complicating pregnancy, third trimester Obesity complicating childbirth Obesity complicating the puerperium Endo, nutritional and metab diseases comp preg, unsp tri Endo, nutritional and metab diseases comp preg, first tri Endo, nutritional and metab diseases comp preg, second tri Endo, nutritional and metab diseases comp preg, third tri Endocrine, nutritional and metabolic diseases comp chldbrth Endocrine, nutritional and metabolic diseases comp the puerp Alcohol use complicating pregnancy, unspecified trimester Alcohol use complicating pregnancy, first trimester Alcohol use complicating pregnancy, second trimester Alcohol use complicating pregnancy, third trimester Alcohol use complicating childbirth Alcohol use complicating the puerperium Drug use complicating pregnancy, unspecified trimester Drug use complicating pregnancy, first trimester Drug use complicating pregnancy, second trimester Drug use complicating pregnancy, third trimester Drug use complicating childbirth Drug use complicating the puerperium Smoking (tobacco) complicating pregnancy, unsp trimester Smoking (tobacco) complicating pregnancy, first trimester Smoking (tobacco) complicating pregnancy, second trimester Smoking (tobacco) complicating pregnancy, third trimester Smoking (tobacco) complicating childbirth Smoking (tobacco) complicating the puerperium Oth mental disorders complicating pregnancy, unsp trimester Oth mental disorders complicating pregnancy, first trimester Oth mental disorders comp pregnancy, second trimester Oth mental disorders complicating pregnancy, third trimester Other mental disorders complicating childbirth Other mental disorders complicating the puerperium Diseases of the nervous sys comp pregnancy, unsp trimester Diseases of the nervous sys comp pregnancy, first trimester Diseases of the nervous sys comp pregnancy, second trimester Diseases of the nervous sys comp pregnancy, third trimester Diseases of the nervous system complicating childbirth Diseases of the nervous system complicating the puerperium Diseases of the circ sys comp pregnancy, first trimester Diseases of the circ sys comp pregnancy, second trimester Diseases of the circ sys comp pregnancy, third trimester Diseases of the circ sys comp pregnancy, unsp trimester Diseases of the circulatory system complicating childbirth Diseases of the circ sys complicating the puerperium Diseases of the resp sys comp pregnancy, first trimester Diseases of the resp sys comp pregnancy, second trimester Diseases of the resp sys comp pregnancy, third trimester Diseases of the resp sys comp pregnancy, unsp trimester Diseases of the respiratory system complicating childbirth Diseases of the resp sys complicating the puerperium Diseases of the dgstv sys comp pregnancy, first trimester Diseases of the dgstv sys comp pregnancy, second trimester Diseases of the dgstv sys comp pregnancy, third trimester Diseases of the dgstv sys comp pregnancy, unsp trimester Diseases of the digestive system complicating childbirth Diseases of the digestive system complicating the puerperium Diseases of the skin, subcu comp pregnancy, first trimester Diseases of the skin, subcu comp pregnancy, second trimester Diseases of the skin, subcu comp pregnancy, third trimester Diseases of the skin, subcu comp pregnancy, unsp trimester Diseases of the skin, subcu complicating childbirth Diseases of the skin, subcu complicating the puerperium Abnormal glucose complicating pregnancy Abnormal glucose complicating childbirth Abnormal glucose complicating the puerperium

1.44 Definitions of Medicare Code Edits

September 2011

Maternity diagnoses (age 12 through 55)

O99820 O99824 O99825 O99830 O99834 O99835 O99840 O99841 O99842 O99843 O99844 O99845 O9989 O9A111 O9A112 O9A113 O9A119 O9A12 O9A13 O9A211 O9A212 O9A213 O9A219 O9A22 O9A23 O9A311 O9A312 O9A313 O9A319 O9A32 O9A33 O9A411 O9A412 O9A413 O9A419 O9A42 O9A43 O9A511 O9A512 O9A513 O9A519 O9A52 O9A53 Z0371 Z0372 Z0373 Z0374 Z0375 Z0379 Z3201 Z331 Z332 Z3400 Z3401 Z3402 Z3403 Z3480 Z3481 Z3482 Z3483 Z3490 Z3491 Z3492 Z3493 Z36 Z370 Z371 Z372

Streptococcus B carrier state complicating pregnancy Streptococcus B carrier state complicating childbirth Streptococcus B carrier state complicating the puerperium Other infection carrier state complicating pregnancy Other infection carrier state complicating childbirth Other infection carrier state complicating the puerperium Bariatric surgery status comp pregnancy, unsp trimester Bariatric surgery status comp pregnancy, first trimester Bariatric surgery status comp pregnancy, second trimester Bariatric surgery status comp pregnancy, third trimester Bariatric surgery status complicating childbirth Bariatric surgery status complicating the puerperium Oth diseases and cond comp pregnancy, chldbrth and the puerp Malignant neoplasm complicating pregnancy, first trimester Malignant neoplasm complicating pregnancy, second trimester Malignant neoplasm complicating pregnancy, third trimester Malignant neoplasm complicating pregnancy, unsp trimester Malignant neoplasm complicating childbirth Malignant neoplasm complicating the puerperium Inj/poisn/oth conseq of external causes comp preg, first tri Inj/poisn/oth conseq of extrn causes comp preg, second tri Inj/poisn/oth conseq of external causes comp preg, third tri Inj/poisn/oth conseq of external causes comp preg, unsp tri Inj/poisn/oth conseq of external causes comp childbirth Inj/poisn/oth conseq of external causes comp the puerperium Physical abuse complicating pregnancy, first trimester Physical abuse complicating pregnancy, second trimester Physical abuse complicating pregnancy, third trimester Physical abuse complicating pregnancy, unspecified trimester Physical abuse complicating childbirth Physical abuse complicating the puerperium Sexual abuse complicating pregnancy, first trimester Sexual abuse complicating pregnancy, second trimester Sexual abuse complicating pregnancy, third trimester Sexual abuse complicating pregnancy, unspecified trimester Sexual abuse complicating childbirth Sexual abuse complicating the puerperium Psychological abuse complicating pregnancy, first trimester Psychological abuse complicating pregnancy, second trimester Psychological abuse complicating pregnancy, third trimester Psychological abuse complicating pregnancy, unsp trimester Psychological abuse complicating childbirth Psychological abuse complicating the puerperium Encntr for susp prob w amnio cavity and membrane ruled out Encounter for suspected placental problem ruled out Encounter for suspected fetal anomaly ruled out Encounter for suspected problem with fetal growth ruled out Encounter for suspected cervical shortening ruled out Encntr for oth suspected maternal and fetal cond ruled out Encounter for pregnancy test, result positive Pregnant state, incidental Encounter for elective termination of pregnancy Encntr for suprvsn of normal first pregnancy, unsp trimester Encntr for suprvsn of normal first preg, first trimester Encntr for suprvsn of normal first preg, second trimester Encntr for suprvsn of normal first preg, third trimester Encounter for suprvsn of normal pregnancy, unsp trimester Encounter for suprvsn of normal pregnancy, first trimester Encounter for suprvsn of normal pregnancy, second trimester Encounter for suprvsn of normal pregnancy, third trimester Encntr for suprvsn of normal pregnancy, unsp, unsp trimester Encntr for suprvsn of normal preg, unsp, first trimester Encntr for suprvsn of normal preg, unsp, second trimester Encntr for suprvsn of normal preg, unsp, third trimester Encounter for antenatal screening of mother Single live birth Single stillbirth Twins, both liveborn

September 2011

Edit code lists 1.45

Maternity diagnoses (age 12 through 55)

Z373 Z374 Z3750 Z3751 Z3752 Z3753 Z3754 Z3759 Z3760 Z3761 Z3762 Z3763 Z3764 Z3769 Z377 Z379 Z390 Z391 Z392 Z640

Twins, one liveborn and one stillborn Twins, both stillborn Multiple births, unspecified, all liveborn Triplets, all liveborn Quadruplets, all liveborn Quintuplets, all liveborn Sextuplets, all liveborn Other multiple births, all liveborn Multiple births, unspecified, some liveborn Triplets, some liveborn Quadruplets, some liveborn Quintuplets, some liveborn Sextuplets, some liveborn Other multiple births, some liveborn Other multiple births, all stillborn Outcome of delivery, unspecified Encntr for care and exam of mother immediately after del Encounter for care and examination of lactating mother Encounter for routine postpartum follow-up Problems related to unwanted pregnancy

1.46 Definitions of Medicare Code Edits

September 2011

Adult diagnoses (age greater than 14)


A1814 C9150 C9151 C9152 E28310 E28319 F0150 F0151 F03 F69 G112 G1221 G301 H02031 H02032 H02033 H02034 H02035 H02036 H02039 H02131 H02132 H02133 H02134 H02135 H02136 H02139 H25011 H25012 H25013 H25019 H25031 H25032 H25033 H25039 H25041 H25042 H25043 H25049 H25091 H25092 H25093 H25099 H2510 H2511 H2512 H2513 H2520 H2521 H2522 H2523 H25811 H25812 H25813 H25819 H2589 H259 H31111 H31112 H31113 H31119 H3530 H3531 H3532 H35441 Tuberculosis of prostate Adult T-cell lymph/leuk (HTLV-1-assoc) not achieve remission Adult T-cell lymphoma/leukemia (HTLV-1-assoc), in remission Adult T-cell lymphoma/leukemia (HTLV-1-assoc), in relapse Symptomatic premature menopause Asymptomatic premature menopause Vascular dementia without behavioral disturbance Vascular dementia with behavioral disturbance Unspecified dementia Unspecified disorder of adult personality and behavior Late-onset cerebellar ataxia Amyotrophic lateral sclerosis Alzheimer's disease with late onset Senile entropion of right upper eyelid Senile entropion of right lower eyelid Senile entropion of right eye, unspecified eyelid Senile entropion of left upper eyelid Senile entropion of left lower eyelid Senile entropion of left eye, unspecified eyelid Senile entropion of unspecified eye, unspecified eyelid Senile ectropion of right upper eyelid Senile ectropion of right lower eyelid Senile ectropion of right eye, unspecified eyelid Senile ectropion of left upper eyelid Senile ectropion of left lower eyelid Senile ectropion of left eye, unspecified eyelid Senile ectropion of unspecified eye, unspecified eyelid Cortical age-related cataract, right eye Cortical age-related cataract, left eye Cortical age-related cataract, bilateral Cortical age-related cataract, unspecified eye Anterior subcapsular polar age-related cataract, right eye Anterior subcapsular polar age-related cataract, left eye Anterior subcapsular polar age-related cataract, bilateral Anterior subcapsular polar age-related cataract, unsp eye Posterior subcapsular polar age-related cataract, right eye Posterior subcapsular polar age-related cataract, left eye Posterior subcapsular polar age-related cataract, bilateral Posterior subcapsular polar age-related cataract, unsp eye Other age-related incipient cataract, right eye Other age-related incipient cataract, left eye Other age-related incipient cataract, bilateral Other age-related incipient cataract, unspecified eye Age-related nuclear cataract, unspecified eye Age-related nuclear cataract, right eye Age-related nuclear cataract, left eye Age-related nuclear cataract, bilateral Age-related cataract, morgagnian type, unspecified eye Age-related cataract, morgagnian type, right eye Age-related cataract, morgagnian type, left eye Age-related cataract, morgagnian type, bilateral Combined forms of age-related cataract, right eye Combined forms of age-related cataract, left eye Combined forms of age-related cataract, bilateral Combined forms of age-related cataract, unspecified eye Other age-related cataract Unspecified age-related cataract Age-related choroidal atrophy, right eye Age-related choroidal atrophy, left eye Age-related choroidal atrophy, bilateral Age-related choroidal atrophy, unspecified eye Unspecified macular degeneration (age-related) Nonexudative age-related macular degeneration Exudative age-related macular degeneration Age-related reticular degeneration of retina, right eye

September 2011

Edit code lists 1.47

Adult diagnoses (age greater than 14)

H35442 H35443 H35449 I230 I231 I232 I233 I236 I237 I238 I2510 I25110 I25111 I25118 I25119 I25700 I25701 I25708 I25709 I25710 I25711 I25718 I25719 I25720 I25721 I25728 I25729 I25730 I25731 I25738 I25739 I25760 I25761 I25768 I25769 I25790 I25791 I25798 I25799 I25810 I25812 I2583 I510 I513 I672 I700 I701 I70201 I70202 I70203 I70208 I70209 I70211 I70212 I70213 I70218 I70219 I70221 I70222 I70223 I70228 I70229 I70231 I70232 I70233 I70234 I70235 I70238

Age-related reticular degeneration of retina, left eye Age-related reticular degeneration of retina, bilateral Age-related reticular degeneration of retina, unsp eye Hemopericardium as current complication following AMI Atrial septal defect as current complication following AMI Ventricular septal defect as current comp following AMI Rupture of card wall w/o hemoperic as current comp fol AMI Thombos of atrium/auric append/ventr as current comp fol AMI Postinfarction angina Oth current complications following AMI Athscl heart disease of native coronary artery w/o ang pctrs Athscl heart disease of native cor art w unstable ang pctrs Athscl heart disease of native cor art w ang pctrs w spasm Athscl heart disease of native cor art w oth ang pctrs Athscl heart disease of native cor art w unsp ang pctrs Atherosclerosis of CABG, unsp, w unstable angina pectoris Athscl CABG, unsp, w angina pectoris w documented spasm Atherosclerosis of CABG, unsp, w oth angina pectoris Atherosclerosis of CABG, unsp, w unsp angina pectoris Athscl autologous vein CABG w unstable angina pectoris Athscl autologous vein CABG w ang pctrs w documented spasm Athscl autologous vein CABG w oth angina pectoris Athscl autologous vein CABG w unsp angina pectoris Athscl autologous artery CABG w unstable angina pectoris Athscl autologous artery CABG w ang pctrs w documented spasm Athscl autologous artery CABG w oth angina pectoris Athscl autologous artery CABG w unsp angina pectoris Athscl nonautologous biological CABG w unstable ang pctrs Athscl nonaut biological CABG w ang pctrs w documented spasm Athscl nonautologous biological CABG w oth angina pectoris Athscl nonautologous biological CABG w unsp angina pectoris Athscl bypass of cor art of txplt heart w unstable angina Athscl bypass of cor art of txplt heart w ang pctrs w spasm Athscl bypass of cor art of txplt heart w oth ang pctrs Athscl bypass of cor art of txplt heart w unsp ang pctrs Atherosclerosis of CABG w unstable angina pectoris Atherosclerosis of CABG w angina pectoris w documented spasm Atherosclerosis of CABG w oth angina pectoris Atherosclerosis of CABG w unsp angina pectoris Atherosclerosis of CABG w/o angina pectoris Athscl bypass of cor art of transplanted heart w/o ang pctrs Coronary atherosclerosis due to lipid rich plaque Cardiac septal defect, acquired Intracardiac thrombosis, not elsewhere classified Cerebral atherosclerosis Atherosclerosis of aorta Atherosclerosis of renal artery Unsp athscl native arteries of extremities, right leg Unsp athscl native arteries of extremities, left leg Unsp athscl native arteries of extremities, bilateral legs Unsp athscl native arteries of extremities, oth extremity Unsp athscl native arteries of extremities, unsp extremity Athscl native arteries of extrm w intrmt claud, right leg Athscl native arteries of extrm w intrmt claud, left leg Athscl native arteries of extrm w intrmt claud, bi legs Athscl native arteries of extrm w intrmt claud, oth extrm Athscl native arteries of extrm w intrmt claud, unsp extrm Athscl native arteries of extremities w rest pain, right leg Athscl native arteries of extremities w rest pain, left leg Athscl native arteries of extrm w rest pain, bilateral legs Athscl native arteries of extrm w rest pain, oth extremity Athscl native arteries of extrm w rest pain, unsp extremity Athscl native arteries of right leg w ulceration of thigh Athscl native arteries of right leg w ulceration of calf Athscl native arteries of right leg w ulceration of ankle Athscl native art of right leg w ulcer of heel and midfoot Athscl native arteries of right leg w ulcer oth prt foot Athscl natv art of right leg w ulcer oth prt lower right leg

1.48 Definitions of Medicare Code Edits

September 2011

Adult diagnoses (age greater than 14)

I70239 I70241 I70242 I70243 I70244 I70245 I70248 I70249 I7025 I70261 I70262 I70263 I70268 I70269 I70291 I70292 I70293 I70298 I70299 I70301 I70302 I70303 I70308 I70309 I70311 I70312 I70313 I70318 I70319 I70321 I70322 I70323 I70328 I70329 I70331 I70332 I70333 I70334 I70335 I70338 I70339 I70341 I70342 I70343 I70344 I70345 I70348 I70349 I7035 I70361 I70362 I70363 I70368 I70369 I70391 I70392 I70393 I70398 I70399 I70401 I70402 I70403 I70408 I70409 I70411 I70412 I70413 I70418

Athscl native arteries of right leg w ulcer of unsp site Athscl native arteries of left leg w ulceration of thigh Athscl native arteries of left leg w ulceration of calf Athscl native arteries of left leg w ulceration of ankle Athscl native art of left leg w ulcer of heel and midfoot Athscl native arteries of left leg w ulceration oth prt foot Athscl native art of left leg w ulcer oth prt lower left leg Athscl native arteries of left leg w ulceration of unsp site Athscl native arteries of extremities w ulceration Athscl native arteries of extremities w gangrene, right leg Athscl native arteries of extremities w gangrene, left leg Athscl native arteries of extrm w gangrene, bilateral legs Athscl native arteries of extrm w gangrene, oth extremity Athscl native arteries of extrm w gangrene, unsp extremity Oth athscl native arteries of extremities, right leg Oth athscl native arteries of extremities, left leg Oth athscl native arteries of extremities, bilateral legs Oth athscl native arteries of extremities, oth extremity Oth athscl native arteries of extremities, unsp extremity Unsp athscl unsp type bypass of the extremities, right leg Unsp athscl unsp type bypass of the extremities, left leg Unsp athscl unsp type bypass of the extrm, bilateral legs Unsp athscl unsp type bypass of the extrm, oth extremity Unsp athscl unsp type bypass of the extrm, unsp extremity Athscl unsp type bypass of extrm w intrmt claud, right leg Athscl unsp type bypass of extrm w intrmt claud, left leg Athscl unsp type bypass of the extrm w intrmt claud, bi legs Athscl unsp type bypass of extrm w intrmt claud, oth extrm Athscl unsp type bypass of extrm w intrmt claud, unsp extrm Athscl unsp type bypass of the extrm w rest pain, right leg Athscl unsp type bypass of the extrm w rest pain, left leg Athscl unsp type bypass of the extrm w rest pain, bi legs Athscl unsp type bypass of the extrm w rest pain, oth extrm Athscl unsp type bypass of the extrm w rest pain, unsp extrm Athscl unsp type bypass of the right leg w ulcer of thigh Athscl unsp type bypass of the right leg w ulcer of calf Athscl unsp type bypass of the right leg w ulcer of ankle Athscl unsp type bypass of r leg w ulcer of heel and midft Athscl unsp type bypass of right leg w ulcer oth prt foot Athscl unsp type bypass of right leg w ulcer oth prt low leg Athscl unsp type bypass of right leg w ulcer of unsp site Athscl unsp type bypass of the left leg w ulcer of thigh Athscl unsp type bypass of the left leg w ulceration of calf Athscl unsp type bypass of the left leg w ulcer of ankle Athscl unsp type bypass of left leg w ulc of heel and midft Athscl unsp type bypass of the left leg w ulcer oth prt foot Athscl unsp type bypass of left leg w ulcer oth prt low leg Athscl unsp type bypass of the left leg w ulcer of unsp site Athscl unsp type bypass graft(s) of extremity w ulceration Athscl unsp type bypass of the extrm w gangrene, right leg Athscl unsp type bypass of the extrm w gangrene, left leg Athscl unsp type bypass of the extrm w gangrene, bi legs Athscl unsp type bypass of the extrm w gangrene, oth extrm Athscl unsp type bypass of the extrm w gangrene, unsp extrm Oth athscl unsp type bypass of the extremities, right leg Oth athscl unsp type bypass of the extremities, left leg Oth athscl unsp type bypass of the extrm, bilateral legs Oth athscl unsp type bypass of the extrm, oth extremity Oth athscl unsp type bypass of the extrm, unsp extremity Unsp athscl autologous vein bypass of the extrm, right leg Unsp athscl autologous vein bypass of the extrm, left leg Unsp athscl autol vein bypass of the extrm, bilateral legs Unsp athscl autol vein bypass of the extrm, oth extremity Unsp athscl autol vein bypass of the extrm, unsp extremity Athscl autol vein bypass of extrm w intrmt claud, right leg Athscl autol vein bypass of extrm w intrmt claud, left leg Athscl autol vein bypass of extrm w intrmt claud, bi legs Athscl autol vein bypass of extrm w intrmt claud, oth extrm

September 2011

Edit code lists 1.49

Adult diagnoses (age greater than 14)

I70419 I70421 I70422 I70423 I70428 I70429 I70431 I70432 I70433 I70434 I70435 I70438 I70439 I70441 I70442 I70443 I70444 I70445 I70448 I70449 I7045 I70461 I70462 I70463 I70468 I70469 I70491 I70492 I70493 I70498 I70499 I70501 I70502 I70503 I70508 I70509 I70511 I70512 I70513 I70518 I70519 I70521 I70522 I70523 I70528 I70529 I70531 I70532 I70533 I70534 I70535 I70538 I70539 I70541 I70542 I70543 I70544 I70545 I70548 I70549 I7055 I70561 I70562 I70563 I70568 I70569 I70591 I70592

Athscl autol vein bypass of extrm w intrmt claud, unsp extrm Athscl autol vein bypass of the extrm w rest pain, right leg Athscl autol vein bypass of the extrm w rest pain, left leg Athscl autol vein bypass of the extrm w rest pain, bi legs Athscl autol vein bypass of the extrm w rest pain, oth extrm Athscl autol vein bypass of extrm w rest pain, unsp extrm Athscl autol vein bypass of the right leg w ulcer of thigh Athscl autol vein bypass of the right leg w ulcer of calf Athscl autol vein bypass of the right leg w ulcer of ankle Athscl autol vein bypass of r leg w ulcer of heel and midft Athscl autol vein bypass of right leg w ulcer oth prt foot Athscl autol vein bypass of r leg w ulcer oth prt low leg Athscl autol vein bypass of right leg w ulcer of unsp site Athscl autol vein bypass of the left leg w ulcer of thigh Athscl autol vein bypass of the left leg w ulcer of calf Athscl autol vein bypass of the left leg w ulcer of ankle Athscl autol vein bypass of left leg w ulc of heel and midft Athscl autol vein bypass of left leg w ulcer oth prt foot Athscl autol vein bypass of left leg w ulcer oth prt low leg Athscl autol vein bypass of left leg w ulcer of unsp site Athscl autologous vein bypass of extremity w ulceration Athscl autol vein bypass of the extrm w gangrene, right leg Athscl autol vein bypass of the extrm w gangrene, left leg Athscl autol vein bypass of the extrm w gangrene, bi legs Athscl autol vein bypass of the extrm w gangrene, oth extrm Athscl autol vein bypass of the extrm w gangrene, unsp extrm Oth athscl autologous vein bypass of the extrm, right leg Oth athscl autologous vein bypass of the extrm, left leg Oth athscl autol vein bypass of the extrm, bilateral legs Oth athscl autol vein bypass of the extrm, oth extremity Oth athscl autol vein bypass of the extrm, unsp extremity Unsp athscl nonaut bio bypass of the extremities, right leg Unsp athscl nonaut bio bypass of the extremities, left leg Unsp athscl nonaut bio bypass of the extrm, bilateral legs Unsp athscl nonaut bio bypass of the extrm, oth extremity Unsp athscl nonaut bio bypass of the extrm, unsp extremity Athscl nonaut bio bypass of extrm w intrmt claud, right leg Athscl nonaut bio bypass of extrm w intrmt claud, left leg Athscl nonaut bio bypass of extrm w intrmt claud, bi legs Athscl nonaut bio bypass of extrm w intrmt claud, oth extrm Athscl nonaut bio bypass of extrm w intrmt claud, unsp extrm Athscl nonaut bio bypass of the extrm w rest pain, right leg Athscl nonaut bio bypass of the extrm w rest pain, left leg Athscl nonaut bio bypass of the extrm w rest pain, bi legs Athscl nonaut bio bypass of the extrm w rest pain, oth extrm Athscl nonaut bio bypass of extrm w rest pain, unsp extrm Athscl nonaut bio bypass of the right leg w ulcer of thigh Athscl nonaut bio bypass of the right leg w ulcer of calf Athscl nonaut bio bypass of the right leg w ulcer of ankle Athscl nonaut bio bypass of r leg w ulcer of heel and midft Athscl nonaut bio bypass of right leg w ulcer oth prt foot Athscl nonaut bio bypass of r leg w ulcer oth prt low leg Athscl nonaut bio bypass of right leg w ulcer of unsp site Athscl nonaut bio bypass of the left leg w ulcer of thigh Athscl nonaut bio bypass of the left leg w ulcer of calf Athscl nonaut bio bypass of the left leg w ulcer of ankle Athscl nonaut bio bypass of left leg w ulc of heel and midft Athscl nonaut bio bypass of left leg w ulcer oth prt foot Athscl nonaut bio bypass of left leg w ulcer oth prt low leg Athscl nonaut bio bypass of left leg w ulcer of unsp site Athscl nonautologous bio bypass of extremity w ulceration Athscl nonaut bio bypass of the extrm w gangrene, right leg Athscl nonaut bio bypass of the extrm w gangrene, left leg Athscl nonaut bio bypass of the extrm w gangrene, bi legs Athscl nonaut bio bypass of the extrm w gangrene, oth extrm Athscl nonaut bio bypass of the extrm w gangrene, unsp extrm Oth athscl nonaut bio bypass of the extremities, right leg Oth athscl nonaut bio bypass of the extremities, left leg

1.50 Definitions of Medicare Code Edits

September 2011

Adult diagnoses (age greater than 14)

I70593 I70598 I70599 I70601 I70602 I70603 I70608 I70609 I70611 I70612 I70613 I70618 I70619 I70621 I70622 I70623 I70628 I70629 I70631 I70632 I70633 I70634 I70635 I70638 I70639 I70641 I70642 I70643 I70644 I70645 I70648 I70649 I7065 I70661 I70662 I70663 I70668 I70669 I70691 I70692 I70693 I70698 I70699 I70701 I70702 I70703 I70708 I70709 I70711 I70712 I70713 I70718 I70719 I70721 I70722 I70723 I70728 I70729 I70731 I70732 I70733 I70734 I70735 I70738 I70739 I70741 I70742 I70743

Oth athscl nonaut bio bypass of the extrm, bilateral legs Oth athscl nonaut bio bypass of the extrm, oth extremity Oth athscl nonaut bio bypass of the extrm, unsp extremity Unsp athscl nonbiol bypass of the extremities, right leg Unsp athscl nonbiol bypass of the extremities, left leg Unsp athscl nonbiol bypass of the extrm, bilateral legs Unsp athscl nonbiol bypass of the extremities, oth extremity Unsp athscl nonbiol bypass of the extrm, unsp extremity Athscl nonbiol bypass of the extrm w intrmt claud, right leg Athscl nonbiol bypass of the extrm w intrmt claud, left leg Athscl nonbiol bypass of the extrm w intrmt claud, bi legs Athscl nonbiol bypass of the extrm w intrmt claud, oth extrm Athscl nonbiol bypass of extrm w intrmt claud, unsp extrm Athscl nonbiol bypass of the extrm w rest pain, right leg Athscl nonbiol bypass of the extrm w rest pain, left leg Athscl nonbiol bypass of the extrm w rest pain, bi legs Athscl nonbiol bypass of the extrm w rest pain, oth extrm Athscl nonbiol bypass of the extrm w rest pain, unsp extrm Athscl nonbiol bypass of the right leg w ulceration of thigh Athscl nonbiol bypass of the right leg w ulceration of calf Athscl nonbiol bypass of the right leg w ulceration of ankle Athscl nonbiol bypass of right leg w ulcer of heel and midft Athscl nonbiol bypass of the right leg w ulcer oth prt foot Athscl nonbiol bypass of right leg w ulcer oth prt low leg Athscl nonbiol bypass of the right leg w ulcer of unsp site Athscl nonbiol bypass of the left leg w ulceration of thigh Athscl nonbiol bypass of the left leg w ulceration of calf Athscl nonbiol bypass of the left leg w ulceration of ankle Athscl nonbiol bypass of left leg w ulcer of heel and midft Athscl nonbiol bypass of the left leg w ulcer oth prt foot Athscl nonbiol bypass of left leg w ulcer oth prt low leg Athscl nonbiol bypass of the left leg w ulcer of unsp site Athscl nonbiological bypass of extremity w ulceration Athscl nonbiol bypass of the extrm w gangrene, right leg Athscl nonbiol bypass of the extrm w gangrene, left leg Athscl nonbiol bypass of the extrm w gangrene, bi legs Athscl nonbiol bypass of the extrm w gangrene, oth extremity Athscl nonbiol bypass of the extrm w gangrene, unsp extrm Oth athscl nonbiol bypass of the extremities, right leg Oth athscl nonbiological bypass of the extremities, left leg Oth athscl nonbiol bypass of the extremities, bilateral legs Oth athscl nonbiol bypass of the extremities, oth extremity Oth athscl nonbiol bypass of the extremities, unsp extremity Unsp athscl type of bypass of the extremities, right leg Unsp athscl type of bypass of the extremities, left leg Unsp athscl type of bypass of the extrm, bilateral legs Unsp athscl type of bypass of the extremities, oth extremity Unsp athscl type of bypass of the extrm, unsp extremity Athscl type of bypass of the extrm w intrmt claud, right leg Athscl type of bypass of the extrm w intrmt claud, left leg Athscl type of bypass of the extrm w intrmt claud, bi legs Athscl type of bypass of the extrm w intrmt claud, oth extrm Athscl type of bypass of extrm w intrmt claud, unsp extrm Athscl type of bypass of the extrm w rest pain, right leg Athscl type of bypass of the extrm w rest pain, left leg Athscl type of bypass of the extrm w rest pain, bi legs Athscl type of bypass of the extrm w rest pain, oth extrm Athscl type of bypass of the extrm w rest pain, unsp extrm Athscl type of bypass of the right leg w ulceration of thigh Athscl type of bypass of the right leg w ulceration of calf Athscl type of bypass of the right leg w ulceration of ankle Athscl type of bypass of right leg w ulcer of heel and midft Athscl type of bypass of the right leg w ulcer oth prt foot Athscl type of bypass of right leg w ulcer oth prt low leg Athscl type of bypass of the right leg w ulcer of unsp site Athscl type of bypass of the left leg w ulceration of thigh Athscl type of bypass of the left leg w ulceration of calf Athscl type of bypass of the left leg w ulceration of ankle

September 2011

Edit code lists 1.51

Adult diagnoses (age greater than 14)

I70744 I70745 I70748 I70749 I7075 I70761 I70762 I70763 I70768 I70769 I70791 I70792 I70793 I70798 I70799 I708 I7090 I7091 I7092 I83001 I83002 I83003 I83004 I83005 I83008 I83009 I83011 I83012 I83013 I83014 I83015 I83018 I83019 I83021 I83022 I83023 I83024 I83025 I83028 I83029 I8310 I8311 I8312 I83201 I83202 I83203 I83204 I83205 I83208 I83209 I83211 I83212 I83213 I83214 I83215 I83218 I83219 I83221 I83222 I83223 I83224 I83225 I83228 I83229 I83811 I83812 I83813 I83819

Athscl type of bypass of left leg w ulcer of heel and midft Athscl type of bypass of the left leg w ulcer oth prt foot Athscl type of bypass of left leg w ulcer oth prt low leg Athscl type of bypass of the left leg w ulcer of unsp site Athscl type of bypass graft(s) of extremity w ulceration Athscl type of bypass of the extrm w gangrene, right leg Athscl type of bypass of the extrm w gangrene, left leg Athscl type of bypass of the extrm w gangrene, bi legs Athscl type of bypass of the extrm w gangrene, oth extremity Athscl type of bypass of the extrm w gangrene, unsp extrm Oth athscl type of bypass of the extremities, right leg Oth athscl type of bypass of the extremities, left leg Oth athscl type of bypass of the extremities, bilateral legs Oth athscl type of bypass of the extremities, oth extremity Oth athscl type of bypass of the extremities, unsp extremity Atherosclerosis of other arteries Unspecified atherosclerosis Generalized atherosclerosis Chronic total occlusion of artery of the extremities Varicose veins of unsp lower extremity with ulcer of thigh Varicose veins of unsp lower extremity with ulcer of calf Varicose veins of unsp lower extremity with ulcer of ankle Varicos vn unsp lower extremity w ulcer of heel and midfoot Varicos vn unsp lower extremity w ulcer oth part of foot Varicos vn unsp low extrm w ulcer oth part of lower leg Varicose veins of unsp lower extremity w ulcer of unsp site Varicose veins of right lower extremity with ulcer of thigh Varicose veins of right lower extremity with ulcer of calf Varicose veins of right lower extremity with ulcer of ankle Varicose veins of r low extrem w ulcer of heel and midfoot Varicose veins of r low extrem w ulcer oth part of foot Varicose veins of r low extrem w ulcer oth part of lower leg Varicose veins of right lower extremity w ulcer of unsp site Varicose veins of left lower extremity with ulcer of thigh Varicose veins of left lower extremity with ulcer of calf Varicose veins of left lower extremity with ulcer of ankle Varicose veins of l low extrem w ulcer of heel and midfoot Varicose veins of l low extrem w ulcer oth part of foot Varicose veins of l low extrem w ulcer oth part of lower leg Varicose veins of left lower extremity w ulcer of unsp site Varicose veins of unsp lower extremity with inflammation Varicose veins of right lower extremity with inflammation Varicose veins of left lower extremity with inflammation Varicos vn unsp low extrm w ulc of thigh and inflammation Varicos vn unsp low extrm w ulc of calf and inflammation Varicos vn unsp low extrm w ulc of ankle and inflammation Varicos vn unsp low extrm w ulc of heel and midft and inflam Varicos vn unsp low extrm w ulc oth part of foot and inflam Varicos vn unsp low extrm w ulc oth prt low extrm and inflam Varicos vn unsp low extrm w ulc of unsp site and inflam Varicos vn of r low extrem w ulc of thigh and inflammation Varicos vn of r low extrem w ulc of calf and inflammation Varicos vn of r low extrem w ulc of ankle and inflammation Varicos vn of r low extrem w ulc of heel & midft and inflam Varicos vn of r low extrem w ulc oth part of foot and inflam Varicos vn of r low extrem w ulc oth prt low extrm & inflam Varicos vn of r low extrem w ulc of unsp site and inflam Varicos vn of l low extrem w ulc of thigh and inflammation Varicos vn of l low extrem w ulc of calf and inflammation Varicos vn of l low extrem w ulc of ankle and inflammation Varicos vn of l low extrem w ulc of heel & midft and inflam Varicos vn of l low extrem w ulc oth part of foot and inflam Varicos vn of l low extrem w ulc oth prt low extrm & inflam Varicos vn of l low extrem w ulc of unsp site and inflam Varicose veins of right lower extremities with pain Varicose veins of left lower extremities with pain Varicose veins of bilateral lower extremities with pain Varicose veins of unspecified lower extremities with pain

1.52 Definitions of Medicare Code Edits

September 2011

Adult diagnoses (age greater than 14)

I83891 I83892 I83893 I83899 I8390 I8391 I8392 I8393 I868 I972 J60 J61 K311 K700 K7010 K7011 K702 K7030 K7031 K7040 K7041 K709 M061 M4210 M4211 M4212 M4213 M4214 M4215 M4216 M4217 M4218 M4219 M720 M8000XA M8000XD M8000XG M8000XK M8000XP M8000XS M80011A M80011D M80011G M80011K M80011P M80011S M80012A M80012D M80012G M80012K M80012P M80012S M80019A M80019D M80019G M80019K M80019P M80019S M80021A M80021D M80021G M80021K M80021P M80021S M80022A M80022D M80022G M80022K

Varicose veins of right low extrm w oth complications Varicose veins of left lower extremities w oth complications Varicose veins of bi low extrem w oth complications Varicose veins of unsp lower extremities w oth complications Asymptomatic varicose veins of unspecified lower extremity Asymptomatic varicose veins of right lower extremity Asymptomatic varicose veins of left lower extremity Asymptomatic varicose veins of bilateral lower extremities Varicose veins of other specified sites Postmastectomy lymphedema syndrome Coalworker's pneumoconiosis Pneumoconiosis due to asbestos and other mineral fibers Adult hypertrophic pyloric stenosis Alcoholic fatty liver Alcoholic hepatitis without ascites Alcoholic hepatitis with ascites Alcoholic fibrosis and sclerosis of liver Alcoholic cirrhosis of liver without ascites Alcoholic cirrhosis of liver with ascites Alcoholic hepatic failure without coma Alcoholic hepatic failure with coma Alcoholic liver disease, unspecified Adult-onset Still's disease Adult osteochondrosis of spine, site unspecified Adult osteochondrosis of spine, occipt-atlan-ax region Adult osteochondrosis of spine, cervical region Adult osteochondrosis of spine, cervicothoracic region Adult osteochondrosis of spine, thoracic region Adult osteochondrosis of spine, thoracolumbar region Adult osteochondrosis of spine, lumbar region Adult osteochondrosis of spine, lumbosacral region Adult osteochondrosis of spine, sacr/sacrocygl region Adult osteochondrosis of spine, multiple sites in spine Palmar fascial fibromatosis [Dupuytren] Age-rel osteopor w current path fracture, unsp site, init Age-rel osteopor w crnt path fx, unsp site, 7thD Age-rel osteopor w crnt path fx, unsp site, 7thG Age-rel osteopor w crnt path fx, unsp site, 7thK Age-rel osteopor w crnt path fx, unsp site, 7thP Age-rel osteopor w current path fracture, unsp site, sequela Age-rel osteopor w current path fracture, r shoulder, init Age-rel osteopor w crnt path fx, r shldr, 7thD Age-rel osteopor w crnt path fx, r shldr, 7thG Age-rel osteopor w crnt path fx, r shldr, 7thK Age-rel osteopor w crnt path fx, r shldr, 7thP Age-rel osteopor w current path fx, r shoulder, sequela Age-rel osteopor w current path fracture, l shoulder, init Age-rel osteopor w crnt path fx, l shldr, 7thD Age-rel osteopor w crnt path fx, l shldr, 7thG Age-rel osteopor w crnt path fx, l shldr, 7thK Age-rel osteopor w crnt path fx, l shldr, 7thP Age-rel osteopor w current path fx, l shoulder, sequela Age-rel osteopor w current path fx, unsp shoulder, init Age-rel osteopor w crnt path fx, unsp shldr, 7thD Age-rel osteopor w crnt path fx, unsp shldr, 7thG Age-rel osteopor w crnt path fx, unsp shldr, 7thK Age-rel osteopor w crnt path fx, unsp shldr, 7thP Age-rel osteopor w current path fx, unsp shoulder, sequela Age-rel osteopor w current path fracture, r humerus, init Age-rel osteopor w crnt path fx, r humer, 7thD Age-rel osteopor w crnt path fx, r humer, 7thG Age-rel osteopor w crnt path fx, r humer, 7thK Age-rel osteopor w crnt path fx, r humer, 7thP Age-rel osteopor w current path fracture, r humerus, sequela Age-rel osteopor w current path fracture, l humerus, init Age-rel osteopor w crnt path fx, l humer, 7thD Age-rel osteopor w crnt path fx, l humer, 7thG Age-rel osteopor w crnt path fx, l humer, 7thK

September 2011

Edit code lists 1.53

Adult diagnoses (age greater than 14)

M80022P M80022S M80029A M80029D M80029G M80029K M80029P M80029S M80031A M80031D M80031G M80031K M80031P M80031S M80032A M80032D M80032G M80032K M80032P M80032S M80039A M80039D M80039G M80039K M80039P M80039S M80041A M80041D M80041G M80041K M80041P M80041S M80042A M80042D M80042G M80042K M80042P M80042S M80049A M80049D M80049G M80049K M80049P M80049S M80051A M80051D M80051G M80051K M80051P M80051S M80052A M80052D M80052G M80052K M80052P M80052S M80059A M80059D M80059G M80059K M80059P M80059S M80061A M80061D M80061G M80061K M80061P M80061S

Age-rel osteopor w crnt path fx, l humer, 7thP Age-rel osteopor w current path fracture, l humerus, sequela Age-rel osteopor w current path fracture, unsp humerus, init Age-rel osteopor w crnt path fx, unsp humer, 7thD Age-rel osteopor w crnt path fx, unsp humer, 7thG Age-rel osteopor w crnt path fx, unsp humer, 7thK Age-rel osteopor w crnt path fx, unsp humer, 7thP Age-rel osteopor w current path fx, unsp humerus, sequela Age-rel osteopor w current path fracture, r forearm, init Age-rel osteopor w crnt path fx, r forearm, 7thD Age-rel osteopor w crnt path fx, r forearm, 7thG Age-rel osteopor w crnt path fx, r forearm, 7thK Age-rel osteopor w crnt path fx, r forearm, 7thP Age-rel osteopor w current path fracture, r forearm, sequela Age-rel osteopor w current path fracture, l forearm, init Age-rel osteopor w crnt path fx, l forearm, 7thD Age-rel osteopor w crnt path fx, l forearm, 7thG Age-rel osteopor w crnt path fx, l forearm, 7thK Age-rel osteopor w crnt path fx, l forearm, 7thP Age-rel osteopor w current path fracture, l forearm, sequela Age-rel osteopor w current path fracture, unsp forearm, init Age-rel osteopor w crnt path fx, unsp forearm, 7thD Age-rel osteopor w crnt path fx, unsp forearm, 7thG Age-rel osteopor w crnt path fx, unsp forearm, 7thK Age-rel osteopor w crnt path fx, unsp forearm, 7thP Age-rel osteopor w current path fx, unsp forearm, sequela Age-rel osteopor w current path fracture, right hand, init Age-rel osteopor w crnt path fx, r hand, 7thD Age-rel osteopor w crnt path fx, r hand, 7thG Age-rel osteopor w crnt path fx, r hand, 7thK Age-rel osteopor w crnt path fx, r hand, 7thP Age-rel osteopor w current path fracture, r hand, sequela Age-rel osteopor w current path fracture, left hand, init Age-rel osteopor w crnt path fx, l hand, 7thD Age-rel osteopor w crnt path fx, l hand, 7thG Age-rel osteopor w crnt path fx, l hand, 7thK Age-rel osteopor w crnt path fx, l hand, 7thP Age-rel osteopor w current path fracture, left hand, sequela Age-rel osteopor w current path fracture, unsp hand, init Age-rel osteopor w crnt path fx, unsp hand, 7thD Age-rel osteopor w crnt path fx, unsp hand, 7thG Age-rel osteopor w crnt path fx, unsp hand, 7thK Age-rel osteopor w crnt path fx, unsp hand, 7thP Age-rel osteopor w current path fracture, unsp hand, sequela Age-rel osteopor w current path fracture, right femur, init Age-rel osteopor w crnt path fx, r femr, 7thD Age-rel osteopor w crnt path fx, r femr, 7thG Age-rel osteopor w crnt path fx, r femr, 7thK Age-rel osteopor w crnt path fx, r femr, 7thP Age-rel osteopor w current path fracture, r femur, sequela Age-rel osteopor w current path fracture, left femur, init Age-rel osteopor w crnt path fx, l femr, 7thD Age-rel osteopor w crnt path fx, l femr, 7thG Age-rel osteopor w crnt path fx, l femr, 7thK Age-rel osteopor w crnt path fx, l femr, 7thP Age-rel osteopor w current path fracture, l femur, sequela Age-rel osteopor w current path fracture, unsp femur, init Age-rel osteopor w crnt path fx, unsp femr, 7thD Age-rel osteopor w crnt path fx, unsp femr, 7thG Age-rel osteopor w crnt path fx, unsp femr, 7thK Age-rel osteopor w crnt path fx, unsp femr, 7thP Age-rel osteopor w current path fx, unsp femur, sequela Age-rel osteopor w current path fracture, r low leg, init Age-rel osteopor w crnt path fx, r low leg, 7thD Age-rel osteopor w crnt path fx, r low leg, 7thG Age-rel osteopor w crnt path fx, r low leg, 7thK Age-rel osteopor w crnt path fx, r low leg, 7thP Age-rel osteopor w current path fracture, r low leg, sequela

1.54 Definitions of Medicare Code Edits

September 2011

Adult diagnoses (age greater than 14)

M80062A M80062D M80062G M80062K M80062P M80062S M80069A M80069D M80069G M80069K M80069P M80069S M80071A M80071D M80071G M80071K M80071P M80071S M80072A M80072D M80072G M80072K M80072P M80072S M80079A M80079D M80079G M80079K M80079P M80079S M8008XA M8008XD M8008XG M8008XK M8008XP M8008XS M810 M831 M832 M833 M835 M838 M839 M931 N400 N401 N4100 N4101 N4110 N4111 N412 N413 N414 N418 N419 N420 N421 N4281 N4282 N4289 N429 N4601 N46021 N46022 N46023 N46024 N46025 N46029

Age-rel osteopor w current path fracture, l low leg, init Age-rel osteopor w crnt path fx, l low leg, 7thD Age-rel osteopor w crnt path fx, l low leg, 7thG Age-rel osteopor w crnt path fx, l low leg, 7thK Age-rel osteopor w crnt path fx, l low leg, 7thP Age-rel osteopor w current path fracture, l low leg, sequela Age-rel osteopor w current path fracture, unsp low leg, init Age-rel osteopor w crnt path fx, unsp low leg, 7thD Age-rel osteopor w crnt path fx, unsp low leg, 7thG Age-rel osteopor w crnt path fx, unsp low leg, 7thK Age-rel osteopor w crnt path fx, unsp low leg, 7thP Age-rel osteopor w current path fx, unsp low leg, sequela Age-rel osteopor w current path fracture, right ank/ft, init Age-rel osteopor w crnt path fx, r ank/ft, 7thD Age-rel osteopor w crnt path fx, r ank/ft, 7thG Age-rel osteopor w crnt path fx, r ank/ft, 7thK Age-rel osteopor w crnt path fx, r ank/ft, 7thP Age-rel osteopor w current path fx, right ank/ft, sequela Age-rel osteopor w current path fracture, left ank/ft, init Age-rel osteopor w crnt path fx, l ank/ft, 7thD Age-rel osteopor w crnt path fx, l ank/ft, 7thG Age-rel osteopor w crnt path fx, l ank/ft, 7thK Age-rel osteopor w crnt path fx, l ank/ft, 7thP Age-rel osteopor w current path fx, left ank/ft, sequela Age-rel osteopor w current path fracture, unsp ank/ft, init Age-rel osteopor w crnt path fx, unsp ank/ft, 7thD Age-rel osteopor w crnt path fx, unsp ank/ft, 7thG Age-rel osteopor w crnt path fx, unsp ank/ft, 7thK Age-rel osteopor w crnt path fx, unsp ank/ft, 7thP Age-rel osteopor w current path fx, unsp ank/ft, sequela Age-rel osteopor w current path fracture, vertebra(e), init Age-rel osteopor w crnt path fx, verteb, 7thD Age-rel osteopor w crnt path fx, verteb, 7thG Age-rel osteopor w crnt path fx, verteb, 7thK Age-rel osteopor w crnt path fx, verteb, 7thP Age-rel osteopor w current path fracture, verteb, sequela Age-related osteoporosis w/o current pathological fracture Senile osteomalacia Adult osteomalacia due to malabsorption Adult osteomalacia due to malnutrition Other drug-induced osteomalacia in adults Other adult osteomalacia Adult osteomalacia, unspecified Kienbock's disease of adults Enlarged prostate w/o lower urinary tract symptoms (LUTS) Enlarged prostate with lower urinary tract symptoms (LUTS) Acute prostatitis without hematuria Acute prostatitis with hematuria Chronic prostatitis without hematuria Chronic prostatitis with hematuria Abscess of prostate Prostatocystitis Granulomatous prostatitis Other inflammatory diseases of prostate Inflammatory disease of prostate, unspecified Calculus of prostate Congestion and hemorrhage of prostate Prostatodynia syndrome Prostatosis syndrome Other specified disorders of prostate Disorder of prostate, unspecified Organic azoospermia Azoospermia due to drug therapy Azoospermia due to infection Azoospermia due to obstruction of efferent ducts Azoospermia due to radiation Azoospermia due to systemic disease Azoospermia due to other extratesticular causes

September 2011

Edit code lists 1.55

Adult diagnoses (age greater than 14)

N4611 N46121 N46122 N46123 N46124 N46125 N46129 N468 N469 N5201 N5202 N5203 N521 N522 N5231 N5232 N5233 N5234 N5239 N528 N529 N6011 N6012 N6019 N6481 N6482 N650 N651 R4181 R54 R627 R6882 R972 T7401XA T7401XD T7401XS T7411XA T7411XD T7411XS T7421XA T7421XD T7421XS T7431XA T7431XD T7431XS T7491XA T7491XD T7491XS T7601XA T7601XD T7601XS T7611XA T7611XD T7611XS T7621XA T7621XD T7621XS T7631XA T7631XD T7631XS T7691XA T7691XD T7691XS Y0701 Y0711 Y0713 Y07420 Y07430

Organic oligospermia Oligospermia due to drug therapy Oligospermia due to infection Oligospermia due to obstruction of efferent ducts Oligospermia due to radiation Oligospermia due to systemic disease Oligospermia due to other extratesticular causes Other male infertility Male infertility, unspecified Erectile dysfunction due to arterial insufficiency Corporo-venous occlusive erectile dysfunction Comb artrl insuff & corporo-venous occlusv erectile dysfnct Erectile dysfunction due to diseases classified elsewhere Drug-induced erectile dysfunction Erectile dysfunction following radical prostatectomy Erectile dysfunction following radical cystectomy Erectile dysfunction following urethral surgery Erectile dysfunction following simple prostatectomy Other post-surgical erectile dysfunction Other male erectile dysfunction Male erectile dysfunction, unspecified Diffuse cystic mastopathy of right breast Diffuse cystic mastopathy of left breast Diffuse cystic mastopathy of unspecified breast Ptosis of breast Hypoplasia of breast Deformity of reconstructed breast Disproportion of reconstructed breast Age-related cognitive decline Age-related physical debility Adult failure to thrive Decreased libido Elevated prostate specific antigen [PSA] Adult neglect or abandonment, confirmed, initial encounter Adult neglect or abandonment, confirmed, subs encntr Adult neglect or abandonment, confirmed, sequela Adult physical abuse, confirmed, initial encounter Adult physical abuse, confirmed, subsequent encounter Adult physical abuse, confirmed, sequela Adult sexual abuse, confirmed, initial encounter Adult sexual abuse, confirmed, subsequent encounter Adult sexual abuse, confirmed, sequela Adult psychological abuse, confirmed, initial encounter Adult psychological abuse, confirmed, subsequent encounter Adult psychological abuse, confirmed, sequela Unspecified adult maltreatment, confirmed, initial encounter Unspecified adult maltreatment, confirmed, subs encntr Unspecified adult maltreatment, confirmed, sequela Adult neglect or abandonment, suspected, initial encounter Adult neglect or abandonment, suspected, subs encntr Adult neglect or abandonment, suspected, sequela Adult physical abuse, suspected, initial encounter Adult physical abuse, suspected, subsequent encounter Adult physical abuse, suspected, sequela Adult sexual abuse, suspected, initial encounter Adult sexual abuse, suspected, subsequent encounter Adult sexual abuse, suspected, sequela Adult psychological abuse, suspected, initial encounter Adult psychological abuse, suspected, subsequent encounter Adult psychological abuse, suspected, sequela Unspecified adult maltreatment, suspected, initial encounter Unspecified adult maltreatment, suspected, subs encntr Unspecified adult maltreatment, suspected, sequela Husband, perpetrator of maltreatment and neglect Biological father, perpetrator of maltreatment and neglect Adoptive father, perpetrator of maltreatment and neglect Foster father, perpetrator of maltreatment and neglect Stepfather, perpetrator of maltreatment and neglect

1.56 Definitions of Medicare Code Edits

September 2011

Adult diagnoses (age greater than 14)

Y07510 Y07511 Y07512 Y07513 Z0000 Z0001 Z0441 Z0471 Z31441 Z31448 Z421 Z561 Z655 Z681 Z6820 Z6821 Z6822 Z6823 Z6824 Z6825 Z6826 Z6827 Z6828 Z6829 Z6830 Z6831 Z6832 Z6833 Z6834 Z6835 Z6836 Z6837 Z6838 Z6839 Z6841 Z6842 Z6843 Z6844 Z6845 Z72811 Z780 Z8651 Z91410 Z91411 Z91412 Z91419 Z9852

At-home childcare provider, perp of maltreat and neglect Daycare center childcare prov, perp of maltreat and neglect At-home adultcare provider, perp of maltreat and neglect Adultcare center provider, perp of maltreat and neglect Encntr for general adult medical exam w/o abnormal findings Encounter for general adult medical exam w abnormal findings Encounter for exam and obs following alleged adult rape Encntr for exam and obs fol alleged adult physical abuse Encntr for testing of male prtnr of pt w recur preg loss Encounter for oth genetic testing of male for pro mgmt Encounter for breast reconstruction following mastectomy Change of job Exposure to disaster, war and other hostilities Body mass index (BMI) 19 or less, adult Body mass index (BMI) 20.0-20.9, adult Body mass index (BMI) 21.0-21.9, adult Body mass index (BMI) 22.0-22.9, adult Body mass index (BMI) 23.0-23.9, adult Body mass index (BMI) 24.0-24.9, adult Body mass index (BMI) 25.0-25.9, adult Body mass index (BMI) 26.0-26.9, adult Body mass index (BMI) 27.0-27.9, adult Body mass index (BMI) 28.0-28.9, adult Body mass index (BMI) 29.0-29.9, adult Body mass index (BMI) 30.0-30.9, adult Body mass index (BMI) 31.0-31.9, adult Body mass index (BMI) 32.0-32.9, adult Body mass index (BMI) 33.0-33.9, adult Body mass index (BMI) 34.0-34.9, adult Body mass index (BMI) 35.0-35.9, adult Body mass index (BMI) 36.0-36.9, adult Body mass index (BMI) 37.0-37.9, adult Body mass index (BMI) 38.0-38.9, adult Body mass index (BMI) 39.0-39.9, adult Body mass index (BMI) 40.0-44.9, adult Body mass index (BMI) 45.0-49.9, adult Body mass index (BMI) 50-59.9 , adult Body mass index (BMI) 60.0-69.9, adult Body mass index (BMI) 70 or greater, adult Adult antisocial behavior Asymptomatic menopausal state Personal history of combat and operational stress reaction Personal history of adult physical and sexual abuse Personal history of adult psychological abuse Personal history of adult neglect Personal history of unspecified adult abuse Vasectomy status

September 2011

Edit code lists 1.57

5. Sex conflict

Medicare Code Editor detects inconsistencies between a patients sex and any diagnosis or procedure on the patients record. For example, a male patient with cervical cancer (diagnosis) or a female patient with a prostatectomy (procedure). In both instances, the indicated diagnosis or the procedure conflicts with the stated sex of the patient. Therefore, either the patients diagnosis, procedure or sex is presumed to be incorrect. The following pages contain lists of male and female related ICD-10-CM diagnosis and ICD-10-PCS procedure codes with corresponding English descriptions.

Diagnoses allowed for females only


A1816 A1817 A1818 A34 A5142 A5402 A5403 A5424 A5602 A5611 A5901 A6003 A6004 B373 C50011 C50012 C50019 C50111 C50112 C50119 C50211 C50212 C50219 C50311 C50312 C50319 C50411 C50412 C50419 C50511 C50512 C50519 C50611 C50612 C50619 C50811 C50812 C50819 C50911 C50912 C50919 C510 C511 C512 C518 Tuberculosis of cervix Tuberculous female pelvic inflammatory disease Tuberculosis of other female genital organs Obstetrical tetanus Secondary syphilitic female pelvic disease Gonococcal vulvovaginitis, unspecified Gonococcal cervicitis, unspecified Gonococcal female pelvic inflammatory disease Chlamydial vulvovaginitis Chlamydial female pelvic inflammatory disease Trichomonal vulvovaginitis Herpesviral cervicitis Herpesviral vulvovaginitis Candidiasis of vulva and vagina Malignant neoplasm of nipple and areola, right female breast Malignant neoplasm of nipple and areola, left female breast Malignant neoplasm of nipple and areola, unsp female breast Malignant neoplasm of central portion of right female breast Malignant neoplasm of central portion of left female breast Malignant neoplasm of central portion of unsp female breast Malig neoplm of upper-inner quadrant of right female breast Malig neoplasm of upper-inner quadrant of left female breast Malig neoplasm of upper-inner quadrant of unsp female breast Malig neoplm of lower-inner quadrant of right female breast Malig neoplasm of lower-inner quadrant of left female breast Malig neoplasm of lower-inner quadrant of unsp female breast Malig neoplm of upper-outer quadrant of right female breast Malig neoplasm of upper-outer quadrant of left female breast Malig neoplasm of upper-outer quadrant of unsp female breast Malig neoplm of lower-outer quadrant of right female breast Malig neoplasm of lower-outer quadrant of left female breast Malig neoplasm of lower-outer quadrant of unsp female breast Malignant neoplasm of axillary tail of right female breast Malignant neoplasm of axillary tail of left female breast Malignant neoplasm of axillary tail of unsp female breast Malignant neoplasm of ovrlp sites of right female breast Malignant neoplasm of ovrlp sites of left female breast Malignant neoplasm of ovrlp sites of unsp female breast Malignant neoplasm of unsp site of right female breast Malignant neoplasm of unspecified site of left female breast Malignant neoplasm of unsp site of unspecified female breast Malignant neoplasm of labium majus Malignant neoplasm of labium minus Malignant neoplasm of clitoris Malignant neoplasm of overlapping sites of vulva

1.58 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

C519 C52 C530 C531 C538 C539 C540 C541 C542 C543 C548 C549 C55 C561 C562 C569 C5700 C5701 C5702 C5710 C5711 C5712 C5720 C5721 C5722 C573 C574 C577 C578 C579 C58 C7960 C7961 C7962 D060 D061 D067 D069 D070 D071 D072 D0730 D0739 D250 D251 D252 D259 D260 D261 D267 D269 D270 D271 D279 D280 D281 D282 D287 D289 D390 D3910 D3911 D3912 D392 D398 D399 E280 E281

Malignant neoplasm of vulva, unspecified Malignant neoplasm of vagina Malignant neoplasm of endocervix Malignant neoplasm of exocervix Malignant neoplasm of overlapping sites of cervix uteri Malignant neoplasm of cervix uteri, unspecified Malignant neoplasm of isthmus uteri Malignant neoplasm of endometrium Malignant neoplasm of myometrium Malignant neoplasm of fundus uteri Malignant neoplasm of overlapping sites of corpus uteri Malignant neoplasm of corpus uteri, unspecified Malignant neoplasm of uterus, part unspecified Malignant neoplasm of right ovary Malignant neoplasm of left ovary Malignant neoplasm of unspecified ovary Malignant neoplasm of unspecified fallopian tube Malignant neoplasm of right fallopian tube Malignant neoplasm of left fallopian tube Malignant neoplasm of unspecified broad ligament Malignant neoplasm of right broad ligament Malignant neoplasm of left broad ligament Malignant neoplasm of unspecified round ligament Malignant neoplasm of right round ligament Malignant neoplasm of left round ligament Malignant neoplasm of parametrium Malignant neoplasm of uterine adnexa, unspecified Malignant neoplasm of other specified female genital organs Malignant neoplasm of ovrlp sites of female genital organs Malignant neoplasm of female genital organ, unspecified Malignant neoplasm of placenta Secondary malignant neoplasm of unspecified ovary Secondary malignant neoplasm of right ovary Secondary malignant neoplasm of left ovary Carcinoma in situ of endocervix Carcinoma in situ of exocervix Carcinoma in situ of other parts of cervix Carcinoma in situ of cervix, unspecified Carcinoma in situ of endometrium Carcinoma in situ of vulva Carcinoma in situ of vagina Carcinoma in situ of unspecified female genital organs Carcinoma in situ of other female genital organs Submucous leiomyoma of uterus Intramural leiomyoma of uterus Subserosal leiomyoma of uterus Leiomyoma of uterus, unspecified Other benign neoplasm of cervix uteri Other benign neoplasm of corpus uteri Other benign neoplasm of other parts of uterus Other benign neoplasm of uterus, unspecified Benign neoplasm of right ovary Benign neoplasm of left ovary Benign neoplasm of unspecified ovary Benign neoplasm of vulva Benign neoplasm of vagina Benign neoplasm of uterine tubes and ligaments Benign neoplasm of other specified female genital organs Benign neoplasm of female genital organ, unspecified Neoplasm of uncertain behavior of uterus Neoplasm of uncertain behavior of unspecified ovary Neoplasm of uncertain behavior of right ovary Neoplasm of uncertain behavior of left ovary Neoplasm of uncertain behavior of placenta Neoplasm of uncertain behavior of oth female genital organs Neoplasm of uncertain behavior of female genital organ, unsp Estrogen excess Androgen excess

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Diagnoses allowed for females only

E282 E28310 E28319 E2839 E288 E289 E8940 E8941 F5222 F5231 F525 F526 F53 G43D01 G43D09 G43D11 G43D19 I863 L292 M830 N35021 N35028 N3512 N7001 N7002 N7003 N7011 N7012 N7013 N7091 N7092 N7093 N710 N711 N719 N72 N730 N731 N732 N733 N734 N735 N736 N738 N739 N74 N750 N751 N758 N759 N760 N761 N762 N763 N764 N765 N766 N7681 N7689 N770 N771 N800 N801 N802 N803 N804 N805 N806

Polycystic ovarian syndrome Symptomatic premature menopause Asymptomatic premature menopause Other primary ovarian failure Other ovarian dysfunction Ovarian dysfunction, unspecified Asymptomatic postprocedural ovarian failure Symptomatic postprocedural ovarian failure Female sexual arousal disorder Female orgasmic disorder Vaginismus not due to a substance or known physiol condition Dyspareunia not due to a substance or known physiol cond Puerperal psychosis Menstrual migraine, not intractable, with status migrainosus Menstrual migraine, not intractable, w/o status migrainosus Menstrual migraine, intractable, with status migrainosus Menstrual migraine, intractable, without status migrainosus Vulval varices Pruritus vulvae Puerperal osteomalacia Urethral stricture due to childbirth Other post-traumatic urethral stricture, female Postinfective urethral stricture, NEC, female Acute salpingitis Acute oophoritis Acute salpingitis and oophoritis Chronic salpingitis Chronic oophoritis Chronic salpingitis and oophoritis Salpingitis, unspecified Oophoritis, unspecified Salpingitis and oophoritis, unspecified Acute inflammatory disease of uterus Chronic inflammatory disease of uterus Inflammatory disease of uterus, unspecified Inflammatory disease of cervix uteri Acute parametritis and pelvic cellulitis Chronic parametritis and pelvic cellulitis Unspecified parametritis and pelvic cellulitis Female acute pelvic peritonitis Female chronic pelvic peritonitis Female pelvic peritonitis, unspecified Female pelvic peritoneal adhesions (postinfective) Other specified female pelvic inflammatory diseases Female pelvic inflammatory disease, unspecified Female pelvic inflam disorders in diseases classd elswhr Cyst of Bartholin's gland Abscess of Bartholin's gland Other diseases of Bartholin's gland Disease of Bartholin's gland, unspecified Acute vaginitis Subacute and chronic vaginitis Acute vulvitis Subacute and chronic vulvitis Abscess of vulva Ulceration of vagina Ulceration of vulva Mucositis (ulcerative) of vagina and vulva Other specified inflammation of vagina and vulva Ulceration of vulva in diseases classified elsewhere Vaginitis, vulvitis and vulvovaginitis in dis classd elswhr Endometriosis of uterus Endometriosis of ovary Endometriosis of fallopian tube Endometriosis of pelvic peritoneum Endometriosis of rectovaginal septum and vagina Endometriosis of intestine Endometriosis in cutaneous scar

1.60 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

N808 N809 N810 N8110 N8111 N8112 N812 N813 N814 N815 N816 N8181 N8182 N8183 N8184 N8185 N8189 N819 N820 N821 N822 N823 N824 N825 N828 N829 N830 N831 N8320 N8329 N8331 N8332 N8333 N834 N8351 N8352 N8353 N836 N837 N838 N839 N840 N841 N842 N843 N848 N849 N8500 N8501 N8502 N852 N853 N854 N855 N856 N857 N858 N859 N86 N870 N871 N879 N880 N881 N882 N883 N884 N888

Other endometriosis Endometriosis, unspecified Urethrocele Cystocele, unspecified Cystocele, midline Cystocele, lateral Incomplete uterovaginal prolapse Complete uterovaginal prolapse Uterovaginal prolapse, unspecified Vaginal enterocele Rectocele Perineocele Incompetence or weakening of pubocervical tissue Incompetence or weakening of rectovaginal tissue Pelvic muscle wasting Cervical stump prolapse Other female genital prolapse Female genital prolapse, unspecified Vesicovaginal fistula Other female urinary-genital tract fistulae Fistula of vagina to small intestine Fistula of vagina to large intestine Other female intestinal-genital tract fistulae Female genital tract-skin fistulae Other female genital tract fistulae Female genital tract fistula, unspecified Follicular cyst of ovary Corpus luteum cyst Unspecified ovarian cysts Other ovarian cysts Acquired atrophy of ovary Acquired atrophy of fallopian tube Acquired atrophy of ovary and fallopian tube Prolapse and hernia of ovary and fallopian tube Torsion of ovary and ovarian pedicle Torsion of fallopian tube Torsion of ovary, ovarian pedicle and fallopian tube Hematosalpinx Hematoma of broad ligament Oth noninflammatory disord of ovary, fallop and broad ligmt Noninflammatory disord of ovary, fallop & broad ligmt, unsp Polyp of corpus uteri Polyp of cervix uteri Polyp of vagina Polyp of vulva Polyp of other parts of female genital tract Polyp of female genital tract, unspecified Endometrial hyperplasia, unspecified Benign endometrial hyperplasia Endometrial intraepithelial neoplasia [EIN] Hypertrophy of uterus Subinvolution of uterus Malposition of uterus Inversion of uterus Intrauterine synechiae Hematometra Other specified noninflammatory disorders of uterus Noninflammatory disorder of uterus, unspecified Erosion and ectropion of cervix uteri Mild cervical dysplasia Moderate cervical dysplasia Dysplasia of cervix uteri, unspecified Leukoplakia of cervix uteri Old laceration of cervix uteri Stricture and stenosis of cervix uteri Incompetence of cervix uteri Hypertrophic elongation of cervix uteri Other specified noninflammatory disorders of cervix uteri

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Diagnoses allowed for females only

N889 N890 N891 N893 N894 N895 N896 N897 N898 N899 N900 N901 N903 N904 N905 N906 N907 N90810 N90811 N90812 N90813 N90818 N9089 N909 N910 N911 N912 N913 N914 N915 N920 N921 N922 N923 N924 N925 N926 N930 N938 N939 N940 N941 N942 N943 N944 N945 N946 N94810 N94818 N94819 N9489 N949 N950 N951 N952 N958 N959 N96 N970 N971 N972 N978 N979 N980 N981 N982 N983 N988

Noninflammatory disorder of cervix uteri, unspecified Mild vaginal dysplasia Moderate vaginal dysplasia Dysplasia of vagina, unspecified Leukoplakia of vagina Stricture and atresia of vagina Tight hymenal ring Hematocolpos Other specified noninflammatory disorders of vagina Noninflammatory disorder of vagina, unspecified Mild vulvar dysplasia Moderate vulvar dysplasia Dysplasia of vulva, unspecified Leukoplakia of vulva Atrophy of vulva Hypertrophy of vulva Vulvar cyst Female genital mutilation status, unspecified Female genital mutilation Type I status Female genital mutilation Type II status Female genital mutilation Type III status Other female genital mutilation status Oth noninflammatory disorders of vulva and perineum Noninflammatory disorder of vulva and perineum, unspecified Primary amenorrhea Secondary amenorrhea Amenorrhea, unspecified Primary oligomenorrhea Secondary oligomenorrhea Oligomenorrhea, unspecified Excessive and frequent menstruation with regular cycle Excessive and frequent menstruation with irregular cycle Excessive menstruation at puberty Ovulation bleeding Excessive bleeding in the premenopausal period Other specified irregular menstruation Irregular menstruation, unspecified Postcoital and contact bleeding Other specified abnormal uterine and vaginal bleeding Abnormal uterine and vaginal bleeding, unspecified Mittelschmerz Dyspareunia Vaginismus Premenstrual tension syndrome Primary dysmenorrhea Secondary dysmenorrhea Dysmenorrhea, unspecified Vulvar vestibulitis Other vulvodynia Vulvodynia, unspecified Oth cond assoc w female genital organs and menstrual cycle Unsp cond assoc w female genital organs and menstrual cycle Postmenopausal bleeding Menopausal and female climacteric states Postmenopausal atrophic vaginitis Other specified menopausal and perimenopausal disorders Unspecified menopausal and perimenopausal disorder Recurrent pregnancy loss Female infertility associated with anovulation Female infertility of tubal origin Female infertility of uterine origin Female infertility of other origin Female infertility, unspecified Infection associated with artificial insemination Hyperstimulation of ovaries Comp of attempt introduce of fertilized ovum fol in vitro Comp of attempted introduction of embryo in embryo transfer Other complications associated with artificial fertilization

1.62 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

N989 N9912 N992 N993 N9983 O000 O001 O002 O008 O009 O010 O011 O019 O020 O021 O028 O029 O030 O031 O032 O0330 O0331 O0332 O0333 O0334 O0335 O0336 O0337 O0338 O0339 O034 O035 O036 O037 O0380 O0381 O0382 O0383 O0384 O0385 O0386 O0387 O0388 O0389 O039 O045 O046 O047 O0480 O0481 O0482 O0483 O0484 O0485 O0486 O0487 O0488 O0489 O070 O071 O072 O0730 O0731 O0732 O0733 O0734 O0735 O0736

Complication associated with artificial fertilization, unsp Postprocedural urethral stricture, female Postprocedural adhesions of vagina Prolapse of vaginal vault after hysterectomy Residual ovary syndrome Abdominal pregnancy Tubal pregnancy Ovarian pregnancy Other ectopic pregnancy Ectopic pregnancy, unspecified Classical hydatidiform mole Incomplete and partial hydatidiform mole Hydatidiform mole, unspecified Blighted ovum and nonhydatidiform mole Missed abortion Other specified abnormal products of conception Abnormal product of conception, unspecified Genitl trct and pelvic infection fol incmpl spon abortion Delayed or excessive hemor following incmpl spon abortion Embolism following incomplete spontaneous abortion Unsp complication following incomplete spontaneous abortion Shock following incomplete spontaneous abortion Renal failure following incomplete spontaneous abortion Metabolic disorder following incomplete spontaneous abortion Damage to pelvic organs following incomplete spon abortion Oth venous comp following incomplete spontaneous abortion Cardiac arrest following incomplete spontaneous abortion Sepsis following incomplete spontaneous abortion Urinary tract infection following incomplete spon abortion Incomplete spontaneous abortion with other complications Incomplete spontaneous abortion without complication Genitl trct and pelvic infct fol complete or unsp spon abort Delayed or excess hemor fol complete or unsp spon abortion Embolism following complete or unsp spontaneous abortion Unsp comp following complete or unsp spontaneous abortion Shock following complete or unspecified spontaneous abortion Renal failure following complete or unsp spon abortion Metabolic disorder following complete or unsp spon abortion Damage to pelvic organs fol complete or unsp spon abortion Oth venous comp following complete or unsp spon abortion Cardiac arrest following complete or unsp spon abortion Sepsis following complete or unsp spontaneous abortion Urinary tract infection fol complete or unsp spon abortion Complete or unsp spontaneous abortion with oth complications Complete or unsp spontaneous abortion without complication Genitl trct and pelvic infct fol (induced) term of pregnancy Delayed or excess hemor fol (induced) term of pregnancy Embolism following (induced) termination of pregnancy (Induced) termination of pregnancy with unsp complications Shock following (induced) termination of pregnancy Renal failure following (induced) termination of pregnancy Metabolic disorder following (induced) term of pregnancy Damage to pelvic organs fol (induced) term of pregnancy Oth venous comp following (induced) termination of pregnancy Cardiac arrest following (induced) termination of pregnancy Sepsis following (induced) termination of pregnancy Urinary tract infection fol (induced) term of pregnancy (Induced) termination of pregnancy with other complications Genitl trct and pelvic infct fol failed attempt term of preg Delayed or excess hemor fol failed attempt term of pregnancy Embolism following failed attempted termination of pregnancy Failed attempted termination of pregnancy w unsp comp Shock following failed attempted termination of pregnancy Renal failure following failed attempted term of pregnancy Metabolic disorder fol failed attempt term of pregnancy Damage to pelvic organs fol failed attempt term of pregnancy Oth venous comp following failed attempted term of pregnancy Cardiac arrest following failed attempted term of pregnancy

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Edit code lists 1.63

Diagnoses allowed for females only

O0737 O0738 O0739 O074 O080 O081 O082 O083 O084 O085 O086 O087 O0881 O0882 O0883 O0889 O089 O0900 O0901 O0902 O0903 O0910 O0911 O0912 O0913 O09211 O09212 O09213 O09219 O09291 O09292 O09293 O09299 O0930 O0931 O0932 O0933 O0940 O0941 O0942 O0943 O09511 O09512 O09513 O09519 O09521 O09522 O09523 O09529 O09611 O09612 O09613 O09619 O09621 O09622 O09623 O09629 O0970 O0971 O0972 O0973 O09811 O09812 O09813 O09819 O09821 O09822 O09823

Sepsis following failed attempted termination of pregnancy Urinary tract infection fol failed attempt term of pregnancy Failed attempted termination of pregnancy w oth comp Failed attempted termination of pregnancy w/o complication Genitl trct and pelvic infct fol ectopic and molar pregnancy Delayed or excess hemor fol ectopic and molar pregnancy Embolism following ectopic and molar pregnancy Shock following ectopic and molar pregnancy Renal failure following ectopic and molar pregnancy Metabolic disorders following an ectopic and molar pregnancy Damage to pelvic organs and tiss fol an ect and molar preg Oth venous comp following an ectopic and molar pregnancy Cardiac arrest following an ectopic and molar pregnancy Sepsis following ectopic and molar pregnancy Urinary tract infection fol an ectopic and molar pregnancy Other complications following an ectopic and molar pregnancy Unsp complication following an ectopic and molar pregnancy Suprvsn of preg w history of infertility, unsp trimester Suprvsn of preg w history of infertility, first trimester Suprvsn of preg w history of infertility, second trimester Suprvsn of preg w history of infertility, third trimester Suprvsn of preg w history of ectopic or molar preg, unsp tri Suprvsn of preg w history of ect or molar preg, first tri Suprvsn of preg w history of ect or molar preg, second tri Suprvsn of preg w history of ect or molar preg, third tri Suprvsn of preg w history of pre-term labor, first trimester Suprvsn of preg w history of pre-term labor, second tri Suprvsn of preg w history of pre-term labor, third trimester Suprvsn of preg w history of pre-term labor, unsp trimester Suprvsn of preg w poor reprodctv or obstet hx, first tri Suprvsn of preg w poor reprodctv or obstet hx, second tri Suprvsn of preg w poor reprodctv or obstet hx, third tri Suprvsn of preg w poor reprodctv or obstet history, unsp tri Suprvsn of preg w insufficient antenat care, unsp trimester Suprvsn of preg w insufficient antenat care, first trimester Suprvsn of preg w insufficient antenat care, second tri Suprvsn of preg w insufficient antenat care, third trimester Supervision of pregnancy w grand multiparity, unsp trimester Suprvsn of pregnancy w grand multiparity, first trimester Suprvsn of pregnancy w grand multiparity, second trimester Suprvsn of pregnancy w grand multiparity, third trimester Supervision of elderly primigravida, first trimester Supervision of elderly primigravida, second trimester Supervision of elderly primigravida, third trimester Supervision of elderly primigravida, unspecified trimester Supervision of elderly multigravida, first trimester Supervision of elderly multigravida, second trimester Supervision of elderly multigravida, third trimester Supervision of elderly multigravida, unspecified trimester Supervision of young primigravida, first trimester Supervision of young primigravida, second trimester Supervision of young primigravida, third trimester Supervision of young primigravida, unspecified trimester Supervision of young multigravida, first trimester Supervision of young multigravida, second trimester Supervision of young multigravida, third trimester Supervision of young multigravida, unspecified trimester Suprvsn of high risk preg due to social problems, unsp tri Suprvsn of high risk preg due to social problems, first tri Suprvsn of high risk preg due to social problems, second tri Suprvsn of high risk preg due to social problems, third tri Suprvsn of preg rslt from assisted reprodctv tech, first tri Suprvsn of preg rslt from assist reprodctv tech, second tri Suprvsn of preg rslt from assisted reprodctv tech, third tri Suprvsn of preg rslt from assisted reprodctv tech, unsp tri Suprvsn of preg w hx of in utero proc dur prev preg, 1st tri Suprvsn of preg w hx of in utero proc dur prev preg, 2nd tri Suprvsn of preg w hx of in utero proc dur prev preg, 3rd tri

1.64 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O09829 O09891 O09892 O09893 O09899 O0990 O0991 O0992 O0993 O10011 O10012 O10013 O10019 O1002 O1003 O10111 O10112 O10113 O10119 O1012 O1013 O10211 O10212 O10213 O10219 O1022 O1023 O10311 O10312 O10313 O10319 O1032 O1033 O10411 O10412 O10413 O10419 O1042 O1043 O10911 O10912 O10913 O10919 O1092 O1093 O111 O112 O113 O119 O1200 O1201 O1202 O1203 O1210 O1211 O1212 O1213 O1220 O1221 O1222 O1223 O131 O132 O133 O139 O1400 O1402 O1403

Suprvsn of preg w hx of in utero proc dur prev preg,unsp tri Supervision of other high risk pregnancies, first trimester Supervision of other high risk pregnancies, second trimester Supervision of other high risk pregnancies, third trimester Supervision of other high risk pregnancies, unsp trimester Supervision of high risk pregnancy, unsp, unsp trimester Supervision of high risk pregnancy, unsp, first trimester Supervision of high risk pregnancy, unsp, second trimester Supervision of high risk pregnancy, unsp, third trimester Pre-existing essential htn comp pregnancy, first trimester Pre-existing essential htn comp pregnancy, second trimester Pre-existing essential htn comp pregnancy, third trimester Pre-existing essential htn comp pregnancy, unsp trimester Pre-existing essential hypertension complicating childbirth Pre-existing essential hypertension comp the puerperium Pre-exist hyp heart disease comp pregnancy, first trimester Pre-exist hyp heart disease comp pregnancy, second trimester Pre-exist hyp heart disease comp pregnancy, third trimester Pre-exist hyp heart disease comp pregnancy, unsp trimester Pre-existing hypertensive heart disease comp childbirth Pre-existing hypertensive heart disease comp the puerperium Pre-exist hyp chronic kidney disease comp preg, first tri Pre-exist hyp chronic kidney disease comp preg, second tri Pre-exist hyp chronic kidney disease comp preg, third tri Pre-exist hyp chronic kidney disease comp preg, unsp tri Pre-existing hyp chronic kidney disease comp childbirth Pre-existing hyp chronic kidney disease comp the puerperium Pre-exist hyp heart and chr kidney dis comp preg, first tri Pre-exist hyp heart and chr kidney dis comp preg, second tri Pre-exist hyp heart and chr kidney dis comp preg, third tri Pre-exist hyp heart and chr kidney dis comp preg, unsp tri Pre-exist hyp heart and chronic kidney disease comp chldbrth Pre-exist hyp heart and chr kidney disease comp the puerp Pre-existing secondary htn comp pregnancy, first trimester Pre-existing secondary htn comp pregnancy, second trimester Pre-existing secondary htn comp pregnancy, third trimester Pre-existing secondary htn comp pregnancy, unsp trimester Pre-existing secondary hypertension complicating childbirth Pre-existing secondary hypertension comp the puerperium Unsp pre-existing htn comp pregnancy, first trimester Unsp pre-existing htn comp pregnancy, second trimester Unsp pre-existing htn comp pregnancy, third trimester Unsp pre-existing htn comp pregnancy, unsp trimester Unsp pre-existing hypertension complicating childbirth Unsp pre-existing hypertension complicating the puerperium Pre-existing hypertension w pre-eclampsia, first trimester Pre-existing hypertension w pre-eclampsia, second trimester Pre-existing hypertension w pre-eclampsia, third trimester Pre-existing hypertension with pre-eclampsia, unsp trimester Gestational edema, unspecified trimester Gestational edema, first trimester Gestational edema, second trimester Gestational edema, third trimester Gestational proteinuria, unspecified trimester Gestational proteinuria, first trimester Gestational proteinuria, second trimester Gestational proteinuria, third trimester Gestational edema with proteinuria, unspecified trimester Gestational edema with proteinuria, first trimester Gestational edema with proteinuria, second trimester Gestational edema with proteinuria, third trimester Gestational htn w/o significant proteinuria, first trimester Gestatnl htn w/o significant proteinuria, second trimester Gestational htn w/o significant proteinuria, third trimester Gestational htn w/o significant proteinuria, unsp trimester Mild to moderate pre-eclampsia, unspecified trimester Mild to moderate pre-eclampsia, second trimester Mild to moderate pre-eclampsia, third trimester

September 2011

Edit code lists 1.65

Diagnoses allowed for females only

O1410 O1412 O1413 O1420 O1422 O1423 O1490 O1492 O1493 O1500 O1502 O1503 O151 O152 O159 O161 O162 O163 O169 O200 O208 O209 O210 O211 O212 O218 O219 O2200 O2201 O2202 O2203 O2210 O2211 O2212 O2213 O2220 O2221 O2222 O2223 O2230 O2231 O2232 O2233 O2240 O2241 O2242 O2243 O2250 O2251 O2252 O2253 O228X1 O228X2 O228X3 O228X9 O2290 O2291 O2292 O2293 O2300 O2301 O2302 O2303 O2310 O2311 O2312 O2313 O2320

Severe pre-eclampsia, unspecified trimester Severe pre-eclampsia, second trimester Severe pre-eclampsia, third trimester HELLP syndrome (HELLP), unspecified trimester HELLP syndrome (HELLP), second trimester HELLP syndrome (HELLP), third trimester Unspecified pre-eclampsia, unspecified trimester Unspecified pre-eclampsia, second trimester Unspecified pre-eclampsia, third trimester Eclampsia in pregnancy, unspecified trimester Eclampsia in pregnancy, second trimester Eclampsia in pregnancy, third trimester Eclampsia in labor Eclampsia in the puerperium Eclampsia, unspecified as to time period Unspecified maternal hypertension, first trimester Unspecified maternal hypertension, second trimester Unspecified maternal hypertension, third trimester Unspecified maternal hypertension, unspecified trimester Threatened abortion Other hemorrhage in early pregnancy Hemorrhage in early pregnancy, unspecified Mild hyperemesis gravidarum Hyperemesis gravidarum with metabolic disturbance Late vomiting of pregnancy Other vomiting complicating pregnancy Vomiting of pregnancy, unspecified Varicose veins of low extrm in pregnancy, unsp trimester Varicose veins of low extrm in pregnancy, first trimester Varicose veins of low extrm in pregnancy, second trimester Varicose veins of low extrm in pregnancy, third trimester Genital varices in pregnancy, unspecified trimester Genital varices in pregnancy, first trimester Genital varices in pregnancy, second trimester Genital varices in pregnancy, third trimester Superficial thrombophlebitis in pregnancy, unsp trimester Superficial thrombophlebitis in pregnancy, first trimester Superficial thrombophlebitis in pregnancy, second trimester Superficial thrombophlebitis in pregnancy, third trimester Deep phlebothrombosis in pregnancy, unspecified trimester Deep phlebothrombosis in pregnancy, first trimester Deep phlebothrombosis in pregnancy, second trimester Deep phlebothrombosis in pregnancy, third trimester Hemorrhoids in pregnancy, unspecified trimester Hemorrhoids in pregnancy, first trimester Hemorrhoids in pregnancy, second trimester Hemorrhoids in pregnancy, third trimester Cerebral venous thrombosis in pregnancy, unsp trimester Cerebral venous thrombosis in pregnancy, first trimester Cerebral venous thrombosis in pregnancy, second trimester Cerebral venous thrombosis in pregnancy, third trimester Other venous complications in pregnancy, first trimester Other venous complications in pregnancy, second trimester Other venous complications in pregnancy, third trimester Other venous complications in pregnancy, unsp trimester Venous complication in pregnancy, unsp, unsp trimester Venous complication in pregnancy, unsp, first trimester Venous complication in pregnancy, unsp, second trimester Venous complication in pregnancy, unsp, third trimester Infections of kidney in pregnancy, unspecified trimester Infections of kidney in pregnancy, first trimester Infections of kidney in pregnancy, second trimester Infections of kidney in pregnancy, third trimester Infections of bladder in pregnancy, unspecified trimester Infections of bladder in pregnancy, first trimester Infections of bladder in pregnancy, second trimester Infections of bladder in pregnancy, third trimester Infections of urethra in pregnancy, unspecified trimester

1.66 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O2321 O2322 O2323 O2330 O2331 O2332 O2333 O2340 O2341 O2342 O2343 O23511 O23512 O23513 O23519 O23521 O23522 O23523 O23529 O23591 O23592 O23593 O23599 O2390 O2391 O2392 O2393 O24011 O24012 O24013 O24019 O2402 O2403 O24111 O24112 O24113 O24119 O2412 O2413 O24311 O24312 O24313 O24319 O2432 O2433 O24410 O24414 O24419 O24420 O24424 O24429 O24430 O24434 O24439 O24811 O24812 O24813 O24819 O2482 O2483 O24911 O24912 O24913 O24919 O2492 O2493 O2510 O2511

Infections of urethra in pregnancy, first trimester Infections of urethra in pregnancy, second trimester Infections of urethra in pregnancy, third trimester Infections of prt urinary tract in pregnancy, unsp trimester Infect of prt urinary tract in pregnancy, first trimester Infect of prt urinary tract in pregnancy, second trimester Infect of prt urinary tract in pregnancy, third trimester Unsp infection of urinary tract in pregnancy, unsp trimester Unsp infct of urinary tract in pregnancy, first trimester Unsp infct of urinary tract in pregnancy, second trimester Unsp infct of urinary tract in pregnancy, third trimester Infections of cervix in pregnancy, first trimester Infections of cervix in pregnancy, second trimester Infections of cervix in pregnancy, third trimester Infections of cervix in pregnancy, unspecified trimester Salpingo-oophoritis in pregnancy, first trimester Salpingo-oophoritis in pregnancy, second trimester Salpingo-oophoritis in pregnancy, third trimester Salpingo-oophoritis in pregnancy, unspecified trimester Infection oth prt genitl trct in pregnancy, first trimester Infection oth prt genitl trct in pregnancy, second trimester Infection oth prt genitl trct in pregnancy, third trimester Infection oth prt genital tract in pregnancy, unsp trimester Unsp GU tract infection in pregnancy, unsp trimester Unsp GU tract infection in pregnancy, first trimester Unsp GU tract infection in pregnancy, second trimester Unsp GU tract infection in pregnancy, third trimester Pre-existing diabetes, type 1, in pregnancy, first trimester Pre-exist diabetes, type 1, in pregnancy, second trimester Pre-existing diabetes, type 1, in pregnancy, third trimester Pre-existing diabetes, type 1, in pregnancy, unsp trimester Pre-existing diabetes mellitus, type 1, in childbirth Pre-existing diabetes mellitus, type 1, in the puerperium Pre-existing diabetes, type 2, in pregnancy, first trimester Pre-exist diabetes, type 2, in pregnancy, second trimester Pre-existing diabetes, type 2, in pregnancy, third trimester Pre-existing diabetes, type 2, in pregnancy, unsp trimester Pre-existing diabetes mellitus, type 2, in childbirth Pre-existing diabetes mellitus, type 2, in the puerperium Unsp pre-existing diabetes in pregnancy, first trimester Unsp pre-existing diabetes in pregnancy, second trimester Unsp pre-existing diabetes in pregnancy, third trimester Unsp pre-existing diabetes in pregnancy, unsp trimester Unspecified pre-existing diabetes mellitus in childbirth Unspecified pre-existing diabetes mellitus in the puerperium Gestational diabetes mellitus in pregnancy, diet controlled Gestational diabetes in pregnancy, insulin controlled Gestational diabetes mellitus in pregnancy, unsp control Gestational diabetes mellitus in childbirth, diet controlled Gestational diabetes in childbirth, insulin controlled Gestational diabetes mellitus in childbirth, unsp control Gestational diabetes in the puerperium, diet controlled Gestational diabetes in the puerperium, insulin controlled Gestational diabetes in the puerperium, unsp control Oth pre-existing diabetes in pregnancy, first trimester Oth pre-existing diabetes in pregnancy, second trimester Oth pre-existing diabetes in pregnancy, third trimester Oth pre-existing diabetes in pregnancy, unsp trimester Other pre-existing diabetes mellitus in childbirth Other pre-existing diabetes mellitus in the puerperium Unspecified diabetes mellitus in pregnancy, first trimester Unspecified diabetes mellitus in pregnancy, second trimester Unspecified diabetes mellitus in pregnancy, third trimester Unsp diabetes mellitus in pregnancy, unspecified trimester Unspecified diabetes mellitus in childbirth Unspecified diabetes mellitus in the puerperium Malnutrition in pregnancy, unspecified trimester Malnutrition in pregnancy, first trimester

September 2011

Edit code lists 1.67

Diagnoses allowed for females only

O2512 O2513 O252 O253 O2600 O2601 O2602 O2603 O2610 O2611 O2612 O2613 O2620 O2621 O2622 O2623 O2630 O2631 O2632 O2633 O2640 O2641 O2642 O2643 O2650 O2651 O2652 O2653 O26611 O26612 O26613 O26619 O2662 O2663 O26711 O26712 O26713 O26719 O2672 O2673 O26811 O26812 O26813 O26819 O26821 O26822 O26823 O26829 O26831 O26832 O26833 O26839 O26841 O26842 O26843 O26849 O26851 O26852 O26853 O26859 O2686 O26872 O26873 O26879 O26891 O26892 O26893 O26899

Malnutrition in pregnancy, second trimester Malnutrition in pregnancy, third trimester Malnutrition in childbirth Malnutrition in the puerperium Excessive weight gain in pregnancy, unspecified trimester Excessive weight gain in pregnancy, first trimester Excessive weight gain in pregnancy, second trimester Excessive weight gain in pregnancy, third trimester Low weight gain in pregnancy, unspecified trimester Low weight gain in pregnancy, first trimester Low weight gain in pregnancy, second trimester Low weight gain in pregnancy, third trimester Preg care for patient w recurrent preg loss, unsp trimester Preg care for patient w recurrent preg loss, first trimester Preg care for patient w recur preg loss, second trimester Preg care for patient w recurrent preg loss, third trimester Retained uterin contracep dev in pregnancy, unsp trimester Retained uterin contracep dev in pregnancy, first trimester Retained uterin contracep dev in pregnancy, second trimester Retained uterin contracep dev in pregnancy, third trimester Herpes gestationis, unspecified trimester Herpes gestationis, first trimester Herpes gestationis, second trimester Herpes gestationis, third trimester Maternal hypotension syndrome, unspecified trimester Maternal hypotension syndrome, first trimester Maternal hypotension syndrome, second trimester Maternal hypotension syndrome, third trimester Liver disorders in pregnancy, first trimester Liver disorders in pregnancy, second trimester Liver disorders in pregnancy, third trimester Liver disorders in pregnancy, unspecified trimester Liver disorders in childbirth Liver disorders in the puerperium Sublux of symphysis (pubis) in pregnancy, first trimester Sublux of symphysis (pubis) in pregnancy, second trimester Sublux of symphysis (pubis) in pregnancy, third trimester Sublux of symphysis (pubis) in pregnancy, unsp trimester Subluxation of symphysis (pubis) in childbirth Subluxation of symphysis (pubis) in the puerperium Pregnancy related exhaustion and fatigue, first trimester Pregnancy related exhaustion and fatigue, second trimester Pregnancy related exhaustion and fatigue, third trimester Pregnancy related exhaustion and fatigue, unsp trimester Pregnancy related peripheral neuritis, first trimester Pregnancy related peripheral neuritis, second trimester Pregnancy related peripheral neuritis, third trimester Pregnancy related peripheral neuritis, unspecified trimester Pregnancy related renal disease, first trimester Pregnancy related renal disease, second trimester Pregnancy related renal disease, third trimester Pregnancy related renal disease, unspecified trimester Uterine size-date discrepancy, first trimester Uterine size-date discrepancy, second trimester Uterine size-date discrepancy, third trimester Uterine size-date discrepancy, unspecified trimester Spotting complicating pregnancy, first trimester Spotting complicating pregnancy, second trimester Spotting complicating pregnancy, third trimester Spotting complicating pregnancy, unspecified trimester Pruritic urticarial papules and plaques of pregnancy (PUPPP) Cervical shortening, second trimester Cervical shortening, third trimester Cervical shortening, unspecified trimester Oth pregnancy related conditions, first trimester Oth pregnancy related conditions, second trimester Oth pregnancy related conditions, third trimester Oth pregnancy related conditions, unspecified trimester

1.68 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O2690 O2691 O2692 O2693 O280 O281 O282 O283 O284 O285 O288 O289 O29011 O29012 O29013 O29019 O29021 O29022 O29023 O29029 O29091 O29092 O29093 O29099 O29111 O29112 O29113 O29119 O29121 O29122 O29123 O29129 O29191 O29192 O29193 O29199 O29211 O29212 O29213 O29219 O29291 O29292 O29293 O29299 O293X1 O293X2 O293X3 O293X9 O2940 O2941 O2942 O2943 O295X1 O295X2 O295X3 O295X9 O2960 O2961 O2962 O2963 O298X1 O298X2 O298X3 O298X9 O2990 O2991 O2992 O2993

Pregnancy related conditions, unsp, unspecified trimester Pregnancy related conditions, unspecified, first trimester Pregnancy related conditions, unspecified, second trimester Pregnancy related conditions, unspecified, third trimester Abnormal hematolog finding on antenatal screening of mother Abnormal biochemical finding on antenat screening of mother Abnormal cytolog finding on antenatal screening of mother Abnormal ultrasonic finding on antenatal screening of mother Abnormal radiolog finding on antenatal screening of mother Abn chromsoml and genetic find on antenat screen of mother Other abnormal findings on antenatal screening of mother Unsp abnormal findings on antenatal screening of mother Aspirat pneumonitis due to anesth during preg, first tri Aspirat pneumonitis due to anesth during preg, second tri Aspirat pneumonitis due to anesth during preg, third tri Aspirat pneumonitis due to anesth during preg, unsp tri Pressr collapse of lung due to anesth during preg, first tri Pressr collapse of lung d/t anesth during preg, second tri Pressr collapse of lung due to anesth during preg, third tri Pressr collapse of lung due to anesth during preg, unsp tri Oth pulmonary comp of anesth during preg, first trimester Oth pulmonary comp of anesth during preg, second trimester Oth pulmonary comp of anesth during preg, third trimester Oth pulmonary comp of anesth during preg, unsp trimester Cardiac arrest due to anesth during preg, first trimester Cardiac arrest due to anesth during preg, second trimester Cardiac arrest due to anesth during preg, third trimester Cardiac arrest due to anesth during preg, unsp trimester Cardiac failure due to anesth during preg, first trimester Cardiac failure due to anesth during preg, second trimester Cardiac failure due to anesth during preg, third trimester Cardiac failure due to anesth during preg, unsp trimester Oth cardiac comp of anesth during pregnancy, first trimester Oth cardiac comp of anesth during preg, second trimester Oth cardiac comp of anesth during pregnancy, third trimester Oth cardiac comp of anesth during pregnancy, unsp trimester Cerebral anoxia due to anesth during preg, first trimester Cerebral anoxia due to anesth during preg, second trimester Cerebral anoxia due to anesth during preg, third trimester Cerebral anoxia due to anesth during preg, unsp trimester Oth cnsl comp of anesth during pregnancy, first trimester Oth cnsl comp of anesth during pregnancy, second trimester Oth cnsl comp of anesth during pregnancy, third trimester Oth cnsl comp of anesthesia during pregnancy, unsp trimester Toxic reaction to local anesth during preg, first trimester Toxic reaction to local anesth during preg, second trimester Toxic reaction to local anesth during preg, third trimester Toxic reaction to local anesth during preg, unsp trimester Spinal and epidur anesth induce hdache during preg, unsp tri Spinal and epidur anesth induce hdache dur preg, first tri Spinal and epidur anesth induce hdache dur preg, second tri Spinal and epidur anesth induce hdache dur preg, third tri Oth comp of spinal and epidur anesth during preg, first tri Oth comp of spinal and epidur anesth during preg, second tri Oth comp of spinal and epidur anesth during preg, third tri Oth comp of spinal and epidural anesth during preg, unsp tri Failed or difficult intubation for anesth dur preg, unsp tri Fail or difficult intubation for anesth dur preg, first tri Fail or difficult intubation for anesth dur preg, second tri Fail or difficult intubation for anesth dur preg, third tri Oth comp of anesthesia during pregnancy, first trimester Oth comp of anesthesia during pregnancy, second trimester Oth comp of anesthesia during pregnancy, third trimester Oth comp of anesthesia during pregnancy, unsp trimester Unsp comp of anesthesia during pregnancy, unsp trimester Unsp comp of anesthesia during pregnancy, first trimester Unsp comp of anesthesia during pregnancy, second trimester Unsp comp of anesthesia during pregnancy, third trimester

September 2011

Edit code lists 1.69

Diagnoses allowed for females only

O30001 O30002 O30003 O30009 O30011 O30012 O30013 O30019 O30021 O30022 O30023 O30029 O30031 O30032 O30033 O30039 O30041 O30042 O30043 O30049 O30091 O30092 O30093 O30099 O30101 O30102 O30103 O30109 O30111 O30112 O30113 O30119 O30121 O30122 O30123 O30129 O30191 O30192 O30193 O30199 O30201 O30202 O30203 O30209 O30211 O30212 O30213 O30219 O30221 O30222 O30223 O30229 O30291 O30292 O30293 O30299 O30801 O30802 O30803 O30809 O30811 O30812 O30813 O30819 O30821 O30822 O30823 O30829

Twin preg, unsp num plcnta & amnio sacs, first trimester Twin preg, unsp num plcnta & amnio sacs, second trimester Twin preg, unsp num plcnta & amnio sacs, third trimester Twin pregnancy, unsp num plcnta & amnio sacs, unsp trimester Twin pregnancy, monochorionic/monoamniotic, first trimester Twin pregnancy, monochorionic/monoamniotic, second trimester Twin pregnancy, monochorionic/monoamniotic, third trimester Twin pregnancy, monochorionic/monoamniotic, unsp trimester Conjoined twins, first trimester Conjoined twins, second trimester Conjoined twins, third trimester Conjoined twins, unspecified trimester Twin pregnancy, monochorionic/diamniotic, first trimester Twin pregnancy, monochorionic/diamniotic, second trimester Twin pregnancy, monochorionic/diamniotic, third trimester Twin pregnancy, monochorionic/diamniotic, unsp trimester Twin pregnancy, dichorionic/diamniotic, first trimester Twin pregnancy, dichorionic/diamniotic, second trimester Twin pregnancy, dichorionic/diamniotic, third trimester Twin pregnancy, dichorionic/diamniotic, unsp trimester Twin preg, unable to dtrm num plcnta & amnio sacs, first tri Twin preg, unable to dtrm num plcnta & amnio sacs, 2nd tri Twin preg, unable to dtrm num plcnta & amnio sacs, third tri Twin preg, unable to dtrm num plcnta & amnio sacs, unsp tri Triplet preg, unsp num plcnta & amnio sacs, first trimester Triplet preg, unsp num plcnta & amnio sacs, second trimester Triplet preg, unsp num plcnta & amnio sacs, third trimester Triplet preg, unsp num plcnta & amnio sacs, unsp trimester Triplet preg w two or more monochorionic fetuses, first tri Triplet preg w two or more monochorionic fetuses, second tri Triplet preg w two or more monochorionic fetuses, third tri Triplet preg w two or more monochorionic fetuses, unsp tri Triplet preg w two or more monoamnio fetuses, first tri Triplet preg w two or more monoamnio fetuses, second tri Triplet preg w two or more monoamnio fetuses, third tri Triplet preg w two or more monoamnio fetuses, unsp trimester Trp preg, unable to dtrm num plcnta & amnio sacs, first tri Trp preg, unable to dtrm num plcnta & amnio sacs, second tri Trp preg, unable to dtrm num plcnta & amnio sacs, third tri Trp preg, unable to dtrm num plcnta & amnio sacs, unsp tri Quad preg, unsp num plcnta & amnio sacs, first trimester Quad preg, unsp num plcnta & amnio sacs, second trimester Quad preg, unsp num plcnta & amnio sacs, third trimester Quad pregnancy, unsp num plcnta & amnio sacs, unsp trimester Quad preg w two or more monochorionic fetuses, first tri Quad preg w two or more monochorionic fetuses, second tri Quad preg w two or more monochorionic fetuses, third tri Quad preg w two or more monochorionic fetuses, unsp tri Quad preg w two or more monoamnio fetuses, first trimester Quad preg w two or more monoamnio fetuses, second trimester Quad preg w two or more monoamnio fetuses, third trimester Quad preg w two or more monoamnio fetuses, unsp trimester Quad preg, unable to dtrm num plcnta & amnio sacs, first tri Quad preg, unable to dtrm num plcnta & amnio sacs, 2nd tri Quad preg, unable to dtrm num plcnta & amnio sacs, third tri Quad preg, unable to dtrm num plcnta & amnio sacs, unsp tri Oth multiple gest, unsp num plcnta & amnio sacs, first tri Oth multiple gest, unsp num plcnta & amnio sacs, second tri Oth multiple gest, unsp num plcnta & amnio sacs, third tri Oth multiple gest, unsp num plcnta & amnio sacs, unsp tri Oth mult gest w two or more monochorionic fetuses, first tri Oth mult gest w two or more monochorionic fetuses, 2nd tri Oth mult gest w two or more monochorionic fetuses, third tri Oth mult gest w two or more monochorionic fetuses, unsp tri Oth multiple gest w two or more monoamnio fetuses, first tri Oth mult gest w two or more monoamnio fetuses, second tri Oth multiple gest w two or more monoamnio fetuses, third tri Oth multiple gest w two or more monoamnio fetuses, unsp tri

1.70 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O30891 O30892 O30893 O30899 O3090 O3091 O3092 O3093 O3100X0 O3100X1 O3100X2 O3100X3 O3100X4 O3100X5 O3100X9 O3101X0 O3101X1 O3101X2 O3101X3 O3101X4 O3101X5 O3101X9 O3102X0 O3102X1 O3102X2 O3102X3 O3102X4 O3102X5 O3102X9 O3103X0 O3103X1 O3103X2 O3103X3 O3103X4 O3103X5 O3103X9 O3110X0 O3110X1 O3110X2 O3110X3 O3110X4 O3110X5 O3110X9 O3111X0 O3111X1 O3111X2 O3111X3 O3111X4 O3111X5 O3111X9 O3112X0 O3112X1 O3112X2 O3112X3 O3112X4 O3112X5 O3112X9 O3113X0 O3113X1 O3113X2 O3113X3 O3113X4 O3113X5 O3113X9 O3120X0 O3120X1 O3120X2 O3120X3

Oth mult gest, unab to dtrm num plcnta & amnio sacs, 1st tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 2nd tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 3rd tri Oth mult gest,unab to dtrm num plcnta & amnio sacs, unsp tri Multiple gestation, unspecified, unspecified trimester Multiple gestation, unspecified, first trimester Multiple gestation, unspecified, second trimester Multiple gestation, unspecified, third trimester Papyraceous fetus, unsp trimester, not applicable or unsp Papyraceous fetus, unspecified trimester, fetus 1 Papyraceous fetus, unspecified trimester, fetus 2 Papyraceous fetus, unspecified trimester, fetus 3 Papyraceous fetus, unspecified trimester, fetus 4 Papyraceous fetus, unspecified trimester, fetus 5 Papyraceous fetus, unspecified trimester, other fetus Papyraceous fetus, first trimester, not applicable or unsp Papyraceous fetus, first trimester, fetus 1 Papyraceous fetus, first trimester, fetus 2 Papyraceous fetus, first trimester, fetus 3 Papyraceous fetus, first trimester, fetus 4 Papyraceous fetus, first trimester, fetus 5 Papyraceous fetus, first trimester, other fetus Papyraceous fetus, second trimester, not applicable or unsp Papyraceous fetus, second trimester, fetus 1 Papyraceous fetus, second trimester, fetus 2 Papyraceous fetus, second trimester, fetus 3 Papyraceous fetus, second trimester, fetus 4 Papyraceous fetus, second trimester, fetus 5 Papyraceous fetus, second trimester, other fetus Papyraceous fetus, third trimester, not applicable or unsp Papyraceous fetus, third trimester, fetus 1 Papyraceous fetus, third trimester, fetus 2 Papyraceous fetus, third trimester, fetus 3 Papyraceous fetus, third trimester, fetus 4 Papyraceous fetus, third trimester, fetus 5 Papyraceous fetus, third trimester, other fetus Cont preg aft spon abort of one fts or more, unsp tri, unsp Cont preg aft spon abort of one fts or more, unsp tri, fts1 Cont preg aft spon abort of one fts or more, unsp tri, fts2 Cont preg aft spon abort of one fts or more, unsp tri, fts3 Cont preg aft spon abort of one fts or more, unsp tri, fts4 Cont preg aft spon abort of one fts or more, unsp tri, fts5 Cont preg aft spon abort of one fetus or more, unsp tri, oth Cont preg aft spon abort of one fts or more, first tri, unsp Cont preg aft spon abort of one fts or more, first tri, fts1 Cont preg aft spon abort of one fts or more, first tri, fts2 Cont preg aft spon abort of one fts or more, first tri, fts3 Cont preg aft spon abort of one fts or more, first tri, fts4 Cont preg aft spon abort of one fts or more, first tri, fts5 Cont preg aft spon abort of one fts or more, first tri, oth Cont preg aft spon abort of one fetus or more, 2nd tri, unsp Cont preg aft spon abort of one fetus or more, 2nd tri, fts1 Cont preg aft spon abort of one fetus or more, 2nd tri, fts2 Cont preg aft spon abort of one fetus or more, 2nd tri, fts3 Cont preg aft spon abort of one fetus or more, 2nd tri, fts4 Cont preg aft spon abort of one fetus or more, 2nd tri, fts5 Cont preg aft spon abort of one fetus or more, 2nd tri, oth Cont preg aft spon abort of one fts or more, third tri, unsp Cont preg aft spon abort of one fts or more, third tri, fts1 Cont preg aft spon abort of one fts or more, third tri, fts2 Cont preg aft spon abort of one fts or more, third tri, fts3 Cont preg aft spon abort of one fts or more, third tri, fts4 Cont preg aft spon abort of one fts or more, third tri, fts5 Cont preg aft spon abort of one fts or more, third tri, oth Cont preg aft uterin dth of one fts or more, unsp tri, unsp Cont preg aft uterin dth of one fts or more, unsp tri, fts1 Cont preg aft uterin dth of one fts or more, unsp tri, fts2 Cont preg aft uterin dth of one fts or more, unsp tri, fts3

September 2011

Edit code lists 1.71

Diagnoses allowed for females only

O3120X4 O3120X5 O3120X9 O3121X0 O3121X1 O3121X2 O3121X3 O3121X4 O3121X5 O3121X9 O3122X0 O3122X1 O3122X2 O3122X3 O3122X4 O3122X5 O3122X9 O3123X0 O3123X1 O3123X2 O3123X3 O3123X4 O3123X5 O3123X9 O3130X0 O3130X1 O3130X2 O3130X3 O3130X4 O3130X5 O3130X9 O3131X0 O3131X1 O3131X2 O3131X3 O3131X4 O3131X5 O3131X9 O3132X0 O3132X1 O3132X2 O3132X3 O3132X4 O3132X5 O3132X9 O3133X0 O3133X1 O3133X2 O3133X3 O3133X4 O3133X5 O3133X9 O318X10 O318X11 O318X12 O318X13 O318X14 O318X15 O318X19 O318X20 O318X21 O318X22 O318X23 O318X24 O318X25 O318X29 O318X30 O318X31

Cont preg aft uterin dth of one fts or more, unsp tri, fts4 Cont preg aft uterin dth of one fts or more, unsp tri, fts5 Cont preg aft uterin dth of one fetus or more, unsp tri, oth Cont preg aft uterin dth of one fts or more, first tri, unsp Cont preg aft uterin dth of one fts or more, first tri, fts1 Cont preg aft uterin dth of one fts or more, first tri, fts2 Cont preg aft uterin dth of one fts or more, first tri, fts3 Cont preg aft uterin dth of one fts or more, first tri, fts4 Cont preg aft uterin dth of one fts or more, first tri, fts5 Cont preg aft uterin dth of one fts or more, first tri, oth Cont preg aft uterin dth of one fetus or more, 2nd tri, unsp Cont preg aft uterin dth of one fetus or more, 2nd tri, fts1 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts2 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts3 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts4 Cont preg aft uterin dth of one fetus or more, 2nd tri, fts5 Cont preg aft uterin dth of one fetus or more, 2nd tri, oth Cont preg aft uterin dth of one fts or more, third tri, unsp Cont preg aft uterin dth of one fts or more, third tri, fts1 Cont preg aft uterin dth of one fts or more, third tri, fts2 Cont preg aft uterin dth of one fts or more, third tri, fts3 Cont preg aft uterin dth of one fts or more, third tri, fts4 Cont preg aft uterin dth of one fts or more, third tri, fts5 Cont preg aft uterin dth of one fts or more, third tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,unsp Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts1 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts2 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts3 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts4 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri,fts5 Cont preg aft elctv fetl rdct of 1 fts or more,unsp tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, unsp Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts1 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts2 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts3 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts4 Cont preg aft elctv fetl rdct of 1 fts or more,1st tri, fts5 Cont preg aft elctv fetl rdct of 1 fts or more, 1st tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, unsp Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts1 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts2 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts3 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts4 Cont preg aft elctv fetl rdct of 1 fts or more,2nd tri, fts5 Cont preg aft elctv fetl rdct of 1 fts or more, 2nd tri, oth Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, unsp Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts1 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts2 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts3 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts4 Cont preg aft elctv fetl rdct of 1 fts or more,3rd tri, fts5 Cont preg aft elctv fetl rdct of 1 fts or more, 3rd tri, oth Oth comp specific to multiple gest, first trimester, unsp Oth comp specific to multiple gest, first trimester, fetus 1 Oth comp specific to multiple gest, first trimester, fetus 2 Oth comp specific to multiple gest, first trimester, fetus 3 Oth comp specific to multiple gest, first trimester, fetus 4 Oth comp specific to multiple gest, first trimester, fetus 5 Oth comp specific to multiple gest, first trimester, oth Oth comp specific to multiple gest, second trimester, unsp Oth comp specific to multiple gest, second tri, fetus 1 Oth comp specific to multiple gest, second tri, fetus 2 Oth comp specific to multiple gest, second tri, fetus 3 Oth comp specific to multiple gest, second tri, fetus 4 Oth comp specific to multiple gest, second tri, fetus 5 Oth comp specific to multiple gest, second trimester, oth Oth comp specific to multiple gest, third trimester, unsp Oth comp specific to multiple gest, third trimester, fetus 1

1.72 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O318X32 O318X33 O318X34 O318X35 O318X39 O318X90 O318X91 O318X92 O318X93 O318X94 O318X95 O318X99 O320XX0 O320XX1 O320XX2 O320XX3 O320XX4 O320XX5 O320XX9 O321XX0 O321XX1 O321XX2 O321XX3 O321XX4 O321XX5 O321XX9 O322XX0 O322XX1 O322XX2 O322XX3 O322XX4 O322XX5 O322XX9 O323XX0 O323XX1 O323XX2 O323XX3 O323XX4 O323XX5 O323XX9 O324XX0 O324XX1 O324XX2 O324XX3 O324XX4 O324XX5 O324XX9 O326XX0 O326XX1 O326XX2 O326XX3 O326XX4 O326XX5 O326XX9 O328XX0 O328XX1 O328XX2 O328XX3 O328XX4 O328XX5 O328XX9 O329XX0 O329XX1 O329XX2 O329XX3 O329XX4 O329XX5 O329XX9

Oth comp specific to multiple gest, third trimester, fetus 2 Oth comp specific to multiple gest, third trimester, fetus 3 Oth comp specific to multiple gest, third trimester, fetus 4 Oth comp specific to multiple gest, third trimester, fetus 5 Oth comp specific to multiple gest, third trimester, oth Oth comp specific to multiple gest, unsp trimester, unsp Oth comp specific to multiple gest, unsp trimester, fetus 1 Oth comp specific to multiple gest, unsp trimester, fetus 2 Oth comp specific to multiple gest, unsp trimester, fetus 3 Oth comp specific to multiple gest, unsp trimester, fetus 4 Oth comp specific to multiple gest, unsp trimester, fetus 5 Oth comp specific to multiple gestation, unsp trimester, oth Maternal care for unstable lie, not applicable or unsp Maternal care for unstable lie, fetus 1 Maternal care for unstable lie, fetus 2 Maternal care for unstable lie, fetus 3 Maternal care for unstable lie, fetus 4 Maternal care for unstable lie, fetus 5 Maternal care for unstable lie, other fetus Maternal care for breech presentation, unsp Maternal care for breech presentation, fetus 1 Maternal care for breech presentation, fetus 2 Maternal care for breech presentation, fetus 3 Maternal care for breech presentation, fetus 4 Maternal care for breech presentation, fetus 5 Maternal care for breech presentation, other fetus Maternal care for transverse and oblique lie, unsp Maternal care for transverse and oblique lie, fetus 1 Maternal care for transverse and oblique lie, fetus 2 Maternal care for transverse and oblique lie, fetus 3 Maternal care for transverse and oblique lie, fetus 4 Maternal care for transverse and oblique lie, fetus 5 Maternal care for transverse and oblique lie, other fetus Maternal care for face, brow and chin presentation, unsp Maternal care for face, brow and chin presentation, fetus 1 Maternal care for face, brow and chin presentation, fetus 2 Maternal care for face, brow and chin presentation, fetus 3 Maternal care for face, brow and chin presentation, fetus 4 Maternal care for face, brow and chin presentation, fetus 5 Maternal care for face, brow and chin presentation, oth Maternal care for high head at term, not applicable or unsp Maternal care for high head at term, fetus 1 Maternal care for high head at term, fetus 2 Maternal care for high head at term, fetus 3 Maternal care for high head at term, fetus 4 Maternal care for high head at term, fetus 5 Maternal care for high head at term, other fetus Maternal care for compound presentation, unsp Maternal care for compound presentation, fetus 1 Maternal care for compound presentation, fetus 2 Maternal care for compound presentation, fetus 3 Maternal care for compound presentation, fetus 4 Maternal care for compound presentation, fetus 5 Maternal care for compound presentation, other fetus Maternal care for oth malpresentation of fetus, unsp Maternal care for other malpresentation of fetus, fetus 1 Maternal care for other malpresentation of fetus, fetus 2 Maternal care for other malpresentation of fetus, fetus 3 Maternal care for other malpresentation of fetus, fetus 4 Maternal care for other malpresentation of fetus, fetus 5 Maternal care for oth malpresentation of fetus, other fetus Maternal care for malpresentation of fetus, unsp, unsp Maternal care for malpresentation of fetus, unsp, fetus 1 Maternal care for malpresentation of fetus, unsp, fetus 2 Maternal care for malpresentation of fetus, unsp, fetus 3 Maternal care for malpresentation of fetus, unsp, fetus 4 Maternal care for malpresentation of fetus, unsp, fetus 5 Maternal care for malpresentation of fetus, unsp, oth fetus

September 2011

Edit code lists 1.73

Diagnoses allowed for females only

O330 O331 O332 O333XX0 O333XX1 O333XX2 O333XX3 O333XX4 O333XX5 O333XX9 O334XX0 O334XX1 O334XX2 O334XX3 O334XX4 O334XX5 O334XX9 O335XX0 O335XX1 O335XX2 O335XX3 O335XX4 O335XX5 O335XX9 O336XX0 O336XX1 O336XX2 O336XX3 O336XX4 O336XX5 O336XX9 O337 O338 O339 O3400 O3401 O3402 O3403 O3410 O3411 O3412 O3413 O3421 O3429 O3430 O3431 O3432 O3433 O3440 O3441 O3442 O3443 O34511 O34512 O34513 O34519 O34521 O34522 O34523 O34529 O34531 O34532 O34533 O34539 O34591 O34592 O34593 O34599

Matern care for disproprtn d/t deformity of matern pelv bone Matern care for disproprtn d/t generally contracted pelvis Maternal care for disproprtn due to inlet contrctn of pelvis Matern care for disproprtn d/t outlet contrctn of pelv, unsp Matern care for disproprtn d/t outlet contrctn of pelv, fts1 Matern care for disproprtn d/t outlet contrctn of pelv, fts2 Matern care for disproprtn d/t outlet contrctn of pelv, fts3 Matern care for disproprtn d/t outlet contrctn of pelv, fts4 Matern care for disproprtn d/t outlet contrctn of pelv, fts5 Matern care for disproprtn d/t outlet contrctn of pelv, oth Matern care for disproprtn of mix matern & fetl origin, unsp Matern care for disproprtn of mix matern & fetl origin, fts1 Matern care for disproprtn of mix matern & fetl origin, fts2 Matern care for disproprtn of mix matern & fetl origin, fts3 Matern care for disproprtn of mix matern & fetl origin, fts4 Matern care for disproprtn of mix matern & fetl origin, fts5 Matern care for disproprtn of mix matern & fetl origin, oth Matern care for disproprtn d/t unusually large fetus, unsp Matern care for disproprtn d/t unusually large fetus, fts1 Matern care for disproprtn d/t unusually large fetus, fts2 Matern care for disproprtn d/t unusually large fetus, fts3 Matern care for disproprtn d/t unusually large fetus, fts4 Matern care for disproprtn d/t unusually large fetus, fts5 Matern care for disproprtn due to unusually large fetus, oth Matern care for disproprtn due to hydrocephalic fetus, unsp Matern care for disproprtn due to hydrocephalic fetus, fts1 Matern care for disproprtn due to hydrocephalic fetus, fts2 Matern care for disproprtn due to hydrocephalic fetus, fts3 Matern care for disproprtn due to hydrocephalic fetus, fts4 Matern care for disproprtn due to hydrocephalic fetus, fts5 Maternal care for disproprtn due to hydrocephalic fetus, oth Maternal care for disproportion due to oth fetal deformities Maternal care for disproportion of other origin Maternal care for disproportion, unspecified Maternal care for unsp congen malform of uterus, unsp tri Maternal care for unsp congen malform of uterus, first tri Maternal care for unsp congen malform of uterus, second tri Maternal care for unsp congen malform of uterus, third tri Maternal care for benign tumor of corpus uteri, unsp tri Maternal care for benign tumor of corpus uteri, first tri Maternal care for benign tumor of corpus uteri, second tri Maternal care for benign tumor of corpus uteri, third tri Maternal care for scar from previous cesarean delivery Maternal care due to uterine scar from oth previous surgery Maternal care for cervical incompetence, unsp trimester Maternal care for cervical incompetence, first trimester Maternal care for cervical incompetence, second trimester Maternal care for cervical incompetence, third trimester Maternal care for oth abnlt of cervix, unsp trimester Maternal care for oth abnlt of cervix, first trimester Maternal care for oth abnlt of cervix, second trimester Maternal care for oth abnlt of cervix, third trimester Maternal care for incarceration of gravid uterus, first tri Maternal care for incarceration of gravid uterus, second tri Maternal care for incarceration of gravid uterus, third tri Maternal care for incarceration of gravid uterus, unsp tri Maternal care for prolapse of gravid uterus, first trimester Maternal care for prolapse of gravid uterus, second tri Maternal care for prolapse of gravid uterus, third trimester Maternal care for prolapse of gravid uterus, unsp trimester Maternal care for retroversion of gravid uterus, first tri Maternal care for retroversion of gravid uterus, second tri Maternal care for retroversion of gravid uterus, third tri Maternal care for retroversion of gravid uterus, unsp tri Maternal care for oth abnlt of gravid uterus, first tri Maternal care for oth abnlt of gravid uterus, second tri Maternal care for oth abnlt of gravid uterus, third tri Maternal care for oth abnlt of gravid uterus, unsp trimester

1.74 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O3460 O3461 O3462 O3463 O3470 O3471 O3472 O3473 O3480 O3481 O3482 O3483 O3490 O3491 O3492 O3493 O350XX0 O350XX1 O350XX2 O350XX3 O350XX4 O350XX5 O350XX9 O351XX0 O351XX1 O351XX2 O351XX3 O351XX4 O351XX5 O351XX9 O352XX0 O352XX1 O352XX2 O352XX3 O352XX4 O352XX5 O352XX9 O353XX0 O353XX1 O353XX2 O353XX3 O353XX4 O353XX5 O353XX9 O354XX0 O354XX1 O354XX2 O354XX3 O354XX4 O354XX5 O354XX9 O355XX0 O355XX1 O355XX2 O355XX3 O355XX4 O355XX5 O355XX9 O356XX0 O356XX1 O356XX2 O356XX3 O356XX4 O356XX5 O356XX9 O357XX0 O357XX1 O357XX2

Maternal care for abnormality of vagina, unsp trimester Maternal care for abnormality of vagina, first trimester Maternal care for abnormality of vagina, second trimester Maternal care for abnormality of vagina, third trimester Maternal care for abnlt of vulva and perineum, unsp tri Maternal care for abnlt of vulva and perineum, first tri Maternal care for abnlt of vulva and perineum, second tri Maternal care for abnlt of vulva and perineum, third tri Maternal care for oth abnlt of pelvic organs, unsp trimester Maternal care for oth abnlt of pelvic organs, first tri Maternal care for oth abnlt of pelvic organs, second tri Maternal care for oth abnlt of pelvic organs, third tri Maternal care for abnlt of pelvic organ, unsp, unsp tri Maternal care for abnlt of pelvic organ, unsp, first tri Maternal care for abnlt of pelvic organ, unsp, second tri Maternal care for abnlt of pelvic organ, unsp, third tri Maternal care for (suspected) cnsl malform in fetus, unsp Maternal care for (suspected) cnsl malform in fetus, fetus 1 Maternal care for (suspected) cnsl malform in fetus, fetus 2 Maternal care for (suspected) cnsl malform in fetus, fetus 3 Maternal care for (suspected) cnsl malform in fetus, fetus 4 Maternal care for (suspected) cnsl malform in fetus, fetus 5 Maternal care for (suspected) cnsl malform in fetus, oth Maternal care for chromosomal abnormality in fetus, unsp Maternal care for chromosomal abnormality in fetus, fetus 1 Maternal care for chromosomal abnormality in fetus, fetus 2 Maternal care for chromosomal abnormality in fetus, fetus 3 Maternal care for chromosomal abnormality in fetus, fetus 4 Maternal care for chromosomal abnormality in fetus, fetus 5 Maternal care for chromosomal abnormality in fetus, oth Maternal care for hereditary disease in fetus, unsp Maternal care for hereditary disease in fetus, fetus 1 Maternal care for hereditary disease in fetus, fetus 2 Maternal care for hereditary disease in fetus, fetus 3 Maternal care for hereditary disease in fetus, fetus 4 Maternal care for hereditary disease in fetus, fetus 5 Maternal care for hereditary disease in fetus, oth Matern care for damag to fts from viral dis in mother, unsp Matern care for damag to fts from viral dis in mother, fts1 Matern care for damag to fts from viral dis in mother, fts2 Matern care for damag to fts from viral dis in mother, fts3 Matern care for damag to fts from viral dis in mother, fts4 Matern care for damag to fts from viral dis in mother, fts5 Matern care for damag to fetus from viral dis in mother, oth Maternal care for damage to fetus from alcohol, unsp Maternal care for damage to fetus from alcohol, fetus 1 Maternal care for damage to fetus from alcohol, fetus 2 Maternal care for damage to fetus from alcohol, fetus 3 Maternal care for damage to fetus from alcohol, fetus 4 Maternal care for damage to fetus from alcohol, fetus 5 Maternal care for damage to fetus from alcohol, oth Maternal care for (suspected) damage to fetus by drugs, unsp Maternal care for damage to fetus by drugs, fetus 1 Maternal care for damage to fetus by drugs, fetus 2 Maternal care for damage to fetus by drugs, fetus 3 Maternal care for damage to fetus by drugs, fetus 4 Maternal care for damage to fetus by drugs, fetus 5 Maternal care for (suspected) damage to fetus by drugs, oth Maternal care for damage to fetus by radiation, unsp Maternal care for damage to fetus by radiation, fetus 1 Maternal care for damage to fetus by radiation, fetus 2 Maternal care for damage to fetus by radiation, fetus 3 Maternal care for damage to fetus by radiation, fetus 4 Maternal care for damage to fetus by radiation, fetus 5 Maternal care for damage to fetus by radiation, oth Maternal care for damage to fetus by oth medical proc, unsp Matern care for damage to fetus by oth medical proc, fetus 1 Matern care for damage to fetus by oth medical proc, fetus 2

September 2011

Edit code lists 1.75

Diagnoses allowed for females only

O357XX3 O357XX4 O357XX5 O357XX9 O358XX0 O358XX1 O358XX2 O358XX3 O358XX4 O358XX5 O358XX9 O359XX0 O359XX1 O359XX2 O359XX3 O359XX4 O359XX5 O359XX9 O360110 O360111 O360112 O360113 O360114 O360115 O360119 O360120 O360121 O360122 O360123 O360124 O360125 O360129 O360130 O360131 O360132 O360133 O360134 O360135 O360139 O360190 O360191 O360192 O360193 O360194 O360195 O360199 O360910 O360911 O360912 O360913 O360914 O360915 O360919 O360920 O360921 O360922 O360923 O360924 O360925 O360929 O360930 O360931 O360932 O360933 O360934 O360935 O360939 O360990

Matern care for damage to fetus by oth medical proc, fetus 3 Matern care for damage to fetus by oth medical proc, fetus 4 Matern care for damage to fetus by oth medical proc, fetus 5 Maternal care for damage to fetus by oth medical proc, oth Maternal care for oth fetal abnormality and damage, unsp Maternal care for oth fetal abnormality and damage, fetus 1 Maternal care for oth fetal abnormality and damage, fetus 2 Maternal care for oth fetal abnormality and damage, fetus 3 Maternal care for oth fetal abnormality and damage, fetus 4 Maternal care for oth fetal abnormality and damage, fetus 5 Maternal care for oth fetal abnormality and damage, oth Maternal care for fetal abnormality and damage, unsp, unsp Maternal care for fetal abnlt and damage, unsp, fetus 1 Maternal care for fetal abnlt and damage, unsp, fetus 2 Maternal care for fetal abnlt and damage, unsp, fetus 3 Maternal care for fetal abnlt and damage, unsp, fetus 4 Maternal care for fetal abnlt and damage, unsp, fetus 5 Maternal care for fetal abnormality and damage, unsp, oth Maternal care for anti-D antibodies, first trimester, unsp Maternal care for anti-D antibodies, first tri, fetus 1 Maternal care for anti-D antibodies, first tri, fetus 2 Maternal care for anti-D antibodies, first tri, fetus 3 Maternal care for anti-D antibodies, first tri, fetus 4 Maternal care for anti-D antibodies, first tri, fetus 5 Maternal care for anti-D antibodies, first trimester, oth Maternal care for anti-D antibodies, second trimester, unsp Maternal care for anti-D antibodies, second tri, fetus 1 Maternal care for anti-D antibodies, second tri, fetus 2 Maternal care for anti-D antibodies, second tri, fetus 3 Maternal care for anti-D antibodies, second tri, fetus 4 Maternal care for anti-D antibodies, second tri, fetus 5 Maternal care for anti-D antibodies, second trimester, oth Maternal care for anti-D antibodies, third trimester, unsp Maternal care for anti-D antibodies, third tri, fetus 1 Maternal care for anti-D antibodies, third tri, fetus 2 Maternal care for anti-D antibodies, third tri, fetus 3 Maternal care for anti-D antibodies, third tri, fetus 4 Maternal care for anti-D antibodies, third tri, fetus 5 Maternal care for anti-D antibodies, third trimester, oth Maternal care for anti-D antibodies, unsp trimester, unsp Maternal care for anti-D antibodies, unsp trimester, fetus 1 Maternal care for anti-D antibodies, unsp trimester, fetus 2 Maternal care for anti-D antibodies, unsp trimester, fetus 3 Maternal care for anti-D antibodies, unsp trimester, fetus 4 Maternal care for anti-D antibodies, unsp trimester, fetus 5 Maternal care for anti-D antibodies, unsp trimester, oth Maternal care for oth rhesus isoimmun, first trimester, unsp Maternal care for oth rhesus isoimmun, first tri, fetus 1 Maternal care for oth rhesus isoimmun, first tri, fetus 2 Maternal care for oth rhesus isoimmun, first tri, fetus 3 Maternal care for oth rhesus isoimmun, first tri, fetus 4 Maternal care for oth rhesus isoimmun, first tri, fetus 5 Maternal care for oth rhesus isoimmun, first trimester, oth Maternal care for oth rhesus isoimmun, second tri, unsp Maternal care for oth rhesus isoimmun, second tri, fetus 1 Maternal care for oth rhesus isoimmun, second tri, fetus 2 Maternal care for oth rhesus isoimmun, second tri, fetus 3 Maternal care for oth rhesus isoimmun, second tri, fetus 4 Maternal care for oth rhesus isoimmun, second tri, fetus 5 Maternal care for oth rhesus isoimmun, second trimester, oth Maternal care for oth rhesus isoimmun, third trimester, unsp Maternal care for oth rhesus isoimmun, third tri, fetus 1 Maternal care for oth rhesus isoimmun, third tri, fetus 2 Maternal care for oth rhesus isoimmun, third tri, fetus 3 Maternal care for oth rhesus isoimmun, third tri, fetus 4 Maternal care for oth rhesus isoimmun, third tri, fetus 5 Maternal care for oth rhesus isoimmun, third trimester, oth Maternal care for oth rhesus isoimmun, unsp trimester, unsp

1.76 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O360991 O360992 O360993 O360994 O360995 O360999 O361110 O361111 O361112 O361113 O361114 O361115 O361119 O361120 O361121 O361122 O361123 O361124 O361125 O361129 O361130 O361131 O361132 O361133 O361134 O361135 O361139 O361190 O361191 O361192 O361193 O361194 O361195 O361199 O361910 O361911 O361912 O361913 O361914 O361915 O361919 O361920 O361921 O361922 O361923 O361924 O361925 O361929 O361930 O361931 O361932 O361933 O361934 O361935 O361939 O361990 O361991 O361992 O361993 O361994 O361995 O361999 O3620X0 O3620X1 O3620X2 O3620X3 O3620X4 O3620X5

Maternal care for oth rhesus isoimmun, unsp tri, fetus 1 Maternal care for oth rhesus isoimmun, unsp tri, fetus 2 Maternal care for oth rhesus isoimmun, unsp tri, fetus 3 Maternal care for oth rhesus isoimmun, unsp tri, fetus 4 Maternal care for oth rhesus isoimmun, unsp tri, fetus 5 Maternal care for oth rhesus isoimmun, unsp trimester, oth Maternal care for Anti-A sensitization, first tri, unsp Maternal care for Anti-A sensitization, first tri, fetus 1 Maternal care for Anti-A sensitization, first tri, fetus 2 Maternal care for Anti-A sensitization, first tri, fetus 3 Maternal care for Anti-A sensitization, first tri, fetus 4 Maternal care for Anti-A sensitization, first tri, fetus 5 Maternal care for Anti-A sensitization, first trimester, oth Maternal care for Anti-A sensitization, second tri, unsp Maternal care for Anti-A sensitization, second tri, fetus 1 Maternal care for Anti-A sensitization, second tri, fetus 2 Maternal care for Anti-A sensitization, second tri, fetus 3 Maternal care for Anti-A sensitization, second tri, fetus 4 Maternal care for Anti-A sensitization, second tri, fetus 5 Maternal care for Anti-A sensitization, second tri, oth Maternal care for Anti-A sensitization, third tri, unsp Maternal care for Anti-A sensitization, third tri, fetus 1 Maternal care for Anti-A sensitization, third tri, fetus 2 Maternal care for Anti-A sensitization, third tri, fetus 3 Maternal care for Anti-A sensitization, third tri, fetus 4 Maternal care for Anti-A sensitization, third tri, fetus 5 Maternal care for Anti-A sensitization, third trimester, oth Maternal care for Anti-A sensitization, unsp trimester, unsp Maternal care for Anti-A sensitization, unsp tri, fetus 1 Maternal care for Anti-A sensitization, unsp tri, fetus 2 Maternal care for Anti-A sensitization, unsp tri, fetus 3 Maternal care for Anti-A sensitization, unsp tri, fetus 4 Maternal care for Anti-A sensitization, unsp tri, fetus 5 Maternal care for Anti-A sensitization, unsp trimester, oth Maternal care for oth isoimmunization, first trimester, unsp Maternal care for oth isoimmun, first trimester, fetus 1 Maternal care for oth isoimmun, first trimester, fetus 2 Maternal care for oth isoimmun, first trimester, fetus 3 Maternal care for oth isoimmun, first trimester, fetus 4 Maternal care for oth isoimmun, first trimester, fetus 5 Maternal care for oth isoimmunization, first trimester, oth Maternal care for oth isoimmun, second trimester, unsp Maternal care for oth isoimmun, second trimester, fetus 1 Maternal care for oth isoimmun, second trimester, fetus 2 Maternal care for oth isoimmun, second trimester, fetus 3 Maternal care for oth isoimmun, second trimester, fetus 4 Maternal care for oth isoimmun, second trimester, fetus 5 Maternal care for oth isoimmunization, second trimester, oth Maternal care for oth isoimmunization, third trimester, unsp Maternal care for oth isoimmun, third trimester, fetus 1 Maternal care for oth isoimmun, third trimester, fetus 2 Maternal care for oth isoimmun, third trimester, fetus 3 Maternal care for oth isoimmun, third trimester, fetus 4 Maternal care for oth isoimmun, third trimester, fetus 5 Maternal care for oth isoimmunization, third trimester, oth Maternal care for oth isoimmunization, unsp trimester, unsp Maternal care for oth isoimmun, unsp trimester, fetus 1 Maternal care for oth isoimmun, unsp trimester, fetus 2 Maternal care for oth isoimmun, unsp trimester, fetus 3 Maternal care for oth isoimmun, unsp trimester, fetus 4 Maternal care for oth isoimmun, unsp trimester, fetus 5 Maternal care for oth isoimmunization, unsp trimester, oth Maternal care for hydrops fetalis, unsp trimester, unsp Maternal care for hydrops fetalis, unsp trimester, fetus 1 Maternal care for hydrops fetalis, unsp trimester, fetus 2 Maternal care for hydrops fetalis, unsp trimester, fetus 3 Maternal care for hydrops fetalis, unsp trimester, fetus 4 Maternal care for hydrops fetalis, unsp trimester, fetus 5

September 2011

Edit code lists 1.77

Diagnoses allowed for females only

O3620X9 O3621X0 O3621X1 O3621X2 O3621X3 O3621X4 O3621X5 O3621X9 O3622X0 O3622X1 O3622X2 O3622X3 O3622X4 O3622X5 O3622X9 O3623X0 O3623X1 O3623X2 O3623X3 O3623X4 O3623X5 O3623X9 O364XX0 O364XX1 O364XX2 O364XX3 O364XX4 O364XX5 O364XX9 O365110 O365111 O365112 O365113 O365114 O365115 O365119 O365120 O365121 O365122 O365123 O365124 O365125 O365129 O365130 O365131 O365132 O365133 O365134 O365135 O365139 O365190 O365191 O365192 O365193 O365194 O365195 O365199 O365910 O365911 O365912 O365913 O365914 O365915 O365919 O365920 O365921 O365922 O365923

Maternal care for hydrops fetalis, unsp trimester, oth fetus Maternal care for hydrops fetalis, first trimester, unsp Maternal care for hydrops fetalis, first trimester, fetus 1 Maternal care for hydrops fetalis, first trimester, fetus 2 Maternal care for hydrops fetalis, first trimester, fetus 3 Maternal care for hydrops fetalis, first trimester, fetus 4 Maternal care for hydrops fetalis, first trimester, fetus 5 Maternal care for hydrops fetalis, first trimester, oth Maternal care for hydrops fetalis, second trimester, unsp Maternal care for hydrops fetalis, second trimester, fetus 1 Maternal care for hydrops fetalis, second trimester, fetus 2 Maternal care for hydrops fetalis, second trimester, fetus 3 Maternal care for hydrops fetalis, second trimester, fetus 4 Maternal care for hydrops fetalis, second trimester, fetus 5 Maternal care for hydrops fetalis, second trimester, oth Maternal care for hydrops fetalis, third trimester, unsp Maternal care for hydrops fetalis, third trimester, fetus 1 Maternal care for hydrops fetalis, third trimester, fetus 2 Maternal care for hydrops fetalis, third trimester, fetus 3 Maternal care for hydrops fetalis, third trimester, fetus 4 Maternal care for hydrops fetalis, third trimester, fetus 5 Maternal care for hydrops fetalis, third trimester, oth Maternal care for intrauterine death, not applicable or unsp Maternal care for intrauterine death, fetus 1 Maternal care for intrauterine death, fetus 2 Maternal care for intrauterine death, fetus 3 Maternal care for intrauterine death, fetus 4 Maternal care for intrauterine death, fetus 5 Maternal care for intrauterine death, other fetus Matern care for known or susp placntl insuff, 1st tri, unsp Matern care for known or susp placntl insuff, 1st tri, fts1 Matern care for known or susp placntl insuff, 1st tri, fts2 Matern care for known or susp placntl insuff, 1st tri, fts3 Matern care for known or susp placntl insuff, 1st tri, fts4 Matern care for known or susp placntl insuff, 1st tri, fts5 Matern care for known or susp placntl insuff, first tri, oth Matern care for known or susp placntl insuff, 2nd tri, unsp Matern care for known or susp placntl insuff, 2nd tri, fts1 Matern care for known or susp placntl insuff, 2nd tri, fts2 Matern care for known or susp placntl insuff, 2nd tri, fts3 Matern care for known or susp placntl insuff, 2nd tri, fts4 Matern care for known or susp placntl insuff, 2nd tri, fts5 Matern care for known or susp placntl insuff, 2nd tri, oth Matern care for or susp placntl insuff, third tri, unsp Matern care for or susp placntl insuff, third tri, fts1 Matern care for or susp placntl insuff, third tri, fts2 Matern care for or susp placntl insuff, third tri, fts3 Matern care for or susp placntl insuff, third tri, fts4 Matern care for or susp placntl insuff, third tri, fts5 Matern care for known or susp placntl insuff, third tri, oth Matern care for known or susp placntl insuff, unsp tri, unsp Matern care for known or susp placntl insuff, unsp tri, fts1 Matern care for known or susp placntl insuff, unsp tri, fts2 Matern care for known or susp placntl insuff, unsp tri, fts3 Matern care for known or susp placntl insuff, unsp tri, fts4 Matern care for known or susp placntl insuff, unsp tri, fts5 Matern care for known or susp placntl insuff, unsp tri, oth Matern care for oth or susp poor fetl grth, 1st tri, unsp Matern care for oth or susp poor fetl grth, 1st tri, fts1 Matern care for oth or susp poor fetl grth, 1st tri, fts2 Matern care for oth or susp poor fetl grth, 1st tri, fts3 Matern care for oth or susp poor fetl grth, 1st tri, fts4 Matern care for oth or susp poor fetl grth, 1st tri, fts5 Matern care for oth or susp poor fetl grth, 1st tri, oth Matern care for oth or susp poor fetl grth, 2nd tri, unsp Matern care for oth or susp poor fetl grth, 2nd tri, fts1 Matern care for oth or susp poor fetl grth, 2nd tri, fts2 Matern care for oth or susp poor fetl grth, 2nd tri, fts3

1.78 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O365924 O365925 O365929 O365930 O365931 O365932 O365933 O365934 O365935 O365939 O365990 O365991 O365992 O365993 O365994 O365995 O365999 O3660X0 O3660X1 O3660X2 O3660X3 O3660X4 O3660X5 O3660X9 O3661X0 O3661X1 O3661X2 O3661X3 O3661X4 O3661X5 O3661X9 O3662X0 O3662X1 O3662X2 O3662X3 O3662X4 O3662X5 O3662X9 O3663X0 O3663X1 O3663X2 O3663X3 O3663X4 O3663X5 O3663X9 O3670X0 O3670X1 O3670X2 O3670X3 O3670X4 O3670X5 O3670X9 O3671X0 O3671X1 O3671X2 O3671X3 O3671X4 O3671X5 O3671X9 O3672X0 O3672X1 O3672X2 O3672X3 O3672X4 O3672X5 O3672X9 O3673X0 O3673X1

Matern care for oth or susp poor fetl grth, 2nd tri, fts4 Matern care for oth or susp poor fetl grth, 2nd tri, fts5 Matern care for oth or susp poor fetl grth, 2nd tri, oth Matern care for oth or susp poor fetl grth, third tri, unsp Matern care for oth or susp poor fetl grth, third tri, fts1 Matern care for oth or susp poor fetl grth, third tri, fts2 Matern care for oth or susp poor fetl grth, third tri, fts3 Matern care for oth or susp poor fetl grth, third tri, fts4 Matern care for oth or susp poor fetl grth, third tri, fts5 Matern care for oth or susp poor fetl grth, third tri, oth Matern care for oth or susp poor fetl grth, unsp tri, unsp Matern care for oth or susp poor fetl grth, unsp tri, fts1 Matern care for oth or susp poor fetl grth, unsp tri, fts2 Matern care for oth or susp poor fetl grth, unsp tri, fts3 Matern care for oth or susp poor fetl grth, unsp tri, fts4 Matern care for oth or susp poor fetl grth, unsp tri, fts5 Matern care for oth or susp poor fetl grth, unsp tri, oth Maternal care for excess fetal growth, unsp trimester, unsp Maternal care for excess fetal growth, unsp tri, fetus 1 Maternal care for excess fetal growth, unsp tri, fetus 2 Maternal care for excess fetal growth, unsp tri, fetus 3 Maternal care for excess fetal growth, unsp tri, fetus 4 Maternal care for excess fetal growth, unsp tri, fetus 5 Maternal care for excess fetal growth, unsp trimester, oth Maternal care for excess fetal growth, first trimester, unsp Maternal care for excess fetal growth, first tri, fetus 1 Maternal care for excess fetal growth, first tri, fetus 2 Maternal care for excess fetal growth, first tri, fetus 3 Maternal care for excess fetal growth, first tri, fetus 4 Maternal care for excess fetal growth, first tri, fetus 5 Maternal care for excess fetal growth, first trimester, oth Maternal care for excess fetal growth, second tri, unsp Maternal care for excess fetal growth, second tri, fetus 1 Maternal care for excess fetal growth, second tri, fetus 2 Maternal care for excess fetal growth, second tri, fetus 3 Maternal care for excess fetal growth, second tri, fetus 4 Maternal care for excess fetal growth, second tri, fetus 5 Maternal care for excess fetal growth, second trimester, oth Maternal care for excess fetal growth, third trimester, unsp Maternal care for excess fetal growth, third tri, fetus 1 Maternal care for excess fetal growth, third tri, fetus 2 Maternal care for excess fetal growth, third tri, fetus 3 Maternal care for excess fetal growth, third tri, fetus 4 Maternal care for excess fetal growth, third tri, fetus 5 Maternal care for excess fetal growth, third trimester, oth Maternal care for viable fetus in abd preg, unsp tri, unsp Matern care for viable fetus in abd preg, unsp tri, fetus 1 Matern care for viable fetus in abd preg, unsp tri, fetus 2 Matern care for viable fetus in abd preg, unsp tri, fetus 3 Matern care for viable fetus in abd preg, unsp tri, fetus 4 Matern care for viable fetus in abd preg, unsp tri, fetus 5 Maternal care for viable fetus in abd preg, unsp tri, oth Maternal care for viable fetus in abd preg, first tri, unsp Matern care for viable fetus in abd preg, first tri, fetus 1 Matern care for viable fetus in abd preg, first tri, fetus 2 Matern care for viable fetus in abd preg, first tri, fetus 3 Matern care for viable fetus in abd preg, first tri, fetus 4 Matern care for viable fetus in abd preg, first tri, fetus 5 Maternal care for viable fetus in abd preg, first tri, oth Maternal care for viable fetus in abd preg, second tri, unsp Matern care for viable fetus in abd preg, second tri, fts1 Matern care for viable fetus in abd preg, second tri, fts2 Matern care for viable fetus in abd preg, second tri, fts3 Matern care for viable fetus in abd preg, second tri, fts4 Matern care for viable fetus in abd preg, second tri, fts5 Maternal care for viable fetus in abd preg, second tri, oth Maternal care for viable fetus in abd preg, third tri, unsp Matern care for viable fetus in abd preg, third tri, fetus 1

September 2011

Edit code lists 1.79

Diagnoses allowed for females only

O3673X2 O3673X3 O3673X4 O3673X5 O3673X9 O368120 O368121 O368122 O368123 O368124 O368125 O368129 O368130 O368131 O368132 O368133 O368134 O368135 O368139 O368190 O368191 O368192 O368193 O368194 O368195 O368199 O368210 O368211 O368212 O368213 O368214 O368215 O368219 O368220 O368221 O368222 O368223 O368224 O368225 O368229 O368230 O368231 O368232 O368233 O368234 O368235 O368239 O368290 O368291 O368292 O368293 O368294 O368295 O368299 O368910 O368911 O368912 O368913 O368914 O368915 O368919 O368920 O368921 O368922 O368923 O368924 O368925 O368929

Matern care for viable fetus in abd preg, third tri, fetus 2 Matern care for viable fetus in abd preg, third tri, fetus 3 Matern care for viable fetus in abd preg, third tri, fetus 4 Matern care for viable fetus in abd preg, third tri, fetus 5 Maternal care for viable fetus in abd preg, third tri, oth Decreased fetal movements, second trimester, unsp Decreased fetal movements, second trimester, fetus 1 Decreased fetal movements, second trimester, fetus 2 Decreased fetal movements, second trimester, fetus 3 Decreased fetal movements, second trimester, fetus 4 Decreased fetal movements, second trimester, fetus 5 Decreased fetal movements, second trimester, other fetus Decreased fetal movements, third trimester, unsp Decreased fetal movements, third trimester, fetus 1 Decreased fetal movements, third trimester, fetus 2 Decreased fetal movements, third trimester, fetus 3 Decreased fetal movements, third trimester, fetus 4 Decreased fetal movements, third trimester, fetus 5 Decreased fetal movements, third trimester, other fetus Decreased fetal movements, unsp trimester, unsp Decreased fetal movements, unspecified trimester, fetus 1 Decreased fetal movements, unspecified trimester, fetus 2 Decreased fetal movements, unspecified trimester, fetus 3 Decreased fetal movements, unspecified trimester, fetus 4 Decreased fetal movements, unspecified trimester, fetus 5 Decreased fetal movements, unsp trimester, other fetus Fetal anemia and thrombocytopenia, first trimester, unsp Fetal anemia and thrombocytopenia, first trimester, fetus 1 Fetal anemia and thrombocytopenia, first trimester, fetus 2 Fetal anemia and thrombocytopenia, first trimester, fetus 3 Fetal anemia and thrombocytopenia, first trimester, fetus 4 Fetal anemia and thrombocytopenia, first trimester, fetus 5 Fetal anemia and thrombocytopenia, first trimester, oth Fetal anemia and thrombocytopenia, second trimester, unsp Fetal anemia and thrombocytopenia, second trimester, fetus 1 Fetal anemia and thrombocytopenia, second trimester, fetus 2 Fetal anemia and thrombocytopenia, second trimester, fetus 3 Fetal anemia and thrombocytopenia, second trimester, fetus 4 Fetal anemia and thrombocytopenia, second trimester, fetus 5 Fetal anemia and thrombocytopenia, second trimester, oth Fetal anemia and thrombocytopenia, third trimester, unsp Fetal anemia and thrombocytopenia, third trimester, fetus 1 Fetal anemia and thrombocytopenia, third trimester, fetus 2 Fetal anemia and thrombocytopenia, third trimester, fetus 3 Fetal anemia and thrombocytopenia, third trimester, fetus 4 Fetal anemia and thrombocytopenia, third trimester, fetus 5 Fetal anemia and thrombocytopenia, third trimester, oth Fetal anemia and thrombocytopenia, unsp trimester, unsp Fetal anemia and thrombocytopenia, unsp trimester, fetus 1 Fetal anemia and thrombocytopenia, unsp trimester, fetus 2 Fetal anemia and thrombocytopenia, unsp trimester, fetus 3 Fetal anemia and thrombocytopenia, unsp trimester, fetus 4 Fetal anemia and thrombocytopenia, unsp trimester, fetus 5 Fetal anemia and thrombocytopenia, unsp trimester, oth fetus Maternal care for oth fetal problems, first trimester, unsp Maternal care for oth fetal problems, first tri, fetus 1 Maternal care for oth fetal problems, first tri, fetus 2 Maternal care for oth fetal problems, first tri, fetus 3 Maternal care for oth fetal problems, first tri, fetus 4 Maternal care for oth fetal problems, first tri, fetus 5 Maternal care for oth fetal problems, first trimester, oth Maternal care for oth fetal problems, second trimester, unsp Maternal care for oth fetal problems, second tri, fetus 1 Maternal care for oth fetal problems, second tri, fetus 2 Maternal care for oth fetal problems, second tri, fetus 3 Maternal care for oth fetal problems, second tri, fetus 4 Maternal care for oth fetal problems, second tri, fetus 5 Maternal care for oth fetal problems, second trimester, oth

1.80 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O368930 O368931 O368932 O368933 O368934 O368935 O368939 O368990 O368991 O368992 O368993 O368994 O368995 O368999 O3690X0 O3690X1 O3690X2 O3690X3 O3690X4 O3690X5 O3690X9 O3691X0 O3691X1 O3691X2 O3691X3 O3691X4 O3691X5 O3691X9 O3692X0 O3692X1 O3692X2 O3692X3 O3692X4 O3692X5 O3692X9 O3693X0 O3693X1 O3693X2 O3693X3 O3693X4 O3693X5 O3693X9 O401XX0 O401XX1 O401XX2 O401XX3 O401XX4 O401XX5 O401XX9 O402XX0 O402XX1 O402XX2 O402XX3 O402XX4 O402XX5 O402XX9 O403XX0 O403XX1 O403XX2 O403XX3 O403XX4 O403XX5 O403XX9 O409XX0 O409XX1 O409XX2 O409XX3 O409XX4

Maternal care for oth fetal problems, third trimester, unsp Maternal care for oth fetal problems, third tri, fetus 1 Maternal care for oth fetal problems, third tri, fetus 2 Maternal care for oth fetal problems, third tri, fetus 3 Maternal care for oth fetal problems, third tri, fetus 4 Maternal care for oth fetal problems, third tri, fetus 5 Maternal care for oth fetal problems, third trimester, oth Maternal care for oth fetal problems, unsp trimester, unsp Maternal care for oth fetal problems, unsp tri, fetus 1 Maternal care for oth fetal problems, unsp tri, fetus 2 Maternal care for oth fetal problems, unsp tri, fetus 3 Maternal care for oth fetal problems, unsp tri, fetus 4 Maternal care for oth fetal problems, unsp tri, fetus 5 Maternal care for oth fetal problems, unsp trimester, oth Maternal care for fetal problem, unsp, unsp trimester, unsp Maternal care for fetal problem, unsp, unsp tri, fetus 1 Maternal care for fetal problem, unsp, unsp tri, fetus 2 Maternal care for fetal problem, unsp, unsp tri, fetus 3 Maternal care for fetal problem, unsp, unsp tri, fetus 4 Maternal care for fetal problem, unsp, unsp tri, fetus 5 Maternal care for fetal problem, unsp, unsp trimester, oth Maternal care for fetal problem, unsp, first trimester, unsp Maternal care for fetal problem, unsp, first tri, fetus 1 Maternal care for fetal problem, unsp, first tri, fetus 2 Maternal care for fetal problem, unsp, first tri, fetus 3 Maternal care for fetal problem, unsp, first tri, fetus 4 Maternal care for fetal problem, unsp, first tri, fetus 5 Maternal care for fetal problem, unsp, first trimester, oth Maternal care for fetal problem, unsp, second tri, unsp Maternal care for fetal problem, unsp, second tri, fetus 1 Maternal care for fetal problem, unsp, second tri, fetus 2 Maternal care for fetal problem, unsp, second tri, fetus 3 Maternal care for fetal problem, unsp, second tri, fetus 4 Maternal care for fetal problem, unsp, second tri, fetus 5 Maternal care for fetal problem, unsp, second trimester, oth Maternal care for fetal problem, unsp, third trimester, unsp Maternal care for fetal problem, unsp, third tri, fetus 1 Maternal care for fetal problem, unsp, third tri, fetus 2 Maternal care for fetal problem, unsp, third tri, fetus 3 Maternal care for fetal problem, unsp, third tri, fetus 4 Maternal care for fetal problem, unsp, third tri, fetus 5 Maternal care for fetal problem, unsp, third trimester, oth Polyhydramnios, first trimester, not applicable or unsp Polyhydramnios, first trimester, fetus 1 Polyhydramnios, first trimester, fetus 2 Polyhydramnios, first trimester, fetus 3 Polyhydramnios, first trimester, fetus 4 Polyhydramnios, first trimester, fetus 5 Polyhydramnios, first trimester, other fetus Polyhydramnios, second trimester, not applicable or unsp Polyhydramnios, second trimester, fetus 1 Polyhydramnios, second trimester, fetus 2 Polyhydramnios, second trimester, fetus 3 Polyhydramnios, second trimester, fetus 4 Polyhydramnios, second trimester, fetus 5 Polyhydramnios, second trimester, other fetus Polyhydramnios, third trimester, not applicable or unsp Polyhydramnios, third trimester, fetus 1 Polyhydramnios, third trimester, fetus 2 Polyhydramnios, third trimester, fetus 3 Polyhydramnios, third trimester, fetus 4 Polyhydramnios, third trimester, fetus 5 Polyhydramnios, third trimester, other fetus Polyhydramnios, unsp trimester, not applicable or unsp Polyhydramnios, unspecified trimester, fetus 1 Polyhydramnios, unspecified trimester, fetus 2 Polyhydramnios, unspecified trimester, fetus 3 Polyhydramnios, unspecified trimester, fetus 4

September 2011

Edit code lists 1.81

Diagnoses allowed for females only

O409XX5 O409XX9 O4100X0 O4100X1 O4100X2 O4100X3 O4100X4 O4100X5 O4100X9 O4101X0 O4101X1 O4101X2 O4101X3 O4101X4 O4101X5 O4101X9 O4102X0 O4102X1 O4102X2 O4102X3 O4102X4 O4102X5 O4102X9 O4103X0 O4103X1 O4103X2 O4103X3 O4103X4 O4103X5 O4103X9 O411010 O411011 O411012 O411013 O411014 O411015 O411019 O411020 O411021 O411022 O411023 O411024 O411025 O411029 O411030 O411031 O411032 O411033 O411034 O411035 O411039 O411090 O411091 O411092 O411093 O411094 O411095 O411099 O411210 O411211 O411212 O411213 O411214 O411215 O411219 O411220 O411221 O411222

Polyhydramnios, unspecified trimester, fetus 5 Polyhydramnios, unspecified trimester, other fetus Oligohydramnios, unsp trimester, not applicable or unsp Oligohydramnios, unspecified trimester, fetus 1 Oligohydramnios, unspecified trimester, fetus 2 Oligohydramnios, unspecified trimester, fetus 3 Oligohydramnios, unspecified trimester, fetus 4 Oligohydramnios, unspecified trimester, fetus 5 Oligohydramnios, unspecified trimester, other fetus Oligohydramnios, first trimester, not applicable or unsp Oligohydramnios, first trimester, fetus 1 Oligohydramnios, first trimester, fetus 2 Oligohydramnios, first trimester, fetus 3 Oligohydramnios, first trimester, fetus 4 Oligohydramnios, first trimester, fetus 5 Oligohydramnios, first trimester, other fetus Oligohydramnios, second trimester, not applicable or unsp Oligohydramnios, second trimester, fetus 1 Oligohydramnios, second trimester, fetus 2 Oligohydramnios, second trimester, fetus 3 Oligohydramnios, second trimester, fetus 4 Oligohydramnios, second trimester, fetus 5 Oligohydramnios, second trimester, other fetus Oligohydramnios, third trimester, not applicable or unsp Oligohydramnios, third trimester, fetus 1 Oligohydramnios, third trimester, fetus 2 Oligohydramnios, third trimester, fetus 3 Oligohydramnios, third trimester, fetus 4 Oligohydramnios, third trimester, fetus 5 Oligohydramnios, third trimester, other fetus Infct of amniotic sac and membrns, unsp, first tri, unsp Infct of amniotic sac and membrns, unsp, first tri, fetus 1 Infct of amniotic sac and membrns, unsp, first tri, fetus 2 Infct of amniotic sac and membrns, unsp, first tri, fetus 3 Infct of amniotic sac and membrns, unsp, first tri, fetus 4 Infct of amniotic sac and membrns, unsp, first tri, fetus 5 Infct of amniotic sac and membrns, unsp, first tri, oth Infct of amniotic sac and membrns, unsp, second tri, unsp Infct of amniotic sac and membrns, unsp, second tri, fetus 1 Infct of amniotic sac and membrns, unsp, second tri, fetus 2 Infct of amniotic sac and membrns, unsp, second tri, fetus 3 Infct of amniotic sac and membrns, unsp, second tri, fetus 4 Infct of amniotic sac and membrns, unsp, second tri, fetus 5 Infct of amniotic sac and membrns, unsp, second tri, oth Infct of amniotic sac and membrns, unsp, third tri, unsp Infct of amniotic sac and membrns, unsp, third tri, fetus 1 Infct of amniotic sac and membrns, unsp, third tri, fetus 2 Infct of amniotic sac and membrns, unsp, third tri, fetus 3 Infct of amniotic sac and membrns, unsp, third tri, fetus 4 Infct of amniotic sac and membrns, unsp, third tri, fetus 5 Infct of amniotic sac and membrns, unsp, third tri, oth Infct of amniotic sac and membrns, unsp, unsp tri, unsp Infct of amniotic sac and membrns, unsp, unsp tri, fetus 1 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 2 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 3 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 4 Infct of amniotic sac and membrns, unsp, unsp tri, fetus 5 Infct of amniotic sac and membrns, unsp, unsp trimester, oth Chorioamnionitis, first trimester, not applicable or unsp Chorioamnionitis, first trimester, fetus 1 Chorioamnionitis, first trimester, fetus 2 Chorioamnionitis, first trimester, fetus 3 Chorioamnionitis, first trimester, fetus 4 Chorioamnionitis, first trimester, fetus 5 Chorioamnionitis, first trimester, other fetus Chorioamnionitis, second trimester, not applicable or unsp Chorioamnionitis, second trimester, fetus 1 Chorioamnionitis, second trimester, fetus 2

1.82 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O411223 O411224 O411225 O411229 O411230 O411231 O411232 O411233 O411234 O411235 O411239 O411290 O411291 O411292 O411293 O411294 O411295 O411299 O411410 O411411 O411412 O411413 O411414 O411415 O411419 O411420 O411421 O411422 O411423 O411424 O411425 O411429 O411430 O411431 O411432 O411433 O411434 O411435 O411439 O411490 O411491 O411492 O411493 O411494 O411495 O411499 O418X10 O418X11 O418X12 O418X13 O418X14 O418X15 O418X19 O418X20 O418X21 O418X22 O418X23 O418X24 O418X25 O418X29 O418X30 O418X31 O418X32 O418X33 O418X34 O418X35 O418X39 O418X90

Chorioamnionitis, second trimester, fetus 3 Chorioamnionitis, second trimester, fetus 4 Chorioamnionitis, second trimester, fetus 5 Chorioamnionitis, second trimester, other fetus Chorioamnionitis, third trimester, not applicable or unsp Chorioamnionitis, third trimester, fetus 1 Chorioamnionitis, third trimester, fetus 2 Chorioamnionitis, third trimester, fetus 3 Chorioamnionitis, third trimester, fetus 4 Chorioamnionitis, third trimester, fetus 5 Chorioamnionitis, third trimester, other fetus Chorioamnionitis, unsp trimester, not applicable or unsp Chorioamnionitis, unspecified trimester, fetus 1 Chorioamnionitis, unspecified trimester, fetus 2 Chorioamnionitis, unspecified trimester, fetus 3 Chorioamnionitis, unspecified trimester, fetus 4 Chorioamnionitis, unspecified trimester, fetus 5 Chorioamnionitis, unspecified trimester, other fetus Placentitis, first trimester, not applicable or unspecified Placentitis, first trimester, fetus 1 Placentitis, first trimester, fetus 2 Placentitis, first trimester, fetus 3 Placentitis, first trimester, fetus 4 Placentitis, first trimester, fetus 5 Placentitis, first trimester, other fetus Placentitis, second trimester, not applicable or unspecified Placentitis, second trimester, fetus 1 Placentitis, second trimester, fetus 2 Placentitis, second trimester, fetus 3 Placentitis, second trimester, fetus 4 Placentitis, second trimester, fetus 5 Placentitis, second trimester, other fetus Placentitis, third trimester, not applicable or unspecified Placentitis, third trimester, fetus 1 Placentitis, third trimester, fetus 2 Placentitis, third trimester, fetus 3 Placentitis, third trimester, fetus 4 Placentitis, third trimester, fetus 5 Placentitis, third trimester, other fetus Placentitis, unsp trimester, not applicable or unspecified Placentitis, unspecified trimester, fetus 1 Placentitis, unspecified trimester, fetus 2 Placentitis, unspecified trimester, fetus 3 Placentitis, unspecified trimester, fetus 4 Placentitis, unspecified trimester, fetus 5 Placentitis, unspecified trimester, other fetus Oth disrd of amniotic fluid and membrns, first tri, unsp Oth disrd of amniotic fluid and membrns, first tri, fetus 1 Oth disrd of amniotic fluid and membrns, first tri, fetus 2 Oth disrd of amniotic fluid and membrns, first tri, fetus 3 Oth disrd of amniotic fluid and membrns, first tri, fetus 4 Oth disrd of amniotic fluid and membrns, first tri, fetus 5 Oth disrd of amniotic fluid and membrns, first tri, oth Oth disrd of amniotic fluid and membrns, second tri, unsp Oth disrd of amniotic fluid and membrns, second tri, fetus 1 Oth disrd of amniotic fluid and membrns, second tri, fetus 2 Oth disrd of amniotic fluid and membrns, second tri, fetus 3 Oth disrd of amniotic fluid and membrns, second tri, fetus 4 Oth disrd of amniotic fluid and membrns, second tri, fetus 5 Oth disrd of amniotic fluid and membrns, second tri, oth Oth disrd of amniotic fluid and membrns, third tri, unsp Oth disrd of amniotic fluid and membrns, third tri, fetus 1 Oth disrd of amniotic fluid and membrns, third tri, fetus 2 Oth disrd of amniotic fluid and membrns, third tri, fetus 3 Oth disrd of amniotic fluid and membrns, third tri, fetus 4 Oth disrd of amniotic fluid and membrns, third tri, fetus 5 Oth disrd of amniotic fluid and membrns, third tri, oth Oth disrd of amniotic fluid and membrns, unsp tri, unsp

September 2011

Edit code lists 1.83

Diagnoses allowed for females only

O418X91 O418X92 O418X93 O418X94 O418X95 O418X99 O4190X0 O4190X1 O4190X2 O4190X3 O4190X4 O4190X5 O4190X9 O4191X0 O4191X1 O4191X2 O4191X3 O4191X4 O4191X5 O4191X9 O4192X0 O4192X1 O4192X2 O4192X3 O4192X4 O4192X5 O4192X9 O4193X0 O4193X1 O4193X2 O4193X3 O4193X4 O4193X5 O4193X9 O4200 O42011 O42012 O42013 O42019 O4202 O4210 O42111 O42112 O42113 O42119 O4212 O4290 O42911 O42912 O42913 O42919 O4292 O43011 O43012 O43013 O43019 O43021 O43022 O43023 O43029 O43101 O43102 O43103 O43109 O43111 O43112 O43113 O43119

Oth disrd of amniotic fluid and membrns, unsp tri, fetus 1 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 2 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 3 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 4 Oth disrd of amniotic fluid and membrns, unsp tri, fetus 5 Oth disrd of amniotic fluid and membrns, unsp trimester, oth Disorder of amniotic fluid and membrns, unsp, unsp tri, unsp Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 1 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 2 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 3 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 4 Disorder of amnio fluid and membrns, unsp, unsp tri, fetus 5 Disorder of amniotic fluid and membrns, unsp, unsp tri, oth Disorder of amnio fluid and membrns, unsp, first tri, unsp Disord of amnio fluid and membrns, unsp, first tri, fetus 1 Disord of amnio fluid and membrns, unsp, first tri, fetus 2 Disord of amnio fluid and membrns, unsp, first tri, fetus 3 Disord of amnio fluid and membrns, unsp, first tri, fetus 4 Disord of amnio fluid and membrns, unsp, first tri, fetus 5 Disorder of amniotic fluid and membrns, unsp, first tri, oth Disorder of amnio fluid and membrns, unsp, second tri, unsp Disord of amnio fluid and membrns, unsp, second tri, fetus 1 Disord of amnio fluid and membrns, unsp, second tri, fetus 2 Disord of amnio fluid and membrns, unsp, second tri, fetus 3 Disord of amnio fluid and membrns, unsp, second tri, fetus 4 Disord of amnio fluid and membrns, unsp, second tri, fetus 5 Disorder of amnio fluid and membrns, unsp, second tri, oth Disorder of amnio fluid and membrns, unsp, third tri, unsp Disord of amnio fluid and membrns, unsp, third tri, fetus 1 Disord of amnio fluid and membrns, unsp, third tri, fetus 2 Disord of amnio fluid and membrns, unsp, third tri, fetus 3 Disord of amnio fluid and membrns, unsp, third tri, fetus 4 Disord of amnio fluid and membrns, unsp, third tri, fetus 5 Disorder of amniotic fluid and membrns, unsp, third tri, oth Prem ROM, onset labor w/n 24 hr of rupt, unsp weeks of gest Pretrm prem ROM, onset labor w/n 24 hours of rupt, first tri Pretrm prem ROM, onset labor w/n 24 hours of rupt, 2nd tri Pretrm prem ROM, onset labor w/n 24 hours of rupt, third tri Pretrm prem ROM, onset labor w/n 24 hours of rupt, unsp tri Full-term prem ROM, onset labor within 24 hours of rupture Prem ROM, onset labor > 24 hr fol rupt, unsp weeks of gest Pretrm prem ROM, onset labor > 24 hours fol rupt, first tri Pretrm prem ROM, onset labor > 24 hours fol rupt, second tri Pretrm prem ROM, onset labor > 24 hours fol rupt, third tri Pretrm prem ROM, onset labor > 24 hours fol rupt, unsp tri Full-term premature ROM, onset labor > 24 hours fol rupture Prem ROM, 7th0 betw rupt & onst labr, unsp weeks of gest Pretrm prem ROM, unsp time betw rupt and onset labr, 1st tri Pretrm prem ROM, unsp time betw rupt and onset labr, 2nd tri Pretrm prem ROM, unsp time betw rupt and onst labr, 3rd tri Pretrm prem ROM, unsp time betw rupt and onst labr, unsp tri Full-term prem ROM, unsp time betw rupture and onset labor Fetomaternal placental transfusion syndrome, first trimester Fetomaternal placental transfuse syndrome, second trimester Fetomaternal placental transfusion syndrome, third trimester Fetomaternal placental transfusion syndrome, unsp trimester Fetus-to-fetus placental transfuse syndrome, first trimester Fetus-to-fetus placntl transfuse syndrome, second trimester Fetus-to-fetus placental transfuse syndrome, third trimester Fetus-to-fetus placental transfuse syndrome, unsp trimester Malformation of placenta, unspecified, first trimester Malformation of placenta, unspecified, second trimester Malformation of placenta, unspecified, third trimester Malformation of placenta, unspecified, unspecified trimester Circumvallate placenta, first trimester Circumvallate placenta, second trimester Circumvallate placenta, third trimester Circumvallate placenta, unspecified trimester

1.84 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O43121 O43122 O43123 O43129 O43191 O43192 O43193 O43199 O43211 O43212 O43213 O43219 O43221 O43222 O43223 O43229 O43231 O43232 O43233 O43239 O43811 O43812 O43813 O43819 O43891 O43892 O43893 O43899 O4390 O4391 O4392 O4393 O4400 O4401 O4402 O4403 O4410 O4411 O4412 O4413 O45001 O45002 O45003 O45009 O45011 O45012 O45013 O45019 O45021 O45022 O45023 O45029 O45091 O45092 O45093 O45099 O458X1 O458X2 O458X3 O458X9 O4590 O4591 O4592 O4593 O46001 O46002 O46003 O46009

Velamentous insertion of umbilical cord, first trimester Velamentous insertion of umbilical cord, second trimester Velamentous insertion of umbilical cord, third trimester Velamentous insertion of umbilical cord, unsp trimester Other malformation of placenta, first trimester Other malformation of placenta, second trimester Other malformation of placenta, third trimester Other malformation of placenta, unspecified trimester Placenta accreta, first trimester Placenta accreta, second trimester Placenta accreta, third trimester Placenta accreta, unspecified trimester Placenta increta, first trimester Placenta increta, second trimester Placenta increta, third trimester Placenta increta, unspecified trimester Placenta percreta, first trimester Placenta percreta, second trimester Placenta percreta, third trimester Placenta percreta, unspecified trimester Placental infarction, first trimester Placental infarction, second trimester Placental infarction, third trimester Placental infarction, unspecified trimester Other placental disorders, first trimester Other placental disorders, second trimester Other placental disorders, third trimester Other placental disorders, unspecified trimester Unspecified placental disorder, unspecified trimester Unspecified placental disorder, first trimester Unspecified placental disorder, second trimester Unspecified placental disorder, third trimester Placenta previa specified as w/o hemorrhage, unsp trimester Placenta previa specified as w/o hemorrhage, first trimester Placenta previa specified as w/o hemor, second trimester Placenta previa specified as w/o hemorrhage, third trimester Placenta previa with hemorrhage, unspecified trimester Placenta previa with hemorrhage, first trimester Placenta previa with hemorrhage, second trimester Placenta previa with hemorrhage, third trimester Prem separtn of placenta w coag defect, unsp, first tri Prem separtn of placenta w coag defect, unsp, second tri Prem separtn of placenta w coag defect, unsp, third tri Prem separtn of placenta w coag defect, unsp, unsp trimester Prem separtn of placenta w afibrinogenemia, first trimester Prem separtn of placenta w afibrinogenemia, second trimester Prem separtn of placenta w afibrinogenemia, third trimester Prem separtn of placenta w afibrinogenemia, unsp trimester Prem separtn of placenta w dissem intravasc coag, first tri Prem separtn of placenta w dissem intravasc coag, second tri Prem separtn of placenta w dissem intravasc coag, third tri Prem separtn of placenta w dissem intravasc coag, unsp tri Prem separtn of placenta w oth coag defect, first trimester Prem separtn of placenta w oth coag defect, second trimester Prem separtn of placenta w oth coag defect, third trimester Prem separtn of placenta w oth coag defect, unsp trimester Other premature separation of placenta, first trimester Other premature separation of placenta, second trimester Other premature separation of placenta, third trimester Other premature separation of placenta, unsp trimester Premature separation of placenta, unsp, unsp trimester Premature separation of placenta, unsp, first trimester Premature separation of placenta, unsp, second trimester Premature separation of placenta, unsp, third trimester Antepartum hemorrhage w coag defect, unsp, first trimester Antepartum hemorrhage w coag defect, unsp, second trimester Antepartum hemorrhage w coag defect, unsp, third trimester Antepartum hemorrhage w coag defect, unsp, unsp trimester

September 2011

Edit code lists 1.85

Diagnoses allowed for females only

O46011 O46012 O46013 O46019 O46021 O46022 O46023 O46029 O46091 O46092 O46093 O46099 O468X1 O468X2 O468X3 O468X9 O4690 O4691 O4692 O4693 O4700 O4702 O4703 O471 O479 O480 O481 O6000 O6002 O6003 O6010X0 O6010X1 O6010X2 O6010X3 O6010X4 O6010X5 O6010X9 O6012X0 O6012X1 O6012X2 O6012X3 O6012X4 O6012X5 O6012X9 O6013X0 O6013X1 O6013X2 O6013X3 O6013X4 O6013X5 O6013X9 O6014X0 O6014X1 O6014X2 O6014X3 O6014X4 O6014X5 O6014X9 O6020X0 O6020X1 O6020X2 O6020X3 O6020X4 O6020X5 O6020X9 O6022X0 O6022X1 O6022X2

Antepartum hemorrhage with afibrinogenemia, first trimester Antepartum hemorrhage with afibrinogenemia, second trimester Antepartum hemorrhage with afibrinogenemia, third trimester Antepartum hemorrhage with afibrinogenemia, unsp trimester Antepart hemorrhage w dissem intravasc coag, first trimester Antepart hemor w dissem intravasc coag, second trimester Antepart hemorrhage w dissem intravasc coag, third trimester Antepart hemorrhage w dissem intravasc coag, unsp trimester Antepartum hemorrhage w oth coag defect, first trimester Antepartum hemorrhage w oth coag defect, second trimester Antepartum hemorrhage w oth coag defect, third trimester Antepartum hemorrhage w oth coag defect, unsp trimester Other antepartum hemorrhage, first trimester Other antepartum hemorrhage, second trimester Other antepartum hemorrhage, third trimester Other antepartum hemorrhage, unspecified trimester Antepartum hemorrhage, unspecified, unspecified trimester Antepartum hemorrhage, unspecified, first trimester Antepartum hemorrhage, unspecified, second trimester Antepartum hemorrhage, unspecified, third trimester False labor before 37 completed weeks of gest, unsp tri False labor before 37 completed weeks of gest, second tri False labor before 37 completed weeks of gest, third tri False labor at or after 37 completed weeks of gestation False labor, unspecified Post-term pregnancy Prolonged pregnancy Preterm labor without delivery, unspecified trimester Preterm labor without delivery, second trimester Preterm labor without delivery, third trimester Preterm labor w preterm delivery, unsp trimester, unsp Preterm labor with preterm delivery, unsp trimester, fetus 1 Preterm labor with preterm delivery, unsp trimester, fetus 2 Preterm labor with preterm delivery, unsp trimester, fetus 3 Preterm labor with preterm delivery, unsp trimester, fetus 4 Preterm labor with preterm delivery, unsp trimester, fetus 5 Preterm labor w preterm delivery, unsp trimester, oth fetus Preterm labor second tri w preterm delivery second tri, unsp Preterm labor second tri w preterm del second tri, fetus 1 Preterm labor second tri w preterm del second tri, fetus 2 Preterm labor second tri w preterm del second tri, fetus 3 Preterm labor second tri w preterm del second tri, fetus 4 Preterm labor second tri w preterm del second tri, fetus 5 Preterm labor second tri w preterm delivery second tri, oth Preterm labor second tri w preterm delivery third tri, unsp Preterm labor second tri w preterm del third tri, fetus 1 Preterm labor second tri w preterm del third tri, fetus 2 Preterm labor second tri w preterm del third tri, fetus 3 Preterm labor second tri w preterm del third tri, fetus 4 Preterm labor second tri w preterm del third tri, fetus 5 Preterm labor second tri w preterm delivery third tri, oth Preterm labor third tri w preterm delivery third tri, unsp Preterm labor third tri w preterm del third tri, fetus 1 Preterm labor third tri w preterm del third tri, fetus 2 Preterm labor third tri w preterm del third tri, fetus 3 Preterm labor third tri w preterm del third tri, fetus 4 Preterm labor third tri w preterm del third tri, fetus 5 Preterm labor third tri w preterm delivery third tri, oth Term delivery w preterm labor, unsp trimester, unsp Term delivery with preterm labor, unsp trimester, fetus 1 Term delivery with preterm labor, unsp trimester, fetus 2 Term delivery with preterm labor, unsp trimester, fetus 3 Term delivery with preterm labor, unsp trimester, fetus 4 Term delivery with preterm labor, unsp trimester, fetus 5 Term delivery with preterm labor, unsp trimester, oth fetus Term delivery w preterm labor, second trimester, unsp Term delivery with preterm labor, second trimester, fetus 1 Term delivery with preterm labor, second trimester, fetus 2

1.86 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O6022X3 O6022X4 O6022X5 O6022X9 O6023X0 O6023X1 O6023X2 O6023X3 O6023X4 O6023X5 O6023X9 O610 O611 O618 O619 O620 O621 O622 O623 O624 O628 O629 O630 O631 O632 O639 O640XX0 O640XX1 O640XX2 O640XX3 O640XX4 O640XX5 O640XX9 O641XX0 O641XX1 O641XX2 O641XX3 O641XX4 O641XX5 O641XX9 O642XX0 O642XX1 O642XX2 O642XX3 O642XX4 O642XX5 O642XX9 O643XX0 O643XX1 O643XX2 O643XX3 O643XX4 O643XX5 O643XX9 O644XX0 O644XX1 O644XX2 O644XX3 O644XX4 O644XX5 O644XX9 O645XX0 O645XX1 O645XX2 O645XX3 O645XX4 O645XX5 O645XX9

Term delivery with preterm labor, second trimester, fetus 3 Term delivery with preterm labor, second trimester, fetus 4 Term delivery with preterm labor, second trimester, fetus 5 Term delivery w preterm labor, second trimester, oth fetus Term delivery w preterm labor, third trimester, unsp Term delivery with preterm labor, third trimester, fetus 1 Term delivery with preterm labor, third trimester, fetus 2 Term delivery with preterm labor, third trimester, fetus 3 Term delivery with preterm labor, third trimester, fetus 4 Term delivery with preterm labor, third trimester, fetus 5 Term delivery with preterm labor, third trimester, oth fetus Failed medical induction of labor Failed instrumental induction of labor Other failed induction of labor Failed induction of labor, unspecified Primary inadequate contractions Secondary uterine inertia Other uterine inertia Precipitate labor Hypertonic, incoordinate, and prolonged uterine contractions Other abnormalities of forces of labor Abnormality of forces of labor, unspecified Prolonged first stage (of labor) Prolonged second stage (of labor) Delayed delivery of second twin, triplet, etc. Long labor, unspecified Obstructed labor due to incmpl rotation of fetal head, unsp Obst labor due to incmpl rotation of fetal head, fetus 1 Obst labor due to incmpl rotation of fetal head, fetus 2 Obst labor due to incmpl rotation of fetal head, fetus 3 Obst labor due to incmpl rotation of fetal head, fetus 4 Obst labor due to incmpl rotation of fetal head, fetus 5 Obstructed labor due to incmpl rotation of fetal head, oth Obstructed labor due to breech presentation, unsp Obstructed labor due to breech presentation, fetus 1 Obstructed labor due to breech presentation, fetus 2 Obstructed labor due to breech presentation, fetus 3 Obstructed labor due to breech presentation, fetus 4 Obstructed labor due to breech presentation, fetus 5 Obstructed labor due to breech presentation, other fetus Obstructed labor due to face presentation, unsp Obstructed labor due to face presentation, fetus 1 Obstructed labor due to face presentation, fetus 2 Obstructed labor due to face presentation, fetus 3 Obstructed labor due to face presentation, fetus 4 Obstructed labor due to face presentation, fetus 5 Obstructed labor due to face presentation, other fetus Obstructed labor due to brow presentation, unsp Obstructed labor due to brow presentation, fetus 1 Obstructed labor due to brow presentation, fetus 2 Obstructed labor due to brow presentation, fetus 3 Obstructed labor due to brow presentation, fetus 4 Obstructed labor due to brow presentation, fetus 5 Obstructed labor due to brow presentation, other fetus Obstructed labor due to shoulder presentation, unsp Obstructed labor due to shoulder presentation, fetus 1 Obstructed labor due to shoulder presentation, fetus 2 Obstructed labor due to shoulder presentation, fetus 3 Obstructed labor due to shoulder presentation, fetus 4 Obstructed labor due to shoulder presentation, fetus 5 Obstructed labor due to shoulder presentation, other fetus Obstructed labor due to compound presentation, unsp Obstructed labor due to compound presentation, fetus 1 Obstructed labor due to compound presentation, fetus 2 Obstructed labor due to compound presentation, fetus 3 Obstructed labor due to compound presentation, fetus 4 Obstructed labor due to compound presentation, fetus 5 Obstructed labor due to compound presentation, other fetus

September 2011

Edit code lists 1.87

Diagnoses allowed for females only

O648XX0 O648XX1 O648XX2 O648XX3 O648XX4 O648XX5 O648XX9 O649XX0 O649XX1 O649XX2 O649XX3 O649XX4 O649XX5 O649XX9 O650 O651 O652 O653 O654 O655 O658 O659 O660 O661 O662 O663 O6640 O6641 O665 O666 O668 O669 O670 O678 O679 O68 O690XX0 O690XX1 O690XX2 O690XX3 O690XX4 O690XX5 O690XX9 O691XX0 O691XX1 O691XX2 O691XX3 O691XX4 O691XX5 O691XX9 O692XX0 O692XX1 O692XX2 O692XX3 O692XX4 O692XX5 O692XX9 O693XX0 O693XX1 O693XX2 O693XX3 O693XX4 O693XX5 O693XX9 O694XX0 O694XX1 O694XX2 O694XX3

Obstructed labor due to oth malposition and malpresent, unsp Obstructed labor due to oth malpos and malpresent, fetus 1 Obstructed labor due to oth malpos and malpresent, fetus 2 Obstructed labor due to oth malpos and malpresent, fetus 3 Obstructed labor due to oth malpos and malpresent, fetus 4 Obstructed labor due to oth malpos and malpresent, fetus 5 Obstructed labor due to oth malposition and malpresent, oth Obstructed labor due to malpos and malpresent, unsp, unsp Obstructed labor due to malpos and malpresent, unsp, fetus 1 Obstructed labor due to malpos and malpresent, unsp, fetus 2 Obstructed labor due to malpos and malpresent, unsp, fetus 3 Obstructed labor due to malpos and malpresent, unsp, fetus 4 Obstructed labor due to malpos and malpresent, unsp, fetus 5 Obstructed labor due to malpos and malpresent, unsp, oth Obstructed labor due to deformed pelvis Obstructed labor due to generally contracted pelvis Obstructed labor due to pelvic inlet contraction Obst labor due to pelvic outlet and mid-cavity contrctn Obstructed labor due to fetopelvic disproportion, unsp Obstructed labor due to abnlt of maternal pelvic organs Obstructed labor due to other maternal pelvic abnormalities Obstructed labor due to maternal pelvic abnormality, unsp Obstructed labor due to shoulder dystocia Obstructed labor due to locked twins Obstructed labor due to unusually large fetus Obstructed labor due to other abnormalities of fetus Failed trial of labor, unspecified Failed attempt vaginal birth after previous cesarean del Attempted application of vacuum extractor and forceps Obstructed labor due to other multiple fetuses Other specified obstructed labor Obstructed labor, unspecified Intrapartum hemorrhage with coagulation defect Other intrapartum hemorrhage Intrapartum hemorrhage, unspecified Labor and delivery comp by abnlt of fetal acid-base balance Labor and delivery complicated by prolapse of cord, unsp Labor and delivery complicated by prolapse of cord, fetus 1 Labor and delivery complicated by prolapse of cord, fetus 2 Labor and delivery complicated by prolapse of cord, fetus 3 Labor and delivery complicated by prolapse of cord, fetus 4 Labor and delivery complicated by prolapse of cord, fetus 5 Labor and delivery complicated by prolapse of cord, oth Labor and delivery comp by cord around neck, w comprsn, unsp Labor and del comp by cord around neck, w comprsn, fetus 1 Labor and del comp by cord around neck, w comprsn, fetus 2 Labor and del comp by cord around neck, w comprsn, fetus 3 Labor and del comp by cord around neck, w comprsn, fetus 4 Labor and del comp by cord around neck, w comprsn, fetus 5 Labor and delivery comp by cord around neck, w comprsn, oth Labor and del comp by oth cord entangle, w comprsn, unsp Labor and del comp by oth cord entangle, w comprsn, fetus 1 Labor and del comp by oth cord entangle, w comprsn, fetus 2 Labor and del comp by oth cord entangle, w comprsn, fetus 3 Labor and del comp by oth cord entangle, w comprsn, fetus 4 Labor and del comp by oth cord entangle, w comprsn, fetus 5 Labor and delivery comp by oth cord entangle, w comprsn, oth Labor and delivery complicated by short cord, unsp Labor and delivery complicated by short cord, fetus 1 Labor and delivery complicated by short cord, fetus 2 Labor and delivery complicated by short cord, fetus 3 Labor and delivery complicated by short cord, fetus 4 Labor and delivery complicated by short cord, fetus 5 Labor and delivery complicated by short cord, other fetus Labor and delivery complicated by vasa previa, unsp Labor and delivery complicated by vasa previa, fetus 1 Labor and delivery complicated by vasa previa, fetus 2 Labor and delivery complicated by vasa previa, fetus 3

1.88 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O694XX4 O694XX5 O694XX9 O695XX0 O695XX1 O695XX2 O695XX3 O695XX4 O695XX5 O695XX9 O6981X0 O6981X1 O6981X2 O6981X3 O6981X4 O6981X5 O6981X9 O6982X0 O6982X1 O6982X2 O6982X3 O6982X4 O6982X5 O6982X9 O6989X0 O6989X1 O6989X2 O6989X3 O6989X4 O6989X5 O6989X9 O699XX0 O699XX1 O699XX2 O699XX3 O699XX4 O699XX5 O699XX9 O700 O701 O702 O703 O704 O709 O7100 O7102 O7103 O711 O712 O713 O714 O715 O716 O717 O7181 O7182 O7189 O719 O720 O721 O722 O723 O730 O731 O740 O741 O742 O743

Labor and delivery complicated by vasa previa, fetus 4 Labor and delivery complicated by vasa previa, fetus 5 Labor and delivery complicated by vasa previa, other fetus Labor and delivery comp by vascular lesion of cord, unsp Labor and delivery comp by vascular lesion of cord, fetus 1 Labor and delivery comp by vascular lesion of cord, fetus 2 Labor and delivery comp by vascular lesion of cord, fetus 3 Labor and delivery comp by vascular lesion of cord, fetus 4 Labor and delivery comp by vascular lesion of cord, fetus 5 Labor and delivery comp by vascular lesion of cord, oth Labor and del comp by cord around neck, w/o comprsn, unsp Labor and del comp by cord around neck, w/o comprsn, fetus 1 Labor and del comp by cord around neck, w/o comprsn, fetus 2 Labor and del comp by cord around neck, w/o comprsn, fetus 3 Labor and del comp by cord around neck, w/o comprsn, fetus 4 Labor and del comp by cord around neck, w/o comprsn, fetus 5 Labor and del comp by cord around neck, w/o comprsn, oth Labor and del comp by oth cord entangle, w/o comprsn, unsp Labor and del comp by oth cord entangle, w/o comprsn, fts1 Labor and del comp by oth cord entangle, w/o comprsn, fts2 Labor and del comp by oth cord entangle, w/o comprsn, fts3 Labor and del comp by oth cord entangle, w/o comprsn, fts4 Labor and del comp by oth cord entangle, w/o comprsn, fts5 Labor and del comp by oth cord entangle, w/o comprsn, oth Labor and delivery complicated by oth cord comp, unsp Labor and delivery complicated by oth cord comp, fetus 1 Labor and delivery complicated by oth cord comp, fetus 2 Labor and delivery complicated by oth cord comp, fetus 3 Labor and delivery complicated by oth cord comp, fetus 4 Labor and delivery complicated by oth cord comp, fetus 5 Labor and delivery complicated by oth cord comp, oth Labor and delivery complicated by cord comp, unsp, unsp Labor and delivery complicated by cord comp, unsp, fetus 1 Labor and delivery complicated by cord comp, unsp, fetus 2 Labor and delivery complicated by cord comp, unsp, fetus 3 Labor and delivery complicated by cord comp, unsp, fetus 4 Labor and delivery complicated by cord comp, unsp, fetus 5 Labor and delivery complicated by cord comp, unsp, oth First degree perineal laceration during delivery Second degree perineal laceration during delivery Third degree perineal laceration during delivery Fourth degree perineal laceration during delivery Anal sphincter tear comp del, not assoc w third degree lac Perineal laceration during delivery, unspecified Rupture of uterus before onset of labor, unsp trimester Rupture of uterus before onset of labor, second trimester Rupture of uterus before onset of labor, third trimester Rupture of uterus during labor Postpartum inversion of uterus Obstetric laceration of cervix Obstetric high vaginal laceration alone Other obstetric injury to pelvic organs Obstetric damage to pelvic joints and ligaments Obstetric hematoma of pelvis Laceration of uterus, not elsewhere classified Other specified trauma to perineum and vulva Other specified obstetric trauma Obstetric trauma, unspecified Third-stage hemorrhage Other immediate postpartum hemorrhage Delayed and secondary postpartum hemorrhage Postpartum coagulation defects Retained placenta without hemorrhage Retained portions of placenta and membranes, w/o hemorrhage Aspirat pneumonitis due to anesth during labor and delivery Oth pulmonary comp of anesthesia during labor and delivery Cardiac comp of anesthesia during labor and delivery Cnsl complications of anesthesia during labor and delivery

September 2011

Edit code lists 1.89

Diagnoses allowed for females only

O744 O745 O746 O747 O748 O749 O750 O751 O752 O753 O754 O755 O7581 O7589 O759 O76 O770 O771 O778 O779 O80 O82 O85 O860 O8611 O8612 O8613 O8619 O8620 O8621 O8622 O8629 O864 O8681 O8689 O870 O871 O872 O873 O874 O878 O879 O88011 O88012 O88013 O88019 O8802 O8803 O88111 O88112 O88113 O88119 O8812 O8813 O88211 O88212 O88213 O88219 O8822 O8823 O88311 O88312 O88313 O88319 O8832 O8833 O88811 O88812

Toxic reaction to local anesthesia during labor and delivery Spinal and epidur anesthesia-induced hdache dur labr and del Oth comp of spinal and epidural anesth during labor and del Failed or difficult intubation for anesth dur labor and del Other complications of anesthesia during labor and delivery Complication of anesthesia during labor and delivery, unsp Maternal distress during labor and delivery Shock during or following labor and delivery Pyrexia during labor, not elsewhere classified Other infection during labor Other complications of obstetric surgery and procedures Delayed delivery after artificial rupture of membranes Maternal exhaustion complicating labor and delivery Other specified complications of labor and delivery Complication of labor and delivery, unspecified Abnlt in fetal heart rate and rhythm comp labor and delivery Labor and delivery complicated by meconium in amniotic fluid Fetal stress in labor or delivery due to drug administration Labor and delivery comp by oth evidence of fetal stress Labor and delivery complicated by fetal stress, unspecified Encounter for full-term uncomplicated delivery Encounter for cesarean delivery without indication Puerperal sepsis Infection of obstetric surgical wound Cervicitis following delivery Endometritis following delivery Vaginitis following delivery Other infection of genital tract following delivery Urinary tract infection following delivery, unspecified Infection of kidney following delivery Infection of bladder following delivery Other urinary tract infection following delivery Pyrexia of unknown origin following delivery Puerperal septic thrombophlebitis Other specified puerperal infections Superficial thrombophlebitis in the puerperium Deep phlebothrombosis in the puerperium Hemorrhoids in the puerperium Cerebral venous thrombosis in the puerperium Varicose veins of lower extremity in the puerperium Other venous complications in the puerperium Venous complication in the puerperium, unspecified Air embolism in pregnancy, first trimester Air embolism in pregnancy, second trimester Air embolism in pregnancy, third trimester Air embolism in pregnancy, unspecified trimester Air embolism in childbirth Air embolism in the puerperium Amniotic fluid embolism in pregnancy, first trimester Amniotic fluid embolism in pregnancy, second trimester Amniotic fluid embolism in pregnancy, third trimester Amniotic fluid embolism in pregnancy, unspecified trimester Amniotic fluid embolism in childbirth Amniotic fluid embolism in the puerperium Thromboembolism in pregnancy, first trimester Thromboembolism in pregnancy, second trimester Thromboembolism in pregnancy, third trimester Thromboembolism in pregnancy, unspecified trimester Thromboembolism in childbirth Thromboembolism in the puerperium Pyemic and septic embolism in pregnancy, first trimester Pyemic and septic embolism in pregnancy, second trimester Pyemic and septic embolism in pregnancy, third trimester Pyemic and septic embolism in pregnancy, unsp trimester Pyemic and septic embolism in childbirth Pyemic and septic embolism in the puerperium Other embolism in pregnancy, first trimester Other embolism in pregnancy, second trimester

1.90 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O88813 O88819 O8882 O8883 O8901 O8909 O891 O892 O893 O894 O895 O896 O898 O899 O900 O901 O902 O903 O904 O905 O906 O9081 O9089 O909 O91011 O91012 O91013 O91019 O9102 O9103 O91111 O91112 O91113 O91119 O9112 O9113 O91211 O91212 O91213 O91219 O9122 O9123 O92011 O92012 O92013 O92019 O9202 O9203 O92111 O92112 O92113 O92119 O9212 O9213 O9220 O9229 O923 O924 O925 O926 O9270 O9279 O94 O98011 O98012 O98013 O98019 O9802

Other embolism in pregnancy, third trimester Other embolism in pregnancy, unspecified trimester Other embolism in childbirth Other embolism in the puerperium Aspiration pneumonitis due to anesth during the puerperium Oth pulmonary comp of anesthesia during the puerperium Cardiac complications of anesthesia during the puerperium Cnsl complications of anesthesia during the puerperium Toxic reaction to local anesthesia during the puerperium Spinal and epidur anesthesia-induced hdache during the puerp Oth comp of spinal and epidural anesth during the puerperium Failed or difficult intubation for anesth during the puerp Other complications of anesthesia during the puerperium Complication of anesthesia during the puerperium, unsp Disruption of cesarean delivery wound Disruption of perineal obstetric wound Hematoma of obstetric wound Peripartum cardiomyopathy Postpartum acute kidney failure Postpartum thyroiditis Postpartum mood disturbance Anemia of the puerperium Oth complications of the puerperium, NEC Complication of the puerperium, unspecified Infection of nipple associated w pregnancy, first trimester Infection of nipple associated w pregnancy, second trimester Infection of nipple associated w pregnancy, third trimester Infection of nipple associated w pregnancy, unsp trimester Infection of nipple associated with the puerperium Infection of nipple associated with lactation Abscess of breast associated with pregnancy, first trimester Abscess of breast associated w pregnancy, second trimester Abscess of breast associated with pregnancy, third trimester Abscess of breast associated with pregnancy, unsp trimester Abscess of breast associated with the puerperium Abscess of breast associated with lactation Nonpurulent mastitis associated w pregnancy, first trimester Nonpurulent mastitis assoc w pregnancy, second trimester Nonpurulent mastitis associated w pregnancy, third trimester Nonpurulent mastitis associated w pregnancy, unsp trimester Nonpurulent mastitis associated with the puerperium Nonpurulent mastitis associated with lactation Retracted nipple associated with pregnancy, first trimester Retracted nipple associated with pregnancy, second trimester Retracted nipple associated with pregnancy, third trimester Retracted nipple associated with pregnancy, unsp trimester Retracted nipple associated with the puerperium Retracted nipple associated with lactation Cracked nipple associated with pregnancy, first trimester Cracked nipple associated with pregnancy, second trimester Cracked nipple associated with pregnancy, third trimester Cracked nipple associated with pregnancy, unsp trimester Cracked nipple associated with the puerperium Cracked nipple associated with lactation Unsp disorder of breast assoc w pregnancy and the puerperium Oth disorders of breast assoc w pregnancy and the puerperium Agalactia Hypogalactia Suppressed lactation Galactorrhea Unspecified disorders of lactation Other disorders of lactation Sequelae of comp of pregnancy, chldbrth, and the puerperium Tuberculosis complicating pregnancy, first trimester Tuberculosis complicating pregnancy, second trimester Tuberculosis complicating pregnancy, third trimester Tuberculosis complicating pregnancy, unspecified trimester Tuberculosis complicating childbirth

September 2011

Edit code lists 1.91

Diagnoses allowed for females only

O9803 O98111 O98112 O98113 O98119 O9812 O9813 O98211 O98212 O98213 O98219 O9822 O9823 O98311 O98312 O98313 O98319 O9832 O9833 O98411 O98412 O98413 O98419 O9842 O9843 O98511 O98512 O98513 O98519 O9852 O9853 O98611 O98612 O98613 O98619 O9862 O9863 O98711 O98712 O98713 O98719 O9872 O9873 O98811 O98812 O98813 O98819 O9882 O9883 O98911 O98912 O98913 O98919 O9892 O9893 O99011 O99012 O99013 O99019 O9902 O9903 O99111 O99112 O99113 O99119 O9912 O9913 O99210

Tuberculosis complicating the puerperium Syphilis complicating pregnancy, first trimester Syphilis complicating pregnancy, second trimester Syphilis complicating pregnancy, third trimester Syphilis complicating pregnancy, unspecified trimester Syphilis complicating childbirth Syphilis complicating the puerperium Gonorrhea complicating pregnancy, first trimester Gonorrhea complicating pregnancy, second trimester Gonorrhea complicating pregnancy, third trimester Gonorrhea complicating pregnancy, unspecified trimester Gonorrhea complicating childbirth Gonorrhea complicating the puerperium Oth infect w sexl mode of transmiss comp preg, first tri Oth infect w sexl mode of transmiss comp preg, second tri Oth infect w sexl mode of transmiss comp preg, third tri Oth infect w sexl mode of transmiss comp preg, unsp tri Oth infections w sexl mode of transmiss comp childbirth Oth infections w sexl mode of transmiss comp the puerperium Viral hepatitis complicating pregnancy, first trimester Viral hepatitis complicating pregnancy, second trimester Viral hepatitis complicating pregnancy, third trimester Viral hepatitis complicating pregnancy, unsp trimester Viral hepatitis complicating childbirth Viral hepatitis complicating the puerperium Other viral diseases complicating pregnancy, first trimester Oth viral diseases complicating pregnancy, second trimester Other viral diseases complicating pregnancy, third trimester Other viral diseases complicating pregnancy, unsp trimester Other viral diseases complicating childbirth Other viral diseases complicating the puerperium Protozoal diseases complicating pregnancy, first trimester Protozoal diseases complicating pregnancy, second trimester Protozoal diseases complicating pregnancy, third trimester Protozoal diseases complicating pregnancy, unsp trimester Protozoal diseases complicating childbirth Protozoal diseases complicating the puerperium Human immunodef disease comp pregnancy, first trimester Human immunodef disease comp pregnancy, second trimester Human immunodef disease comp pregnancy, third trimester Human immunodef disease comp pregnancy, unsp trimester Human immunodeficiency [HIV] disease complicating childbirth Human immunodeficiency disease complicating the puerperium Oth maternal infec/parastc diseases comp preg, first tri Oth maternal infec/parastc diseases comp preg, second tri Oth maternal infec/parastc diseases comp preg, third tri Oth maternal infec/parastc diseases comp preg, unsp tri Oth maternal infec/parastc diseases complicating childbirth Oth maternal infec/parastc diseases comp the puerperium Unsp maternal infec/parastc disease comp preg, first tri Unsp maternal infec/parastc disease comp preg, second tri Unsp maternal infec/parastc disease comp preg, third tri Unsp maternal infec/parastc disease comp preg, unsp tri Unsp maternal infec/parastc disease complicating childbirth Unsp maternal infec/parastc disease comp the puerperium Anemia complicating pregnancy, first trimester Anemia complicating pregnancy, second trimester Anemia complicating pregnancy, third trimester Anemia complicating pregnancy, unspecified trimester Anemia complicating childbirth Anemia complicating the puerperium Oth dis of bld/bld-form org/immun mechnsm comp preg, 1st tri Oth dis of bld/bld-form org/immun mechnsm comp preg, 2nd tri Oth dis of bld/bld-form org/immun mechnsm comp preg, 3rd tri Oth dis of bld/bld-form org/immun mechnsm comp preg,unsp tri Oth dis of the bld/bld-form org/immun mechnsm comp chldbrth Oth dis of the bld/bld-form org/immun mechnsm comp the puerp Obesity complicating pregnancy, unspecified trimester

1.92 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

O99211 O99212 O99213 O99214 O99215 O99280 O99281 O99282 O99283 O99284 O99285 O99310 O99311 O99312 O99313 O99314 O99315 O99320 O99321 O99322 O99323 O99324 O99325 O99330 O99331 O99332 O99333 O99334 O99335 O99340 O99341 O99342 O99343 O99344 O99345 O99350 O99351 O99352 O99353 O99354 O99355 O99411 O99412 O99413 O99419 O9942 O9943 O99511 O99512 O99513 O99519 O9952 O9953 O99611 O99612 O99613 O99619 O9962 O9963 O99711 O99712 O99713 O99719 O9972 O9973 O99810 O99814 O99815

Obesity complicating pregnancy, first trimester Obesity complicating pregnancy, second trimester Obesity complicating pregnancy, third trimester Obesity complicating childbirth Obesity complicating the puerperium Endo, nutritional and metab diseases comp preg, unsp tri Endo, nutritional and metab diseases comp preg, first tri Endo, nutritional and metab diseases comp preg, second tri Endo, nutritional and metab diseases comp preg, third tri Endocrine, nutritional and metabolic diseases comp chldbrth Endocrine, nutritional and metabolic diseases comp the puerp Alcohol use complicating pregnancy, unspecified trimester Alcohol use complicating pregnancy, first trimester Alcohol use complicating pregnancy, second trimester Alcohol use complicating pregnancy, third trimester Alcohol use complicating childbirth Alcohol use complicating the puerperium Drug use complicating pregnancy, unspecified trimester Drug use complicating pregnancy, first trimester Drug use complicating pregnancy, second trimester Drug use complicating pregnancy, third trimester Drug use complicating childbirth Drug use complicating the puerperium Smoking (tobacco) complicating pregnancy, unsp trimester Smoking (tobacco) complicating pregnancy, first trimester Smoking (tobacco) complicating pregnancy, second trimester Smoking (tobacco) complicating pregnancy, third trimester Smoking (tobacco) complicating childbirth Smoking (tobacco) complicating the puerperium Oth mental disorders complicating pregnancy, unsp trimester Oth mental disorders complicating pregnancy, first trimester Oth mental disorders comp pregnancy, second trimester Oth mental disorders complicating pregnancy, third trimester Other mental disorders complicating childbirth Other mental disorders complicating the puerperium Diseases of the nervous sys comp pregnancy, unsp trimester Diseases of the nervous sys comp pregnancy, first trimester Diseases of the nervous sys comp pregnancy, second trimester Diseases of the nervous sys comp pregnancy, third trimester Diseases of the nervous system complicating childbirth Diseases of the nervous system complicating the puerperium Diseases of the circ sys comp pregnancy, first trimester Diseases of the circ sys comp pregnancy, second trimester Diseases of the circ sys comp pregnancy, third trimester Diseases of the circ sys comp pregnancy, unsp trimester Diseases of the circulatory system complicating childbirth Diseases of the circ sys complicating the puerperium Diseases of the resp sys comp pregnancy, first trimester Diseases of the resp sys comp pregnancy, second trimester Diseases of the resp sys comp pregnancy, third trimester Diseases of the resp sys comp pregnancy, unsp trimester Diseases of the respiratory system complicating childbirth Diseases of the resp sys complicating the puerperium Diseases of the dgstv sys comp pregnancy, first trimester Diseases of the dgstv sys comp pregnancy, second trimester Diseases of the dgstv sys comp pregnancy, third trimester Diseases of the dgstv sys comp pregnancy, unsp trimester Diseases of the digestive system complicating childbirth Diseases of the digestive system complicating the puerperium Diseases of the skin, subcu comp pregnancy, first trimester Diseases of the skin, subcu comp pregnancy, second trimester Diseases of the skin, subcu comp pregnancy, third trimester Diseases of the skin, subcu comp pregnancy, unsp trimester Diseases of the skin, subcu complicating childbirth Diseases of the skin, subcu complicating the puerperium Abnormal glucose complicating pregnancy Abnormal glucose complicating childbirth Abnormal glucose complicating the puerperium

September 2011

Edit code lists 1.93

Diagnoses allowed for females only

O99820 O99824 O99825 O99830 O99834 O99835 O99840 O99841 O99842 O99843 O99844 O99845 O9989 O9A111 O9A112 O9A113 O9A119 O9A12 O9A13 O9A211 O9A212 O9A213 O9A219 O9A22 O9A23 O9A311 O9A312 O9A313 O9A319 O9A32 O9A33 O9A411 O9A412 O9A413 O9A419 O9A42 O9A43 O9A511 O9A512 O9A513 O9A519 O9A52 O9A53 P546 Q5001 Q5002 Q501 Q502 Q5031 Q5032 Q5039 Q504 Q505 Q506 Q510 Q5110 Q5111 Q512 Q513 Q514 Q515 Q516 Q517 Q51810 Q51811 Q51818 Q51820 Q51821

Streptococcus B carrier state complicating pregnancy Streptococcus B carrier state complicating childbirth Streptococcus B carrier state complicating the puerperium Other infection carrier state complicating pregnancy Other infection carrier state complicating childbirth Other infection carrier state complicating the puerperium Bariatric surgery status comp pregnancy, unsp trimester Bariatric surgery status comp pregnancy, first trimester Bariatric surgery status comp pregnancy, second trimester Bariatric surgery status comp pregnancy, third trimester Bariatric surgery status complicating childbirth Bariatric surgery status complicating the puerperium Oth diseases and cond comp pregnancy, chldbrth and the puerp Malignant neoplasm complicating pregnancy, first trimester Malignant neoplasm complicating pregnancy, second trimester Malignant neoplasm complicating pregnancy, third trimester Malignant neoplasm complicating pregnancy, unsp trimester Malignant neoplasm complicating childbirth Malignant neoplasm complicating the puerperium Inj/poisn/oth conseq of external causes comp preg, first tri Inj/poisn/oth conseq of extrn causes comp preg, second tri Inj/poisn/oth conseq of external causes comp preg, third tri Inj/poisn/oth conseq of external causes comp preg, unsp tri Inj/poisn/oth conseq of external causes comp childbirth Inj/poisn/oth conseq of external causes comp the puerperium Physical abuse complicating pregnancy, first trimester Physical abuse complicating pregnancy, second trimester Physical abuse complicating pregnancy, third trimester Physical abuse complicating pregnancy, unspecified trimester Physical abuse complicating childbirth Physical abuse complicating the puerperium Sexual abuse complicating pregnancy, first trimester Sexual abuse complicating pregnancy, second trimester Sexual abuse complicating pregnancy, third trimester Sexual abuse complicating pregnancy, unspecified trimester Sexual abuse complicating childbirth Sexual abuse complicating the puerperium Psychological abuse complicating pregnancy, first trimester Psychological abuse complicating pregnancy, second trimester Psychological abuse complicating pregnancy, third trimester Psychological abuse complicating pregnancy, unsp trimester Psychological abuse complicating childbirth Psychological abuse complicating the puerperium Neonatal vaginal hemorrhage Congenital absence of ovary, unilateral Congenital absence of ovary, bilateral Developmental ovarian cyst Congenital torsion of ovary Accessory ovary Ovarian streak Other congenital malformation of ovary Embryonic cyst of fallopian tube Embryonic cyst of broad ligament Oth congenital malformations of fallop and broad ligament Agenesis and aplasia of uterus Doubling of uterus w doubling of cervix and vagina w/o obst Doubling of uterus w doubling of cervix and vagina w obst Other doubling of uterus Bicornate uterus Unicornate uterus Agenesis and aplasia of cervix Embryonic cyst of cervix Congen fistulae betw uterus and digestive and urinary tracts Arcuate uterus Hypoplasia of uterus Other congenital malformations of uterus Cervical duplication Hypoplasia of cervix

1.94 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

Q51828 Q519 Q520 Q5210 Q5211 Q5212 Q522 Q523 Q524 Q525 Q526 Q5270 Q5271 Q5279 Q528 Q529 Q562 Q960 Q961 Q962 Q963 Q964 Q968 Q969 Q970 Q971 Q972 Q973 Q978 Q979 R870 R871 R872 R873 R874 R875 R87610 R87611 R87612 R87613 R87614 R87615 R87616 R87618 R87619 R87620 R87621 R87622 R87623 R87624 R87625 R87628 R87629 R8769 R877 R87810 R87811 R87820 R87821 R8789 R879 R971 S30202A S30202D S30202S S3023XA S3023XD S3023XS

Other congenital malformations of cervix Congenital malformation of uterus and cervix, unspecified Congenital absence of vagina Doubling of vagina, unspecified Transverse vaginal septum Longitudinal vaginal septum Congenital rectovaginal fistula Imperforate hymen Other congenital malformations of vagina Fusion of labia Congenital malformation of clitoris Unspecified congenital malformations of vulva Congenital absence of vulva Other congenital malformations of vulva Other specified congenital malformations of female genitalia Congenital malformation of female genitalia, unspecified Female pseudohermaphroditism, not elsewhere classified Karyotype 45, X Karyotype 46, X iso (Xq) Karyotype 46, X w abnormal sex chromosome, except iso (Xq) Mosaicism, 45, X/46, XX or XY Mosaic, 45, X/other cell line(s) w abnormal sex chromosome Other variants of Turner's syndrome Turner's syndrome, unspecified Karyotype 47, XXX Female with more than three X chromosomes Mosaicism, lines with various numbers of X chromosomes Female with 46, XY karyotype Oth sex chromosome abnormalities, female phenotype Sex chromosome abnormality, female phenotype, unspecified Abn lev enzymes in specimens from female genital organs Abn lev hormones in specimens from female genital organs Abn lev drug/meds/biol subst in specmn from fem gntl organs Abn lev substnc nonmed source in specmn from fem gntl organs Abn immunolog findings in specmn from female genital organs Abn microbiolog find in specmn from female genital organs Atyp squam cell of undet signfc cyto smr crvx (ASC-US) Atyp squam cell not excl hi grd intrepith lesn cyto smr crvx Low grade intrepith lesion cyto smr crvx (LGSIL) High grade intrepith lesion cyto smr crvx (HGSIL) Cytologic evidence of malignancy on smear of cervix Unsatisfactory cytologic smear of cervix Satisfactory cervical smear but lacking transformation zone Oth abnormal cytolog findings on specimens from cervix uteri Unsp abnormal cytolog findings in specmn from cervix uteri Atyp squam cell of undet signfc cyto smr vagn (ASC-US) Atyp squam cell not excl hi grd intrepith lesn cyto smr vagn Low grade intrepith lesion cyto smr vagn (LGSIL) High grade intrepith lesion cyto smr vagn (HGSIL) Cytologic evidence of malignancy on smear of vagina Unsatisfactory cytologic smear of vagina Other abnormal cytological findings on specimens from vagina Unsp abnormal cytological findings in specimens from vagina Abn cytolog find in specmn from oth female genital organs Abn histolog findings in specmn from female genital organs Cerv high risk human papillomavirus (HPV) DNA test positive Vaginal high risk human papillomavirus (HPV) DNA test pos Cerv low risk human papillomavirus (HPV) DNA test positive Vaginal low risk human papillomavirus (HPV) DNA test pos Oth abnormal findings in specmn from female genital organs Unsp abnormal finding in specmn from female genital organs Elevated cancer antigen 125 [CA 125] Contusion of unsp external genital organ, female, init Contusion of unsp external genital organ, female, subs Contusion of unsp external genital organ, female, sequela Contusion of vagina and vulva, initial encounter Contusion of vagina and vulva, subsequent encounter Contusion of vagina and vulva, sequela

September 2011

Edit code lists 1.95

Diagnoses allowed for females only

S30814A S30814D S30814S S30816A S30816D S30816S S30824A S30824D S30824S S30826A S30826D S30826S S30844A S30844D S30844S S30846A S30846D S30846S S30854A S30854D S30854S S30856A S30856D S30856S S30864A S30864D S30864S S30866A S30866D S30866S S30874A S30874D S30874S S30876A S30876D S30876S S3095XA S3095XD S3095XS S3097XA S3097XD S3097XS S3140XA S3140XD S3140XS S3141XA S3141XD S3141XS S3142XA S3142XD S3142XS S3143XA S3143XD S3143XS S3144XA S3144XD S3144XS S3145XA S3145XD S3145XS S31502A S31502D S31502S S31512A S31512D S31512S S31522A S31522D

Abrasion of vagina and vulva, initial encounter Abrasion of vagina and vulva, subsequent encounter Abrasion of vagina and vulva, sequela Abrasion of unsp external genital organs, female, init Abrasion of unsp external genital organs, female, subs Abrasion of unsp external genital organs, female, sequela Blister (nonthermal) of vagina and vulva, initial encounter Blister (nonthermal) of vagina and vulva, subs encntr Blister (nonthermal) of vagina and vulva, sequela Blister of unsp external genital organs, female, init Blister of unsp external genital organs, female, subs Blister of unsp external genital organs, female, sequela External constriction of vagina and vulva, initial encounter External constriction of vagina and vulva, subs encntr External constriction of vagina and vulva, sequela Extrn constrict of unsp extrn genital organs, female, init Extrn constrict of unsp extrn genital organs, female, subs Extrn constrict of unsp extrn gntl organs, female, sequela Superficial foreign body of vagina and vulva, init encntr Superficial foreign body of vagina and vulva, subs encntr Superficial foreign body of vagina and vulva, sequela Superficial fb of unsp external genital organs, female, init Superficial fb of unsp external genital organs, female, subs Superfic fb of unsp external genital organs, female, sequela Insect bite (nonvenomous) of vagina and vulva, init encntr Insect bite (nonvenomous) of vagina and vulva, subs encntr Insect bite (nonvenomous) of vagina and vulva, sequela Insect bite of unsp external genital organs, female, init Insect bite of unsp external genital organs, female, subs Insect bite of unsp external genital organs, female, sequela Other superficial bite of vagina and vulva, init encntr Other superficial bite of vagina and vulva, subs encntr Other superficial bite of vagina and vulva, sequela Oth superfic bite of unsp extrn genital organs, female, init Oth superfic bite of unsp extrn genital organs, female, subs Oth superfic bite of unsp extrn gntl organs, female, sequela Unsp superficial injury of vagina and vulva, init encntr Unsp superficial injury of vagina and vulva, subs encntr Unspecified superficial injury of vagina and vulva, sequela Unsp superfic inj unsp external genital organs, female, init Unsp superfic inj unsp external genital organs, female, subs Unsp superfic inj unsp extrn genital organs, female, sequela Unspecified open wound of vagina and vulva, init encntr Unspecified open wound of vagina and vulva, subs encntr Unspecified open wound of vagina and vulva, sequela Laceration w/o foreign body of vagina and vulva, init encntr Laceration w/o foreign body of vagina and vulva, subs encntr Laceration without foreign body of vagina and vulva, sequela Laceration w foreign body of vagina and vulva, init encntr Laceration w foreign body of vagina and vulva, subs encntr Laceration with foreign body of vagina and vulva, sequela Puncture wound w/o foreign body of vagina and vulva, init Puncture wound w/o foreign body of vagina and vulva, subs Puncture wound w/o foreign body of vagina and vulva, sequela Puncture wound w foreign body of vagina and vulva, init Puncture wound w foreign body of vagina and vulva, subs Puncture wound w foreign body of vagina and vulva, sequela Open bite of vagina and vulva, initial encounter Open bite of vagina and vulva, subsequent encounter Open bite of vagina and vulva, sequela Unsp opn wnd unsp external genital organs, female, init Unsp opn wnd unsp external genital organs, female, subs Unsp opn wnd unsp external genital organs, female, sequela Lac w/o fb of unsp external genital organs, female, init Lac w/o fb of unsp external genital organs, female, subs Lac w/o fb of unsp external genital organs, female, sequela Lac w fb of unsp external genital organs, female, init Lac w fb of unsp external genital organs, female, subs

1.96 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

S31522S S31532A S31532D S31532S S31542A S31542D S31542S S31552A S31552D S31552S S35531A S35531D S35531S S35532A S35532D S35532S S35533A S35533D S35533S S35534A S35534D S35534S S35535A S35535D S35535S S35536A S35536D S35536S S358X1A S358X8A S37401A S37401D S37401S S37402A S37402D S37402S S37409A S37409D S37409S S37421A S37421D S37421S S37422A S37422D S37422S S37429A S37429D S37429S S37431A S37431D S37431S S37432A S37432D S37432S S37439A S37439D S37439S S37491A S37491D S37491S S37492A S37492D S37492S S37499A S37499D S37499S S37501A S37501D

Lac w fb of unsp external genital organs, female, sequela Pnctr w/o fb of unsp external genital organs, female, init Pnctr w/o fb of unsp external genital organs, female, subs Pnctr w/o fb of unsp extrn genital organs, female, sequela Pnctr w fb of unsp external genital organs, female, init Pnctr w fb of unsp external genital organs, female, subs Pnctr w fb of unsp external genital organs, female, sequela Open bite of unsp external genital organs, female, init Open bite of unsp external genital organs, female, subs Open bite of unsp external genital organs, female, sequela Injury of right uterine artery, initial encounter Injury of right uterine artery, subsequent encounter Injury of right uterine artery, sequela Injury of left uterine artery, initial encounter Injury of left uterine artery, subsequent encounter Injury of left uterine artery, sequela Injury of unspecified uterine artery, initial encounter Injury of unspecified uterine artery, subsequent encounter Injury of unspecified uterine artery, sequela Injury of right uterine vein, initial encounter Injury of right uterine vein, subsequent encounter Injury of right uterine vein, sequela Injury of left uterine vein, initial encounter Injury of left uterine vein, subsequent encounter Injury of left uterine vein, sequela Injury of unspecified uterine vein, initial encounter Injury of unspecified uterine vein, subsequent encounter Injury of unspecified uterine vein, sequela Lacerat blood vesls at abd, low back and pelvis level, init Inj oth blood vesls at abd, low back and pelvis level, init Unspecified injury of ovary, unilateral, initial encounter Unspecified injury of ovary, unilateral, subs encntr Unspecified injury of ovary, unilateral, sequela Unspecified injury of ovary, bilateral, initial encounter Unspecified injury of ovary, bilateral, subsequent encounter Unspecified injury of ovary, bilateral, sequela Unspecified injury of ovary, unspecified, initial encounter Unspecified injury of ovary, unspecified, subs encntr Unspecified injury of ovary, unspecified, sequela Contusion of ovary, unilateral, initial encounter Contusion of ovary, unilateral, subsequent encounter Contusion of ovary, unilateral, sequela Contusion of ovary, bilateral, initial encounter Contusion of ovary, bilateral, subsequent encounter Contusion of ovary, bilateral, sequela Contusion of ovary, unspecified, initial encounter Contusion of ovary, unspecified, subsequent encounter Contusion of ovary, unspecified, sequela Laceration of ovary, unilateral, initial encounter Laceration of ovary, unilateral, subsequent encounter Laceration of ovary, unilateral, sequela Laceration of ovary, bilateral, initial encounter Laceration of ovary, bilateral, subsequent encounter Laceration of ovary, bilateral, sequela Laceration of ovary, unspecified, initial encounter Laceration of ovary, unspecified, subsequent encounter Laceration of ovary, unspecified, sequela Other injury of ovary, unilateral, initial encounter Other injury of ovary, unilateral, subsequent encounter Other injury of ovary, unilateral, sequela Other injury of ovary, bilateral, initial encounter Other injury of ovary, bilateral, subsequent encounter Other injury of ovary, bilateral, sequela Other injury of ovary, unspecified, initial encounter Other injury of ovary, unspecified, subsequent encounter Other injury of ovary, unspecified, sequela Unsp injury of fallopian tube, unilateral, init encntr Unsp injury of fallopian tube, unilateral, subs encntr

September 2011

Edit code lists 1.97

Diagnoses allowed for females only

S37501S S37502A S37502D S37502S S37509A S37509D S37509S S37511A S37511D S37511S S37512A S37512D S37512S S37519A S37519D S37519S S37521A S37521D S37521S S37522A S37522D S37522S S37529A S37529D S37529S S37531A S37531D S37531S S37532A S37532D S37532S S37539A S37539D S37539S S37591A S37591D S37591S S37592A S37592D S37592S S37599A S37599D S37599S S3760XA S3760XD S3760XS S3762XA S3762XD S3762XS S3763XA S3763XD S3763XS S3769XA S3769XD S3769XS S38002A S38002D S38002S S3803XA S3803XD S3803XS S38211A S38211D S38211S S38212A S38212D S38212S T192XXA

Unspecified injury of fallopian tube, unilateral, sequela Unspecified injury of fallopian tube, bilateral, init encntr Unspecified injury of fallopian tube, bilateral, subs encntr Unspecified injury of fallopian tube, bilateral, sequela Unsp injury of fallopian tube, unspecified, init encntr Unsp injury of fallopian tube, unspecified, subs encntr Unspecified injury of fallopian tube, unspecified, sequela Primary blast injury of fallopian tube, unilateral, init Primary blast injury of fallopian tube, unilateral, subs Primary blast injury of fallopian tube, unilateral, sequela Primary blast injury of fallopian tube, bilateral, init Primary blast injury of fallopian tube, bilateral, subs Primary blast injury of fallopian tube, bilateral, sequela Primary blast injury of fallopian tube, unsp, init encntr Primary blast injury of fallopian tube, unsp, subs encntr Primary blast injury of fallopian tube, unspecified, sequela Contusion of fallopian tube, unilateral, initial encounter Contusion of fallopian tube, unilateral, subs encntr Contusion of fallopian tube, unilateral, sequela Contusion of fallopian tube, bilateral, initial encounter Contusion of fallopian tube, bilateral, subsequent encounter Contusion of fallopian tube, bilateral, sequela Contusion of fallopian tube, unspecified, initial encounter Contusion of fallopian tube, unspecified, subs encntr Contusion of fallopian tube, unspecified, sequela Laceration of fallopian tube, unilateral, initial encounter Laceration of fallopian tube, unilateral, subs encntr Laceration of fallopian tube, unilateral, sequela Laceration of fallopian tube, bilateral, initial encounter Laceration of fallopian tube, bilateral, subs encntr Laceration of fallopian tube, bilateral, sequela Laceration of fallopian tube, unspecified, initial encounter Laceration of fallopian tube, unspecified, subs encntr Laceration of fallopian tube, unspecified, sequela Other injury of fallopian tube, unilateral, init encntr Other injury of fallopian tube, unilateral, subs encntr Other injury of fallopian tube, unilateral, sequela Other injury of fallopian tube, bilateral, initial encounter Other injury of fallopian tube, bilateral, subs encntr Other injury of fallopian tube, bilateral, sequela Other injury of fallopian tube, unspecified, init encntr Other injury of fallopian tube, unspecified, subs encntr Other injury of fallopian tube, unspecified, sequela Unspecified injury of uterus, initial encounter Unspecified injury of uterus, subsequent encounter Unspecified injury of uterus, sequela Contusion of uterus, initial encounter Contusion of uterus, subsequent encounter Contusion of uterus, sequela Laceration of uterus, initial encounter Laceration of uterus, subsequent encounter Laceration of uterus, sequela Other injury of uterus, initial encounter Other injury of uterus, subsequent encounter Other injury of uterus, sequela Crushing inj unsp external genital organs, female, init Crushing inj unsp external genital organs, female, subs Crushing inj unsp external genital organs, female, sequela Crushing injury of vulva, initial encounter Crushing injury of vulva, subsequent encounter Crushing injury of vulva, sequela Complete traum amp of female external genital organs, init Complete traum amp of female external genital organs, subs Complete traum amp of female extrn genital organs, sequela Partial traum amp of female external genital organs, init Partial traum amp of female external genital organs, subs Partial traum amp of female external genital organs, sequela Foreign body in vulva and vagina, initial encounter

1.98 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

T192XXD T192XXS T193XXA T193XXD T193XXS T2107XA T2107XD T2107XS T2117XA T2117XD T2117XS T2127XA T2127XD T2127XS T2137XA T2137XD T2137XS T2147XA T2147XD T2147XS T2157XA T2157XD T2157XS T2167XA T2167XD T2167XS T2177XA T2177XD T2177XS T288XXA T8331XA T8331XD T8331XS T8332XA T8332XD T8332XS T8339XA T8339XD T8339XS Y0702 Y0704 Y0712 Y0714 Y07411 Y07421 Y07433 Y07434 Y07436 Y07491 Y760 Y761 Y762 Y763 Y768 Z01411 Z01419 Z0142 Z0371 Z0372 Z0373 Z0374 Z0375 Z0379 Z124 Z1272 Z1273 Z1502 Z1504

Foreign body in vulva and vagina, subsequent encounter Foreign body in vulva and vagina, sequela Foreign body in uterus, initial encounter Foreign body in uterus, subsequent encounter Foreign body in uterus, sequela Burn of unsp degree of female genital region, init encntr Burn of unsp degree of female genital region, subs encntr Burn of unspecified degree of female genital region, sequela Burn of first degree of female genital region, init encntr Burn of first degree of female genital region, subs encntr Burn of first degree of female genital region, sequela Burn of second degree of female genital region, init encntr Burn of second degree of female genital region, subs encntr Burn of second degree of female genital region, sequela Burn of third degree of female genital region, init encntr Burn of third degree of female genital region, subs encntr Burn of third degree of female genital region, sequela Corrosion of unsp degree of female genital region, init Corrosion of unsp degree of female genital region, subs Corrosion of unsp degree of female genital region, sequela Corrosion of first degree of female genital region, init Corrosion of first degree of female genital region, subs Corrosion of first degree of female genital region, sequela Corrosion of second degree of female genital region, init Corrosion of second degree of female genital region, subs Corrosion of second degree of female genital region, sequela Corrosion of third degree of female genital region, init Corrosion of third degree of female genital region, subs Corrosion of third degree of female genital region, sequela Corrosion of internal genitourinary organs, init encntr Breakdown (mechanical) of intrauterine contracep dev, init Breakdown (mechanical) of intrauterine contracep dev, subs Breakdown of intrauterine contracep dev, sequela Displacement of intrauterine contraceptive device, init Displacement of intrauterine contraceptive device, subs Displacement of intrauterine contraceptive device, sequela Mech compl of intrauterine contraceptive device, init encntr Mech compl of intrauterine contraceptive device, subs encntr Mech compl of intrauterine contraceptive device, sequela Wife, perpetrator of maltreatment and neglect Female partner, perpetrator of maltreatment and neglect Biological mother, perpetrator of maltreatment and neglect Adoptive mother, perpetrator of maltreatment and neglect Sister, perpetrator of maltreatment and neglect Foster mother, perpetrator of maltreatment and neglect Stepmother, perpetrator of maltreatment and neglect Female friend of parent, perp of maltreat and neglect Stepsister, perpetrator of maltreatment and neglect Female cousin, perpetrator of maltreatment and neglect Diagnostic and monitoring ob/gyn devices assoc w incdt Therapeutic and rehab ob/gyn devices assoc w incdt Prosth/oth implnt/mtrls ob/gyn devices assoc w incdt Surgical instrumnt, matrl and ob/gyn devices assoc w incdt Miscellaneous ob/gyn devices assoc w incdt, NEC Encntr for gyn exam (general) (routine) w abnormal findings Encntr for gyn exam (general) (routine) w/o abn findings Encntr for cerv smear to cnfrm norm smr fol init abn smear Encntr for susp prob w amnio cavity and membrane ruled out Encounter for suspected placental problem ruled out Encounter for suspected fetal anomaly ruled out Encounter for suspected problem with fetal growth ruled out Encounter for suspected cervical shortening ruled out Encntr for oth suspected maternal and fetal cond ruled out Encounter for screening for malignant neoplasm of cervix Encounter for screening for malignant neoplasm of vagina Encounter for screening for malignant neoplasm of ovary Genetic susceptibility to malignant neoplasm of ovary Genetic susceptibility to malignant neoplasm of endometrium

September 2011

Edit code lists 1.99

Diagnoses allowed for females only

Z30011 Z30012 Z30013 Z30014 Z30018 Z30019 Z3041 Z3042 Z30430 Z30431 Z30432 Z30433 Z3049 Z308 Z31430 Z31438 Z3181 Z3182 Z3183 Z3200 Z3201 Z3202 Z331 Z332 Z3400 Z3401 Z3402 Z3403 Z3480 Z3481 Z3482 Z3483 Z3490 Z3491 Z3492 Z3493 Z36 Z370 Z371 Z372 Z373 Z374 Z3750 Z3751 Z3752 Z3753 Z3754 Z3759 Z3760 Z3761 Z3762 Z3763 Z3764 Z3769 Z377 Z379 Z390 Z391 Z392 Z4002 Z4430 Z4431 Z4432 Z45811 Z45812 Z45819 Z52810 Z52811

Encounter for initial prescription of contraceptive pills Encounter for prescription of emergency contraception Encounter for initial prescription of injectable contracep Encounter for initial prescription of uterin contracep dev Encounter for initial prescription of other contraceptives Encounter for initial prescription of contraceptives, unsp Encounter for surveillance of contraceptive pills Encounter for surveillance of injectable contraceptive Encounter for insertion of intrauterine contraceptive device Encounter for routine checking of intrauterine contracep dev Encounter for removal of intrauterine contraceptive device Encntr for removal and reinsertion of uterin contracep dev Encounter for surveillance of other contraceptives Encounter for other contraceptive management Encntr fem for test for genetc dis carrier stat for pro mgmt Encounter for oth genetic testing of female for pro mgmt Encounter for male factor infertility in female patient Encounter for Rh incompatibility status Encounter for assisted reprodctv fertility procedure cycle Encounter for pregnancy test, result unknown Encounter for pregnancy test, result positive Encounter for pregnancy test, result negative Pregnant state, incidental Encounter for elective termination of pregnancy Encntr for suprvsn of normal first pregnancy, unsp trimester Encntr for suprvsn of normal first preg, first trimester Encntr for suprvsn of normal first preg, second trimester Encntr for suprvsn of normal first preg, third trimester Encounter for suprvsn of normal pregnancy, unsp trimester Encounter for suprvsn of normal pregnancy, first trimester Encounter for suprvsn of normal pregnancy, second trimester Encounter for suprvsn of normal pregnancy, third trimester Encntr for suprvsn of normal pregnancy, unsp, unsp trimester Encntr for suprvsn of normal preg, unsp, first trimester Encntr for suprvsn of normal preg, unsp, second trimester Encntr for suprvsn of normal preg, unsp, third trimester Encounter for antenatal screening of mother Single live birth Single stillbirth Twins, both liveborn Twins, one liveborn and one stillborn Twins, both stillborn Multiple births, unspecified, all liveborn Triplets, all liveborn Quadruplets, all liveborn Quintuplets, all liveborn Sextuplets, all liveborn Other multiple births, all liveborn Multiple births, unspecified, some liveborn Triplets, some liveborn Quadruplets, some liveborn Quintuplets, some liveborn Sextuplets, some liveborn Other multiple births, some liveborn Other multiple births, all stillborn Outcome of delivery, unspecified Encntr for care and exam of mother immediately after del Encounter for care and examination of lactating mother Encounter for routine postpartum follow-up Encounter for prophylactic removal of ovary Encntr for fit/adjst of external breast prosth, unsp breast Encounter for fit/adjst of external right breast prosthesis Encounter for fit/adjst of external left breast prosthesis Encounter for adjustment or removal of right breast implant Encounter for adjustment or removal of left breast implant Encounter for adjustment or removal of unsp breast implant Egg (Oocyte) donor under age 35, anonymous recipient Egg (Oocyte) donor under age 35, designated recipient

1.100 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for females only

Z52812 Z52813 Z52819 Z640 Z641 Z780 Z79890 Z8041 Z8540 Z8541 Z8542 Z8543 Z8544 Z86001 Z87410 Z87411 Z87412 Z8742 Z8751 Z8759 Z90710 Z90711 Z90712 Z90721 Z90722 Z975 Z9851 Z98870

Egg (Oocyte) donor age 35 and over, anonymous recipient Egg (Oocyte) donor age 35 and over, designated recipient Egg (Oocyte) donor, unspecified Problems related to unwanted pregnancy Problems related to multiparity Asymptomatic menopausal state Hormone replacement therapy (postmenopausal) Family history of malignant neoplasm of ovary Prsnl history of malig neoplm of unsp female genital organ Personal history of malignant neoplasm of cervix uteri Personal history of malignant neoplasm of oth prt uterus Personal history of malignant neoplasm of ovary Personal history of malig neoplasm of female genital organs Personal history of in-situ neoplasm of cervix uteri Personal history of cervical dysplasia Personal history of vaginal dysplasia Personal history of vulvar dysplasia Personal history of oth diseases of the female genital tract Personal history of pre-term labor Personal history of comp of preg, chldbrth and the puerp Acquired absence of both cervix and uterus Acquired absence of uterus with remaining cervical stump Acquired absence of cervix with remaining uterus Acquired absence of ovaries, unilateral Acquired absence of ovaries, bilateral Presence of (intrauterine) contraceptive device Tubal ligation status Personal history of in utero procedure during pregnancy

September 2011

Edit code lists 1.101

Procedures allowed for females only


0U15075 0U15076 0U15079 0U150J5 0U150J6 0U150J9 0U150K5 0U150K6 0U150K9 0U150Z5 0U150Z6 0U150Z9 0U15475 0U15476 0U15479 0U154J5 0U154J6 0U154J9 0U154K5 0U154K6 0U154K9 0U154Z5 0U154Z6 0U154Z9 0U16075 0U16076 0U16079 0U160J5 0U160J6 0U160J9 0U160K5 0U160K6 0U160K9 0U160Z5 0U160Z6 0U160Z9 0U16475 0U16476 0U16479 0U164J5 0U164J6 0U164J9 0U164K5 0U164K6 0U164K9 0U164Z5 0U164Z6 0U164Z9 0U23X0Z 0U23XYZ 0U28X0Z 0U28XYZ 0U2DX0Z 0U2DXHZ 0U2DXYZ 0U2HX0Z 0U2HXGZ 0U2HXYZ 0U2MX0Z 0U2MXYZ 0U500ZZ 0U503ZZ 0U504ZZ 0U510ZZ 0U513ZZ Bypass R Fallopian Tube to R Fallop w Autol Sub, Open Bypass R Fallopian Tube to L Fallop w Autol Sub, Open Bypass R Fallopian Tube to Uterus w Autol Sub, Open Bypass R Fallopian Tube to R Fallop w Synth Sub, Open Bypass R Fallopian Tube to L Fallop w Synth Sub, Open Bypass R Fallopian Tube to Uterus w Synth Sub, Open Bypass R Fallopian Tube to R Fallop w Nonaut Sub, Open Bypass R Fallopian Tube to L Fallop w Nonaut Sub, Open Bypass R Fallopian Tube to Uterus w Nonaut Sub, Open Bypass Right Fallopian Tube to R Fallop, Open Approach Bypass Right Fallopian Tube to L Fallop, Open Approach Bypass Right Fallopian Tube to Uterus, Open Approach Bypass R Fallopian Tube to R Fallop w Autol Sub, Perc Endo Bypass R Fallopian Tube to L Fallop w Autol Sub, Perc Endo Bypass R Fallopian Tube to Uterus w Autol Sub, Perc Endo Bypass R Fallopian Tube to R Fallop w Synth Sub, Perc Endo Bypass R Fallopian Tube to L Fallop w Synth Sub, Perc Endo Bypass R Fallopian Tube to Uterus w Synth Sub, Perc Endo Bypass R Fallopian Tube to R Fallop w Nonaut Sub, Perc Endo Bypass R Fallopian Tube to L Fallop w Nonaut Sub, Perc Endo Bypass R Fallopian Tube to Uterus w Nonaut Sub, Perc Endo Bypass Right Fallopian Tube to R Fallop, Perc Endo Approach Bypass Right Fallopian Tube to L Fallop, Perc Endo Approach Bypass Right Fallopian Tube to Uterus, Perc Endo Approach Bypass L Fallopian Tube to R Fallop w Autol Sub, Open Bypass L Fallopian Tube to L Fallop w Autol Sub, Open Bypass L Fallopian Tube to Uterus w Autol Sub, Open Bypass L Fallopian Tube to R Fallop w Synth Sub, Open Bypass L Fallopian Tube to L Fallop w Synth Sub, Open Bypass L Fallopian Tube to Uterus w Synth Sub, Open Bypass L Fallopian Tube to R Fallop w Nonaut Sub, Open Bypass L Fallopian Tube to L Fallop w Nonaut Sub, Open Bypass L Fallopian Tube to Uterus w Nonaut Sub, Open Bypass Left Fallopian Tube to R Fallop, Open Approach Bypass Left Fallopian Tube to L Fallop, Open Approach Bypass Left Fallopian Tube to Uterus, Open Approach Bypass L Fallopian Tube to R Fallop w Autol Sub, Perc Endo Bypass L Fallopian Tube to L Fallop w Autol Sub, Perc Endo Bypass L Fallopian Tube to Uterus w Autol Sub, Perc Endo Bypass L Fallopian Tube to R Fallop w Synth Sub, Perc Endo Bypass L Fallopian Tube to L Fallop w Synth Sub, Perc Endo Bypass L Fallopian Tube to Uterus w Synth Sub, Perc Endo Bypass L Fallopian Tube to R Fallop w Nonaut Sub, Perc Endo Bypass L Fallopian Tube to L Fallop w Nonaut Sub, Perc Endo Bypass L Fallopian Tube to Uterus w Nonaut Sub, Perc Endo Bypass Left Fallopian Tube to R Fallop, Perc Endo Approach Bypass Left Fallopian Tube to L Fallop, Perc Endo Approach Bypass Left Fallopian Tube to Uterus, Perc Endo Approach Change Drainage Device in Ovary, External Approach Change Other Device in Ovary, External Approach Change Drainage Device in Fallopian Tube, External Approach Change Other Device in Fallopian Tube, External Approach Change Drainage Device in Uterus and Cervix, Extern Approach Change Contracep Dev in Uterus & Cervix, Extern Approach Change Other Device in Uterus and Cervix, External Approach Change Drain Dev in Vagina & Cul-de-sac, Extern Approach Change Pessary in Vagina and Cul-de-sac, External Approach Change Other Device in Vagina & Cul-de-sac, Extern Approach Change Drainage Device in Vulva, External Approach Change Other Device in Vulva, External Approach Destruction of Right Ovary, Open Approach Destruction of Right Ovary, Percutaneous Approach Destruction of Right Ovary, Percutaneous Endoscopic Approach Destruction of Left Ovary, Open Approach Destruction of Left Ovary, Percutaneous Approach

1.102 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0U514ZZ 0U520ZZ 0U523ZZ 0U524ZZ 0U540ZZ 0U543ZZ 0U544ZZ 0U550ZZ 0U553ZZ 0U554ZZ 0U557ZZ 0U558ZZ 0U560ZZ 0U563ZZ 0U564ZZ 0U567ZZ 0U568ZZ 0U570ZZ 0U573ZZ 0U574ZZ 0U577ZZ 0U578ZZ 0U590ZZ 0U593ZZ 0U594ZZ 0U597ZZ 0U598ZZ 0U5B0ZZ 0U5B3ZZ 0U5B4ZZ 0U5B7ZZ 0U5B8ZZ 0U5C0ZZ 0U5C3ZZ 0U5C4ZZ 0U5C7ZZ 0U5C8ZZ 0U5F0ZZ 0U5F3ZZ 0U5F4ZZ 0U5F7ZZ 0U5F8ZZ 0U5G0ZZ 0U5G3ZZ 0U5G4ZZ 0U5G7ZZ 0U5G8ZZ 0U5GXZZ 0U5J0ZZ 0U5JXZZ 0U5K0ZZ 0U5K3ZZ 0U5K4ZZ 0U5K7ZZ 0U5K8ZZ 0U5L0ZZ 0U5LXZZ 0U5M0ZZ 0U5MXZZ 0U750DZ 0U750ZZ 0U753DZ 0U753ZZ 0U754DZ 0U754ZZ 0U757DZ 0U757ZZ 0U758DZ

Destruction of Left Ovary, Percutaneous Endoscopic Approach Destruction of Bilateral Ovaries, Open Approach Destruction of Bilateral Ovaries, Percutaneous Approach Destruction of Bilateral Ovaries, Perc Endo Approach Destruction of Uterine Supporting Structure, Open Approach Destruction of Uterine Supporting Structure, Perc Approach Destruction of Uterine Support Struct, Perc Endo Approach Destruction of Right Fallopian Tube, Open Approach Destruction of Right Fallopian Tube, Percutaneous Approach Destruction of Right Fallopian Tube, Perc Endo Approach Destruction of Right Fallopian Tube, Via Opening Destruction of Right Fallopian Tube, Endo Destruction of Left Fallopian Tube, Open Approach Destruction of Left Fallopian Tube, Percutaneous Approach Destruction of Left Fallopian Tube, Perc Endo Approach Destruction of Left Fallopian Tube, Via Opening Destruction of Left Fallopian Tube, Endo Destruction of Bilateral Fallopian Tubes, Open Approach Destruction of Bilateral Fallopian Tubes, Perc Approach Destruction of Bilateral Fallopian Tubes, Perc Endo Approach Destruction of Bilateral Fallopian Tubes, Via Opening Destruction of Bilateral Fallopian Tubes, Endo Destruction of Uterus, Open Approach Destruction of Uterus, Percutaneous Approach Destruction of Uterus, Percutaneous Endoscopic Approach Destruction of Uterus, Via Natural or Artificial Opening Destruction of Uterus, Endo Destruction of Endometrium, Open Approach Destruction of Endometrium, Percutaneous Approach Destruction of Endometrium, Percutaneous Endoscopic Approach Destruction of Endometrium, Via Opening Destruction of Endometrium, Endo Destruction of Cervix, Open Approach Destruction of Cervix, Percutaneous Approach Destruction of Cervix, Percutaneous Endoscopic Approach Destruction of Cervix, Via Natural or Artificial Opening Destruction of Cervix, Endo Destruction of Cul-de-sac, Open Approach Destruction of Cul-de-sac, Percutaneous Approach Destruction of Cul-de-sac, Percutaneous Endoscopic Approach Destruction of Cul-de-sac, Via Natural or Artificial Opening Destruction of Cul-de-sac, Endo Destruction of Vagina, Open Approach Destruction of Vagina, Percutaneous Approach Destruction of Vagina, Percutaneous Endoscopic Approach Destruction of Vagina, Via Natural or Artificial Opening Destruction of Vagina, Endo Destruction of Vagina, External Approach Destruction of Clitoris, Open Approach Destruction of Clitoris, External Approach Destruction of Hymen, Open Approach Destruction of Hymen, Percutaneous Approach Destruction of Hymen, Percutaneous Endoscopic Approach Destruction of Hymen, Via Natural or Artificial Opening Destruction of Hymen, Endo Destruction of Vestibular Gland, Open Approach Destruction of Vestibular Gland, External Approach Destruction of Vulva, Open Approach Destruction of Vulva, External Approach Dilate of R Fallopian Tube with Intralum Dev, Open Approach Dilation of Right Fallopian Tube, Open Approach Dilate of R Fallopian Tube with Intralum Dev, Perc Approach Dilation of Right Fallopian Tube, Percutaneous Approach Dilate R Fallopian Tube w Intralum Dev, Perc Endo Dilation of Right Fallopian Tube, Perc Endo Approach Dilation of R Fallopian Tube with Intralum Dev, Via Opening Dilation of Right Fallopian Tube, Via Opening Dilation of Right Fallopian Tube with Intralum Dev, Endo

September 2011

Edit code lists 1.103

Procedures allowed for females only

0U758ZZ 0U760DZ 0U760ZZ 0U763DZ 0U763ZZ 0U764DZ 0U764ZZ 0U767DZ 0U767ZZ 0U768DZ 0U768ZZ 0U770DZ 0U770ZZ 0U773DZ 0U773ZZ 0U774DZ 0U774ZZ 0U777DZ 0U777ZZ 0U778DZ 0U778ZZ 0U790DZ 0U790ZZ 0U793DZ 0U793ZZ 0U794DZ 0U794ZZ 0U797DZ 0U797ZZ 0U798DZ 0U798ZZ 0U7C0DZ 0U7C0ZZ 0U7C3DZ 0U7C3ZZ 0U7C4DZ 0U7C4ZZ 0U7C7DZ 0U7C7ZZ 0U7C8DZ 0U7C8ZZ 0U7G0DZ 0U7G0ZZ 0U7G3DZ 0U7G3ZZ 0U7G4DZ 0U7G4ZZ 0U7G7DZ 0U7G7ZZ 0U7G8DZ 0U7G8ZZ 0U7K0DZ 0U7K0ZZ 0U7K3DZ 0U7K3ZZ 0U7K4DZ 0U7K4ZZ 0U7K7DZ 0U7K7ZZ 0U7K8DZ 0U7K8ZZ 0U800ZZ 0U803ZZ 0U804ZZ 0U810ZZ 0U813ZZ 0U814ZZ 0U820ZZ

Dilation of Right Fallopian Tube, Endo Dilate of L Fallopian Tube with Intralum Dev, Open Approach Dilation of Left Fallopian Tube, Open Approach Dilate of L Fallopian Tube with Intralum Dev, Perc Approach Dilation of Left Fallopian Tube, Percutaneous Approach Dilate L Fallopian Tube w Intralum Dev, Perc Endo Dilation of Left Fallopian Tube, Perc Endo Approach Dilation of L Fallopian Tube with Intralum Dev, Via Opening Dilation of Left Fallopian Tube, Via Opening Dilation of Left Fallopian Tube with Intralum Dev, Endo Dilation of Left Fallopian Tube, Endo Dilate of Bi Fallopian Tube with Intralum Dev, Open Approach Dilation of Bilateral Fallopian Tubes, Open Approach Dilate of Bi Fallopian Tube with Intralum Dev, Perc Approach Dilation of Bilateral Fallopian Tubes, Percutaneous Approach Dilate Bi Fallopian Tube w Intralum Dev, Perc Endo Dilation of Bilateral Fallopian Tubes, Perc Endo Approach Dilation of Bi Fallopian Tube with Intralum Dev, Via Opening Dilation of Bilateral Fallopian Tubes, Via Opening Dilation of Bi Fallopian Tube with Intralum Dev, Endo Dilation of Bilateral Fallopian Tubes, Endo Dilation of Uterus with Intraluminal Device, Open Approach Dilation of Uterus, Open Approach Dilation of Uterus with Intraluminal Device, Perc Approach Dilation of Uterus, Percutaneous Approach Dilation of Uterus with Intralum Dev, Perc Endo Approach Dilation of Uterus, Percutaneous Endoscopic Approach Dilation of Uterus with Intraluminal Device, Via Opening Dilation of Uterus, Via Natural or Artificial Opening Dilation of Uterus with Intraluminal Device, Endo Dilation of Uterus, Endo Dilation of Cervix with Intraluminal Device, Open Approach Dilation of Cervix, Open Approach Dilation of Cervix with Intraluminal Device, Perc Approach Dilation of Cervix, Percutaneous Approach Dilation of Cervix with Intralum Dev, Perc Endo Approach Dilation of Cervix, Percutaneous Endoscopic Approach Dilation of Cervix with Intraluminal Device, Via Opening Dilation of Cervix, Via Natural or Artificial Opening Dilation of Cervix with Intraluminal Device, Endo Dilation of Cervix, Endo Dilation of Vagina with Intraluminal Device, Open Approach Dilation of Vagina, Open Approach Dilation of Vagina with Intraluminal Device, Perc Approach Dilation of Vagina, Percutaneous Approach Dilation of Vagina with Intralum Dev, Perc Endo Approach Dilation of Vagina, Percutaneous Endoscopic Approach Dilation of Vagina with Intraluminal Device, Via Opening Dilation of Vagina, Via Natural or Artificial Opening Dilation of Vagina with Intraluminal Device, Endo Dilation of Vagina, Endo Dilation of Hymen with Intraluminal Device, Open Approach Dilation of Hymen, Open Approach Dilation of Hymen with Intraluminal Device, Perc Approach Dilation of Hymen, Percutaneous Approach Dilation of Hymen with Intralum Dev, Perc Endo Approach Dilation of Hymen, Percutaneous Endoscopic Approach Dilation of Hymen with Intraluminal Device, Via Opening Dilation of Hymen, Via Natural or Artificial Opening Dilation of Hymen with Intraluminal Device, Endo Dilation of Hymen, Endo Division of Right Ovary, Open Approach Division of Right Ovary, Percutaneous Approach Division of Right Ovary, Percutaneous Endoscopic Approach Division of Left Ovary, Open Approach Division of Left Ovary, Percutaneous Approach Division of Left Ovary, Percutaneous Endoscopic Approach Division of Bilateral Ovaries, Open Approach

1.104 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0U823ZZ 0U824ZZ 0U840ZZ 0U843ZZ 0U844ZZ 0U8K7ZZ 0U8K8ZZ 0U9000Z 0U900ZX 0U900ZZ 0U9030Z 0U903ZX 0U903ZZ 0U9040Z 0U904ZX 0U904ZZ 0U90XZZ 0U9100Z 0U910ZX 0U910ZZ 0U9130Z 0U913ZX 0U913ZZ 0U9140Z 0U914ZX 0U914ZZ 0U91XZZ 0U9200Z 0U920ZX 0U920ZZ 0U9230Z 0U923ZX 0U923ZZ 0U9240Z 0U924ZX 0U924ZZ 0U92XZZ 0U9400Z 0U940ZX 0U940ZZ 0U9430Z 0U943ZX 0U943ZZ 0U9440Z 0U944ZX 0U944ZZ 0U9500Z 0U950ZX 0U950ZZ 0U9530Z 0U953ZX 0U953ZZ 0U9540Z 0U954ZX 0U954ZZ 0U9570Z 0U957ZX 0U957ZZ 0U9580Z 0U958ZX 0U958ZZ 0U9600Z 0U960ZX 0U960ZZ 0U9630Z 0U963ZX 0U963ZZ 0U9640Z

Division of Bilateral Ovaries, Percutaneous Approach Division of Bilateral Ovaries, Perc Endo Approach Division of Uterine Supporting Structure, Open Approach Division of Uterine Supporting Structure, Perc Approach Division of Uterine Supporting Structure, Perc Endo Approach Division of Hymen, Via Natural or Artificial Opening Division of Hymen, Endo Drainage of Right Ovary with Drainage Device, Open Approach Drainage of Right Ovary, Open Approach, Diagnostic Drainage of Right Ovary, Open Approach Drainage of Right Ovary with Drainage Device, Perc Approach Drainage of Right Ovary, Percutaneous Approach, Diagnostic Drainage of Right Ovary, Percutaneous Approach Drainage of Right Ovary with Drain Dev, Perc Endo Approach Drainage of Right Ovary, Perc Endo Approach, Diagn Drainage of Right Ovary, Percutaneous Endoscopic Approach Drainage of Right Ovary, External Approach Drainage of Left Ovary with Drainage Device, Open Approach Drainage of Left Ovary, Open Approach, Diagnostic Drainage of Left Ovary, Open Approach Drainage of Left Ovary with Drainage Device, Perc Approach Drainage of Left Ovary, Percutaneous Approach, Diagnostic Drainage of Left Ovary, Percutaneous Approach Drainage of Left Ovary with Drain Dev, Perc Endo Approach Drainage of Left Ovary, Perc Endo Approach, Diagn Drainage of Left Ovary, Percutaneous Endoscopic Approach Drainage of Left Ovary, External Approach Drainage of Bilateral Ovaries with Drain Dev, Open Approach Drainage of Bilateral Ovaries, Open Approach, Diagnostic Drainage of Bilateral Ovaries, Open Approach Drainage of Bilateral Ovaries with Drain Dev, Perc Approach Drainage of Bilateral Ovaries, Percutaneous Approach, Diagn Drainage of Bilateral Ovaries, Percutaneous Approach Drainage of Bi Ovary with Drain Dev, Perc Endo Approach Drainage of Bilateral Ovaries, Perc Endo Approach, Diagn Drainage of Bilateral Ovaries, Perc Endo Approach Drainage of Bilateral Ovaries, External Approach Drain Uterine Support Struct w Drain Dev, Open Drainage of Uterine Support Struct, Open Approach, Diagn Drainage of Uterine Supporting Structure, Open Approach Drain Uterine Support Struct w Drain Dev, Perc Drainage of Uterine Support Struct, Perc Approach, Diagn Drainage of Uterine Supporting Structure, Perc Approach Drain Uterine Support Struct w Drain Dev, Perc Endo Drain of Uterine Support Struct, Perc Endo Approach, Diagn Drainage of Uterine Supporting Structure, Perc Endo Approach Drainage of R Fallopian Tube with Drain Dev, Open Approach Drainage of Right Fallopian Tube, Open Approach, Diagnostic Drainage of Right Fallopian Tube, Open Approach Drainage of R Fallopian Tube with Drain Dev, Perc Approach Drainage of Right Fallopian Tube, Perc Approach, Diagn Drainage of Right Fallopian Tube, Percutaneous Approach Drain of R Fallopian Tube with Drain Dev, Perc Endo Approach Drainage of Right Fallopian Tube, Perc Endo Approach, Diagn Drainage of Right Fallopian Tube, Perc Endo Approach Drainage of Right Fallopian Tube with Drain Dev, Via Opening Drainage of Right Fallopian Tube, Via Opening, Diagn Drainage of Right Fallopian Tube, Via Opening Drainage of Right Fallopian Tube with Drainage Device, Endo Drainage of Right Fallopian Tube, Endo, Diagn Drainage of Right Fallopian Tube, Endo Drainage of L Fallopian Tube with Drain Dev, Open Approach Drainage of Left Fallopian Tube, Open Approach, Diagnostic Drainage of Left Fallopian Tube, Open Approach Drainage of L Fallopian Tube with Drain Dev, Perc Approach Drainage of Left Fallopian Tube, Perc Approach, Diagn Drainage of Left Fallopian Tube, Percutaneous Approach Drain of L Fallopian Tube with Drain Dev, Perc Endo Approach

September 2011

Edit code lists 1.105

Procedures allowed for females only

0U964ZX 0U964ZZ 0U9670Z 0U967ZX 0U967ZZ 0U9680Z 0U968ZX 0U968ZZ 0U9700Z 0U970ZX 0U970ZZ 0U9730Z 0U973ZX 0U973ZZ 0U9740Z 0U974ZX 0U974ZZ 0U9770Z 0U977ZX 0U977ZZ 0U9780Z 0U978ZX 0U978ZZ 0U9900Z 0U990ZX 0U990ZZ 0U9930Z 0U993ZX 0U993ZZ 0U9940Z 0U994ZX 0U994ZZ 0U9970Z 0U997ZX 0U997ZZ 0U9980Z 0U998ZX 0U998ZZ 0U9C00Z 0U9C0ZX 0U9C0ZZ 0U9C30Z 0U9C3ZX 0U9C3ZZ 0U9C40Z 0U9C4ZX 0U9C4ZZ 0U9C70Z 0U9C7ZX 0U9C7ZZ 0U9C80Z 0U9C8ZX 0U9C8ZZ 0U9F00Z 0U9F0ZX 0U9F0ZZ 0U9F30Z 0U9F3ZX 0U9F3ZZ 0U9F40Z 0U9F4ZX 0U9F4ZZ 0U9F70Z 0U9F7ZX 0U9F7ZZ 0U9F80Z 0U9F8ZX 0U9F8ZZ

Drainage of Left Fallopian Tube, Perc Endo Approach, Diagn Drainage of Left Fallopian Tube, Perc Endo Approach Drainage of Left Fallopian Tube with Drain Dev, Via Opening Drainage of Left Fallopian Tube, Via Opening, Diagn Drainage of Left Fallopian Tube, Via Opening Drainage of Left Fallopian Tube with Drainage Device, Endo Drainage of Left Fallopian Tube, Endo, Diagn Drainage of Left Fallopian Tube, Endo Drainage of Bi Fallopian Tube with Drain Dev, Open Approach Drainage of Bilateral Fallopian Tubes, Open Approach, Diagn Drainage of Bilateral Fallopian Tubes, Open Approach Drainage of Bi Fallopian Tube with Drain Dev, Perc Approach Drainage of Bilateral Fallopian Tubes, Perc Approach, Diagn Drainage of Bilateral Fallopian Tubes, Percutaneous Approach Drain Bi Fallopian Tube w Drain Dev, Perc Endo Drainage of Bi Fallopian Tube, Perc Endo Approach, Diagn Drainage of Bilateral Fallopian Tubes, Perc Endo Approach Drainage of Bi Fallopian Tube with Drain Dev, Via Opening Drainage of Bilateral Fallopian Tubes, Via Opening, Diagn Drainage of Bilateral Fallopian Tubes, Via Opening Drainage of Bilateral Fallopian Tubes with Drain Dev, Endo Drainage of Bilateral Fallopian Tubes, Endo, Diagn Drainage of Bilateral Fallopian Tubes, Endo Drainage of Uterus with Drainage Device, Open Approach Drainage of Uterus, Open Approach, Diagnostic Drainage of Uterus, Open Approach Drainage of Uterus with Drainage Device, Perc Approach Drainage of Uterus, Percutaneous Approach, Diagnostic Drainage of Uterus, Percutaneous Approach Drainage of Uterus with Drainage Device, Perc Endo Approach Drainage of Uterus, Percutaneous Endoscopic Approach, Diagn Drainage of Uterus, Percutaneous Endoscopic Approach Drainage of Uterus with Drainage Device, Via Opening Drainage of Uterus, Via Natural or Artificial Opening, Diagn Drainage of Uterus, Via Natural or Artificial Opening Drainage of Uterus with Drainage Device, Endo Drainage of Uterus, Endo, Diagn Drainage of Uterus, Endo Drainage of Cervix with Drainage Device, Open Approach Drainage of Cervix, Open Approach, Diagnostic Drainage of Cervix, Open Approach Drainage of Cervix with Drainage Device, Perc Approach Drainage of Cervix, Percutaneous Approach, Diagnostic Drainage of Cervix, Percutaneous Approach Drainage of Cervix with Drainage Device, Perc Endo Approach Drainage of Cervix, Percutaneous Endoscopic Approach, Diagn Drainage of Cervix, Percutaneous Endoscopic Approach Drainage of Cervix with Drainage Device, Via Opening Drainage of Cervix, Via Natural or Artificial Opening, Diagn Drainage of Cervix, Via Natural or Artificial Opening Drainage of Cervix with Drainage Device, Endo Drainage of Cervix, Endo, Diagn Drainage of Cervix, Endo Drainage of Cul-de-sac with Drainage Device, Open Approach Drainage of Cul-de-sac, Open Approach, Diagnostic Drainage of Cul-de-sac, Open Approach Drainage of Cul-de-sac with Drainage Device, Perc Approach Drainage of Cul-de-sac, Percutaneous Approach, Diagnostic Drainage of Cul-de-sac, Percutaneous Approach Drainage of Cul-de-sac with Drain Dev, Perc Endo Approach Drainage of Cul-de-sac, Perc Endo Approach, Diagn Drainage of Cul-de-sac, Percutaneous Endoscopic Approach Drainage of Cul-de-sac with Drainage Device, Via Opening Drainage of Cul-de-sac, Via Opening, Diagn Drainage of Cul-de-sac, Via Natural or Artificial Opening Drainage of Cul-de-sac with Drainage Device, Endo Drainage of Cul-de-sac, Endo, Diagn Drainage of Cul-de-sac, Endo

1.106 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0U9G00Z Drainage of Vagina with Drainage Device, Open Approach 0U9G0ZX Drainage of Vagina, Open Approach, Diagnostic 0U9G0ZZ Drainage of Vagina, Open Approach 0U9G30Z Drainage of Vagina with Drainage Device, Perc Approach 0U9G3ZX Drainage of Vagina, Percutaneous Approach, Diagnostic 0U9G3ZZ Drainage of Vagina, Percutaneous Approach 0U9G40Z Drainage of Vagina with Drainage Device, Perc Endo Approach 0U9G4ZX Drainage of Vagina, Percutaneous Endoscopic Approach, Diagn 0U9G4ZZ Drainage of Vagina, Percutaneous Endoscopic Approach 0U9G70Z Drainage of Vagina with Drainage Device, Via Opening 0U9G7ZX Drainage of Vagina, Via Natural or Artificial Opening, Diagn 0U9G7ZZ Drainage of Vagina, Via Natural or Artificial Opening 0U9G80Z Drainage of Vagina with Drainage Device, Endo 0U9G8ZX Drainage of Vagina, Endo, Diagn 0U9G8ZZ Drainage of Vagina, Endo 0U9GX0Z Drainage of Vagina with Drainage Device, External Approach 0U9GXZX Drainage of Vagina, External Approach, Diagnostic 0U9GXZZ Drainage of Vagina, External Approach 0U9J00Z Drainage of Clitoris with Drainage Device, Open Approach 0U9J0ZX Drainage of Clitoris, Open Approach, Diagnostic 0U9J0ZZ Drainage of Clitoris, Open Approach 0U9JX0Z Drainage of Clitoris with Drainage Device, External Approach 0U9JXZX Drainage of Clitoris, External Approach, Diagnostic 0U9JXZZ Drainage of Clitoris, External Approach 0U9K00Z Drainage of Hymen with Drainage Device, Open Approach 0U9K0ZX Drainage of Hymen, Open Approach, Diagnostic 0U9K0ZZ Drainage of Hymen, Open Approach 0U9K30Z Drainage of Hymen with Drainage Device, Perc Approach 0U9K3ZX Drainage of Hymen, Percutaneous Approach, Diagnostic 0U9K3ZZ Drainage of Hymen, Percutaneous Approach 0U9K40Z Drainage of Hymen with Drainage Device, Perc Endo Approach 0U9K4ZX Drainage of Hymen, Percutaneous Endoscopic Approach, Diagn 0U9K4ZZ Drainage of Hymen, Percutaneous Endoscopic Approach 0U9K70Z Drainage of Hymen with Drainage Device, Via Opening 0U9K7ZX Drainage of Hymen, Via Natural or Artificial Opening, Diagn 0U9K7ZZ Drainage of Hymen, Via Natural or Artificial Opening 0U9K80Z Drainage of Hymen with Drainage Device, Endo 0U9K8ZX Drainage of Hymen, Endo, Diagn 0U9K8ZZ Drainage of Hymen, Endo 0U9L00Z Drainage of Vestibular Gland with Drain Dev, Open Approach 0U9L0ZX Drainage of Vestibular Gland, Open Approach, Diagnostic 0U9L0ZZ Drainage of Vestibular Gland, Open Approach 0U9LX0Z Drainage of Vestibular Gland with Drain Dev, Extern Approach 0U9LXZX Drainage of Vestibular Gland, External Approach, Diagnostic 0U9LXZZ Drainage of Vestibular Gland, External Approach 0U9M00Z Drainage of Vulva with Drainage Device, Open Approach 0U9M0ZX Drainage of Vulva, Open Approach, Diagnostic 0U9M0ZZ Drainage of Vulva, Open Approach 0U9MX0Z Drainage of Vulva with Drainage Device, External Approach 0U9MXZX Drainage of Vulva, External Approach, Diagnostic 0U9MXZZ Drainage of Vulva, External Approach 0UB00ZX Excision of Right Ovary, Open Approach, Diagnostic 0UB00ZZ Excision of Right Ovary, Open Approach 0UB03ZX Excision of Right Ovary, Percutaneous Approach, Diagnostic 0UB03ZZ Excision of Right Ovary, Percutaneous Approach 0UB04ZX Excision of Right Ovary, Perc Endo Approach, Diagn 0UB04ZZ Excision of Right Ovary, Percutaneous Endoscopic Approach 0UB07ZX Excision of Right Ovary, Via Opening, Diagn 0UB07ZZ Excision of Right Ovary, Via Natural or Artificial Opening 0UB08ZX Excision of Right Ovary, Endo, Diagn 0UB08ZZ Excision of Right Ovary, Endo 0UB10ZX Excision of Left Ovary, Open Approach, Diagnostic 0UB10ZZ Excision of Left Ovary, Open Approach 0UB13ZX Excision of Left Ovary, Percutaneous Approach, Diagnostic 0UB13ZZ Excision of Left Ovary, Percutaneous Approach 0UB14ZX Excision of Left Ovary, Perc Endo Approach, Diagn 0UB14ZZ Excision of Left Ovary, Percutaneous Endoscopic Approach 0UB17ZX Excision of Left Ovary, Via Opening, Diagn

September 2011

Edit code lists 1.107

Procedures allowed for females only

0UB17ZZ 0UB18ZX 0UB18ZZ 0UB20ZX 0UB20ZZ 0UB23ZX 0UB23ZZ 0UB24ZX 0UB24ZZ 0UB27ZX 0UB27ZZ 0UB28ZX 0UB28ZZ 0UB40ZX 0UB40ZZ 0UB43ZX 0UB43ZZ 0UB44ZX 0UB44ZZ 0UB47ZX 0UB47ZZ 0UB48ZX 0UB48ZZ 0UB50ZX 0UB50ZZ 0UB53ZX 0UB53ZZ 0UB54ZX 0UB54ZZ 0UB57ZX 0UB57ZZ 0UB58ZX 0UB58ZZ 0UB60ZX 0UB60ZZ 0UB63ZX 0UB63ZZ 0UB64ZX 0UB64ZZ 0UB67ZX 0UB67ZZ 0UB68ZX 0UB68ZZ 0UB70ZX 0UB70ZZ 0UB73ZX 0UB73ZZ 0UB74ZX 0UB74ZZ 0UB77ZX 0UB77ZZ 0UB78ZX 0UB78ZZ 0UB90ZX 0UB90ZZ 0UB93ZX 0UB93ZZ 0UB94ZX 0UB94ZZ 0UB97ZX 0UB97ZZ 0UB98ZX 0UB98ZZ 0UBC0ZX 0UBC0ZZ 0UBC3ZX 0UBC3ZZ 0UBC4ZX

Excision of Left Ovary, Via Natural or Artificial Opening Excision of Left Ovary, Endo, Diagn Excision of Left Ovary, Endo Excision of Bilateral Ovaries, Open Approach, Diagnostic Excision of Bilateral Ovaries, Open Approach Excision of Bilateral Ovaries, Percutaneous Approach, Diagn Excision of Bilateral Ovaries, Percutaneous Approach Excision of Bilateral Ovaries, Perc Endo Approach, Diagn Excision of Bilateral Ovaries, Perc Endo Approach Excision of Bilateral Ovaries, Via Opening, Diagn Excision of Bilateral Ovaries, Via Opening Excision of Bilateral Ovaries, Endo, Diagn Excision of Bilateral Ovaries, Endo Excision of Uterine Support Struct, Open Approach, Diagn Excision of Uterine Supporting Structure, Open Approach Excision of Uterine Support Struct, Perc Approach, Diagn Excision of Uterine Supporting Structure, Perc Approach Excise of Uterine Support Struct, Perc Endo Approach, Diagn Excision of Uterine Supporting Structure, Perc Endo Approach Excision of Uterine Supporting Structure, Via Opening, Diagn Excision of Uterine Supporting Structure, Via Opening Excision of Uterine Supporting Structure, Endo, Diagn Excision of Uterine Supporting Structure, Endo Excision of Right Fallopian Tube, Open Approach, Diagnostic Excision of Right Fallopian Tube, Open Approach Excision of Right Fallopian Tube, Perc Approach, Diagn Excision of Right Fallopian Tube, Percutaneous Approach Excision of Right Fallopian Tube, Perc Endo Approach, Diagn Excision of Right Fallopian Tube, Perc Endo Approach Excision of Right Fallopian Tube, Via Opening, Diagn Excision of Right Fallopian Tube, Via Opening Excision of Right Fallopian Tube, Endo, Diagn Excision of Right Fallopian Tube, Endo Excision of Left Fallopian Tube, Open Approach, Diagnostic Excision of Left Fallopian Tube, Open Approach Excision of Left Fallopian Tube, Perc Approach, Diagn Excision of Left Fallopian Tube, Percutaneous Approach Excision of Left Fallopian Tube, Perc Endo Approach, Diagn Excision of Left Fallopian Tube, Perc Endo Approach Excision of Left Fallopian Tube, Via Opening, Diagn Excision of Left Fallopian Tube, Via Opening Excision of Left Fallopian Tube, Endo, Diagn Excision of Left Fallopian Tube, Endo Excision of Bilateral Fallopian Tubes, Open Approach, Diagn Excision of Bilateral Fallopian Tubes, Open Approach Excision of Bilateral Fallopian Tubes, Perc Approach, Diagn Excision of Bilateral Fallopian Tubes, Percutaneous Approach Excision of Bi Fallopian Tube, Perc Endo Approach, Diagn Excision of Bilateral Fallopian Tubes, Perc Endo Approach Excision of Bilateral Fallopian Tubes, Via Opening, Diagn Excision of Bilateral Fallopian Tubes, Via Opening Excision of Bilateral Fallopian Tubes, Endo, Diagn Excision of Bilateral Fallopian Tubes, Endo Excision of Uterus, Open Approach, Diagnostic Excision of Uterus, Open Approach Excision of Uterus, Percutaneous Approach, Diagnostic Excision of Uterus, Percutaneous Approach Excision of Uterus, Percutaneous Endoscopic Approach, Diagn Excision of Uterus, Percutaneous Endoscopic Approach Excision of Uterus, Via Natural or Artificial Opening, Diagn Excision of Uterus, Via Natural or Artificial Opening Excision of Uterus, Endo, Diagn Excision of Uterus, Endo Excision of Cervix, Open Approach, Diagnostic Excision of Cervix, Open Approach Excision of Cervix, Percutaneous Approach, Diagnostic Excision of Cervix, Percutaneous Approach Excision of Cervix, Percutaneous Endoscopic Approach, Diagn

1.108 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0UBC4ZZ 0UBC7ZX 0UBC7ZZ 0UBC8ZX 0UBC8ZZ 0UBF0ZX 0UBF0ZZ 0UBF3ZX 0UBF3ZZ 0UBF4ZX 0UBF4ZZ 0UBF7ZX 0UBF7ZZ 0UBF8ZX 0UBF8ZZ 0UBG0ZX 0UBG0ZZ 0UBG3ZX 0UBG3ZZ 0UBG4ZX 0UBG4ZZ 0UBG7ZX 0UBG7ZZ 0UBG8ZX 0UBG8ZZ 0UBGXZX 0UBGXZZ 0UBJ0ZX 0UBJ0ZZ 0UBJXZX 0UBJXZZ 0UBK0ZX 0UBK0ZZ 0UBK3ZX 0UBK3ZZ 0UBK4ZX 0UBK4ZZ 0UBK7ZX 0UBK7ZZ 0UBK8ZX 0UBK8ZZ 0UBL0ZX 0UBL0ZZ 0UBLXZX 0UBLXZZ 0UBM0ZX 0UBM0ZZ 0UBMXZX 0UBMXZZ 0UC00ZZ 0UC03ZZ 0UC04ZZ 0UC10ZZ 0UC13ZZ 0UC14ZZ 0UC20ZZ 0UC23ZZ 0UC24ZZ 0UC40ZZ 0UC43ZZ 0UC44ZZ 0UC50ZZ 0UC53ZZ 0UC54ZZ 0UC57ZZ 0UC58ZZ 0UC60ZZ 0UC63ZZ

Excision of Cervix, Percutaneous Endoscopic Approach Excision of Cervix, Via Natural or Artificial Opening, Diagn Excision of Cervix, Via Natural or Artificial Opening Excision of Cervix, Endo, Diagn Excision of Cervix, Endo Excision of Cul-de-sac, Open Approach, Diagnostic Excision of Cul-de-sac, Open Approach Excision of Cul-de-sac, Percutaneous Approach, Diagnostic Excision of Cul-de-sac, Percutaneous Approach Excision of Cul-de-sac, Perc Endo Approach, Diagn Excision of Cul-de-sac, Percutaneous Endoscopic Approach Excision of Cul-de-sac, Via Opening, Diagn Excision of Cul-de-sac, Via Natural or Artificial Opening Excision of Cul-de-sac, Endo, Diagn Excision of Cul-de-sac, Endo Excision of Vagina, Open Approach, Diagnostic Excision of Vagina, Open Approach Excision of Vagina, Percutaneous Approach, Diagnostic Excision of Vagina, Percutaneous Approach Excision of Vagina, Percutaneous Endoscopic Approach, Diagn Excision of Vagina, Percutaneous Endoscopic Approach Excision of Vagina, Via Natural or Artificial Opening, Diagn Excision of Vagina, Via Natural or Artificial Opening Excision of Vagina, Endo, Diagn Excision of Vagina, Endo Excision of Vagina, External Approach, Diagnostic Excision of Vagina, External Approach Excision of Clitoris, Open Approach, Diagnostic Excision of Clitoris, Open Approach Excision of Clitoris, External Approach, Diagnostic Excision of Clitoris, External Approach Excision of Hymen, Open Approach, Diagnostic Excision of Hymen, Open Approach Excision of Hymen, Percutaneous Approach, Diagnostic Excision of Hymen, Percutaneous Approach Excision of Hymen, Percutaneous Endoscopic Approach, Diagn Excision of Hymen, Percutaneous Endoscopic Approach Excision of Hymen, Via Natural or Artificial Opening, Diagn Excision of Hymen, Via Natural or Artificial Opening Excision of Hymen, Endo, Diagn Excision of Hymen, Endo Excision of Vestibular Gland, Open Approach, Diagnostic Excision of Vestibular Gland, Open Approach Excision of Vestibular Gland, External Approach, Diagnostic Excision of Vestibular Gland, External Approach Excision of Vulva, Open Approach, Diagnostic Excision of Vulva, Open Approach Excision of Vulva, External Approach, Diagnostic Excision of Vulva, External Approach Extirpation of Matter from Right Ovary, Open Approach Extirpation of Matter from Right Ovary, Perc Approach Extirpation of Matter from Right Ovary, Perc Endo Approach Extirpation of Matter from Left Ovary, Open Approach Extirpation of Matter from Left Ovary, Percutaneous Approach Extirpation of Matter from Left Ovary, Perc Endo Approach Extirpation of Matter from Bilateral Ovaries, Open Approach Extirpation of Matter from Bilateral Ovaries, Perc Approach Extirpation of Matter from Bi Ovary, Perc Endo Approach Extirpate matter from Uterine Support Struct, Open Extirpate matter from Uterine Support Struct, Perc Extirpate matter from Uterine Support Struct, Perc Endo Extirpation of Matter from R Fallopian Tube, Open Approach Extirpation of Matter from R Fallopian Tube, Perc Approach Extirpate matter from R Fallopian Tube, Perc Endo Extirpation of Matter from Right Fallopian Tube, Via Opening Extirpation of Matter from Right Fallopian Tube, Endo Extirpation of Matter from L Fallopian Tube, Open Approach Extirpation of Matter from L Fallopian Tube, Perc Approach

September 2011

Edit code lists 1.109

Procedures allowed for females only

0UC64ZZ 0UC67ZZ 0UC68ZZ 0UC70ZZ 0UC73ZZ 0UC74ZZ 0UC77ZZ 0UC78ZZ 0UC90ZZ 0UC93ZZ 0UC94ZZ 0UC97ZZ 0UC98ZZ 0UCB0ZZ 0UCB3ZZ 0UCB4ZZ 0UCB7ZZ 0UCB8ZZ 0UCC0ZZ 0UCC3ZZ 0UCC4ZZ 0UCC7ZZ 0UCC8ZZ 0UCF0ZZ 0UCF3ZZ 0UCF4ZZ 0UCF7ZZ 0UCF8ZZ 0UCG0ZZ 0UCG3ZZ 0UCG4ZZ 0UCG7ZZ 0UCG8ZZ 0UCGXZZ 0UCJ0ZZ 0UCJXZZ 0UCK0ZZ 0UCK3ZZ 0UCK4ZZ 0UCK7ZZ 0UCK8ZZ 0UCL0ZZ 0UCLXZZ 0UCM0ZZ 0UCMXZZ 0UDB7ZX 0UDB7ZZ 0UDB8ZX 0UDB8ZZ 0UDN0ZZ 0UDN3ZZ 0UDN4ZZ 0UF50ZZ 0UF53ZZ 0UF54ZZ 0UF57ZZ 0UF58ZZ 0UF5XZZ 0UF60ZZ 0UF63ZZ 0UF64ZZ 0UF67ZZ 0UF68ZZ 0UF6XZZ 0UF70ZZ 0UF73ZZ 0UF74ZZ 0UF77ZZ

Extirpate matter from L Fallopian Tube, Perc Endo Extirpation of Matter from Left Fallopian Tube, Via Opening Extirpation of Matter from Left Fallopian Tube, Endo Extirpation of Matter from Bi Fallopian Tube, Open Approach Extirpation of Matter from Bi Fallopian Tube, Perc Approach Extirpate matter from Bi Fallopian Tube, Perc Endo Extirpation of Matter from Bi Fallopian Tube, Via Opening Extirpation of Matter from Bilateral Fallopian Tubes, Endo Extirpation of Matter from Uterus, Open Approach Extirpation of Matter from Uterus, Percutaneous Approach Extirpation of Matter from Uterus, Perc Endo Approach Extirpation of Matter from Uterus, Via Opening Extirpation of Matter from Uterus, Endo Extirpation of Matter from Endometrium, Open Approach Extirpation of Matter from Endometrium, Perc Approach Extirpation of Matter from Endometrium, Perc Endo Approach Extirpation of Matter from Endometrium, Via Opening Extirpation of Matter from Endometrium, Endo Extirpation of Matter from Cervix, Open Approach Extirpation of Matter from Cervix, Percutaneous Approach Extirpation of Matter from Cervix, Perc Endo Approach Extirpation of Matter from Cervix, Via Opening Extirpation of Matter from Cervix, Endo Extirpation of Matter from Cul-de-sac, Open Approach Extirpation of Matter from Cul-de-sac, Percutaneous Approach Extirpation of Matter from Cul-de-sac, Perc Endo Approach Extirpation of Matter from Cul-de-sac, Via Opening Extirpation of Matter from Cul-de-sac, Endo Extirpation of Matter from Vagina, Open Approach Extirpation of Matter from Vagina, Percutaneous Approach Extirpation of Matter from Vagina, Perc Endo Approach Extirpation of Matter from Vagina, Via Opening Extirpation of Matter from Vagina, Endo Extirpation of Matter from Vagina, External Approach Extirpation of Matter from Clitoris, Open Approach Extirpation of Matter from Clitoris, External Approach Extirpation of Matter from Hymen, Open Approach Extirpation of Matter from Hymen, Percutaneous Approach Extirpation of Matter from Hymen, Perc Endo Approach Extirpation of Matter from Hymen, Via Opening Extirpation of Matter from Hymen, Endo Extirpation of Matter from Vestibular Gland, Open Approach Extirpation of Matter from Vestibular Gland, Extern Approach Extirpation of Matter from Vulva, Open Approach Extirpation of Matter from Vulva, External Approach Extraction of Endometrium, Via Opening, Diagn Extraction of Endometrium, Via Natural or Artificial Opening Extraction of Endometrium, Endo, Diagn Extraction of Endometrium, Endo Extraction of Ova, Open Extraction of Ova, Percutaneous Extraction of Ova, Percutaneous Endoscopic Fragmentation in Right Fallopian Tube, Open Approach Fragmentation in Right Fallopian Tube, Percutaneous Approach Fragmentation in Right Fallopian Tube, Perc Endo Approach Fragmentation in Right Fallopian Tube, Via Opening Fragmentation in Right Fallopian Tube, Endo Fragmentation in Right Fallopian Tube, External Approach Fragmentation in Left Fallopian Tube, Open Approach Fragmentation in Left Fallopian Tube, Percutaneous Approach Fragmentation in Left Fallopian Tube, Perc Endo Approach Fragmentation in Left Fallopian Tube, Via Opening Fragmentation in Left Fallopian Tube, Endo Fragmentation in Left Fallopian Tube, External Approach Fragmentation in Bilateral Fallopian Tubes, Open Approach Fragmentation in Bilateral Fallopian Tubes, Perc Approach Fragmentation in Bi Fallopian Tube, Perc Endo Approach Fragmentation in Bilateral Fallopian Tubes, Via Opening

1.110 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0UF78ZZ 0UF7XZZ 0UF90ZZ 0UF93ZZ 0UF94ZZ 0UF97ZZ 0UF98ZZ 0UF9XZZ 0UH303Z 0UH333Z 0UH343Z 0UH803Z 0UH833Z 0UH843Z 0UH873Z 0UH883Z 0UH97HZ 0UH98HZ 0UHC7HZ 0UHC8HZ 0UHD03Z 0UHD33Z 0UHD43Z 0UHD73Z 0UHD83Z 0UHF7GZ 0UHF8GZ 0UHG01Z 0UHG31Z 0UHG41Z 0UHG71Z 0UHG7GZ 0UHG81Z 0UHG8GZ 0UHGX1Z 0UHH03Z 0UHH33Z 0UHH43Z 0UHH73Z 0UHH83Z 0UJ30ZZ 0UJ33ZZ 0UJ34ZZ 0UJ3XZZ 0UJ80ZZ 0UJ83ZZ 0UJ84ZZ 0UJ87ZZ 0UJ88ZZ 0UJ8XZZ 0UJD0ZZ 0UJD3ZZ 0UJD4ZZ 0UJD7ZZ 0UJD8ZZ 0UJDXZZ 0UJH0ZZ 0UJH3ZZ 0UJH4ZZ 0UJH7ZZ 0UJH8ZZ 0UJHXZZ 0UJM0ZZ 0UJMXZZ 0UL50CZ 0UL50DZ 0UL50ZZ 0UL53CZ

Fragmentation in Bilateral Fallopian Tubes, Endo Fragmentation in Bilateral Fallopian Tubes, Extern Approach Fragmentation in Uterus, Open Approach Fragmentation in Uterus, Percutaneous Approach Fragmentation in Uterus, Percutaneous Endoscopic Approach Fragmentation in Uterus, Via Natural or Artificial Opening Fragmentation in Uterus, Endo Fragmentation in Uterus, External Approach Insertion of Infusion Device into Ovary, Open Approach Insertion of Infusion Device into Ovary, Perc Approach Insertion of Infusion Device into Ovary, Perc Endo Approach Insertion of Infusion Dev into Fallopian Tube, Open Approach Insertion of Infusion Dev into Fallopian Tube, Perc Approach Insert Infusion Dev in Fallopian Tube, Perc Endo Insertion of Infusion Dev into Fallopian Tube, Via Opening Insertion of Infusion Device into Fallopian Tube, Endo Insertion of Contraceptive Device into Uterus, Via Opening Insertion of Contraceptive Device into Uterus, Endo Insertion of Contraceptive Device into Cervix, Via Opening Insertion of Contraceptive Device into Cervix, Endo Insert of Infusion Dev into Uterus & Cervix, Open Approach Insert of Infusion Dev into Uterus & Cervix, Perc Approach Insert Infusion Dev in Uterus & Cervix, Perc Endo Insertion of Infusion Dev into Uterus & Cervix, Via Opening Insertion of Infusion Device into Uterus and Cervix, Endo Insertion of Pessary into Cul-de-sac, Via Opening Insertion of Pessary into Cul-de-sac, Endo Insertion of Radioactive Element into Vagina, Open Approach Insertion of Radioactive Element into Vagina, Perc Approach Insertion of Radioact Elem into Vagina, Perc Endo Approach Insertion of Radioactive Element into Vagina, Via Opening Insertion of Pessary into Vagina, Via Opening Insertion of Radioactive Element into Vagina, Endo Insertion of Pessary into Vagina, Endo Insertion of Radioact Elem into Vagina, Extern Approach Insert Infusion Dev in Vagina & Cul-de-sac, Open Insert Infusion Dev in Vagina & Cul-de-sac, Perc Insert Infusion Dev in Vagina & Cul-de-sac, Perc Endo Insert of Infusion Dev into Vagina & Cul-de-sac, Via Opening Insertion of Infusion Device into Vagina & Cul-de-sac, Endo Inspection of Ovary, Open Approach Inspection of Ovary, Percutaneous Approach Inspection of Ovary, Percutaneous Endoscopic Approach Inspection of Ovary, External Approach Inspection of Fallopian Tube, Open Approach Inspection of Fallopian Tube, Percutaneous Approach Inspection of Fallopian Tube, Perc Endo Approach Inspection of Fallopian Tube, Via Opening Inspection of Fallopian Tube, Endo Inspection of Fallopian Tube, External Approach Inspection of Uterus and Cervix, Open Approach Inspection of Uterus and Cervix, Percutaneous Approach Inspection of Uterus and Cervix, Perc Endo Approach Inspection of Uterus and Cervix, Via Opening Inspection of Uterus and Cervix, Endo Inspection of Uterus and Cervix, External Approach Inspection of Vagina and Cul-de-sac, Open Approach Inspection of Vagina and Cul-de-sac, Percutaneous Approach Inspection of Vagina and Cul-de-sac, Perc Endo Approach Inspection of Vagina and Cul-de-sac, Via Opening Inspection of Vagina and Cul-de-sac, Endo Inspection of Vagina and Cul-de-sac, External Approach Inspection of Vulva, Open Approach Inspection of Vulva, External Approach Occlusion R Fallopian Tube w Extralum Dev, Open Occlusion R Fallopian Tube w Intralum Dev, Open Occlusion of Right Fallopian Tube, Open Approach Occlusion R Fallopian Tube w Extralum Dev, Perc

September 2011

Edit code lists 1.111

Procedures allowed for females only

0UL53DZ 0UL53ZZ 0UL54CZ 0UL54DZ 0UL54ZZ 0UL57DZ 0UL57ZZ 0UL58DZ 0UL58ZZ 0UL60CZ 0UL60DZ 0UL60ZZ 0UL63CZ 0UL63DZ 0UL63ZZ 0UL64CZ 0UL64DZ 0UL64ZZ 0UL67DZ 0UL67ZZ 0UL68DZ 0UL68ZZ 0UL70CZ 0UL70DZ 0UL70ZZ 0UL73CZ 0UL73DZ 0UL73ZZ 0UL74CZ 0UL74DZ 0UL74ZZ 0UL77DZ 0UL77ZZ 0UL78DZ 0UL78ZZ 0ULF7DZ 0ULF7ZZ 0ULF8DZ 0ULF8ZZ 0ULG7DZ 0ULG7ZZ 0ULG8DZ 0ULG8ZZ 0UM00ZZ 0UM04ZZ 0UM10ZZ 0UM14ZZ 0UM20ZZ 0UM24ZZ 0UM40ZZ 0UM44ZZ 0UM50ZZ 0UM54ZZ 0UM60ZZ 0UM64ZZ 0UM70ZZ 0UM74ZZ 0UM90ZZ 0UM94ZZ 0UMC0ZZ 0UMC4ZZ 0UMF0ZZ 0UMF4ZZ 0UMG0ZZ 0UMG4ZZ 0UMJXZZ 0UMK0ZZ 0UMK4ZZ

Occlusion R Fallopian Tube w Intralum Dev, Perc Occlusion of Right Fallopian Tube, Percutaneous Approach Occlusion R Fallopian Tube w Extralum Dev, Perc Endo Occlusion R Fallopian Tube w Intralum Dev, Perc Endo Occlusion of Right Fallopian Tube, Perc Endo Approach Occlusion of R Fallopian Tube with Intralum Dev, Via Opening Occlusion of Right Fallopian Tube, Via Opening Occlusion of Right Fallopian Tube with Intralum Dev, Endo Occlusion of Right Fallopian Tube, Endo Occlusion L Fallopian Tube w Extralum Dev, Open Occlusion L Fallopian Tube w Intralum Dev, Open Occlusion of Left Fallopian Tube, Open Approach Occlusion L Fallopian Tube w Extralum Dev, Perc Occlusion L Fallopian Tube w Intralum Dev, Perc Occlusion of Left Fallopian Tube, Percutaneous Approach Occlusion L Fallopian Tube w Extralum Dev, Perc Endo Occlusion L Fallopian Tube w Intralum Dev, Perc Endo Occlusion of Left Fallopian Tube, Perc Endo Approach Occlusion of L Fallopian Tube with Intralum Dev, Via Opening Occlusion of Left Fallopian Tube, Via Opening Occlusion of Left Fallopian Tube with Intralum Dev, Endo Occlusion of Left Fallopian Tube, Endo Occlusion Bi Fallopian Tube w Extralum Dev, Open Occlusion Bi Fallopian Tube w Intralum Dev, Open Occlusion of Bilateral Fallopian Tubes, Open Approach Occlusion Bi Fallopian Tube w Extralum Dev, Perc Occlusion Bi Fallopian Tube w Intralum Dev, Perc Occlusion of Bilateral Fallopian Tubes, Perc Approach Occlusion Bi Fallopian Tube w Extralum Dev, Perc Endo Occlusion Bi Fallopian Tube w Intralum Dev, Perc Endo Occlusion of Bilateral Fallopian Tubes, Perc Endo Approach Occlusion Bi Fallopian Tube w Intralum Dev, Via Opening Occlusion of Bilateral Fallopian Tubes, Via Opening Occlusion of Bi Fallopian Tube with Intralum Dev, Endo Occlusion of Bilateral Fallopian Tubes, Endo Occlusion of Cul-de-sac with Intralum Dev, Via Opening Occlusion of Cul-de-sac, Via Natural or Artificial Opening Occlusion of Cul-de-sac with Intraluminal Device, Endo Occlusion of Cul-de-sac, Endo Occlusion of Vagina with Intraluminal Device, Via Opening Occlusion of Vagina, Via Natural or Artificial Opening Occlusion of Vagina with Intraluminal Device, Endo Occlusion of Vagina, Endo Reattachment of Right Ovary, Open Approach Reattachment of Right Ovary, Perc Endo Approach Reattachment of Left Ovary, Open Approach Reattachment of Left Ovary, Percutaneous Endoscopic Approach Reattachment of Bilateral Ovaries, Open Approach Reattachment of Bilateral Ovaries, Perc Endo Approach Reattachment of Uterine Supporting Structure, Open Approach Reattachment of Uterine Support Struct, Perc Endo Approach Reattachment of Right Fallopian Tube, Open Approach Reattachment of Right Fallopian Tube, Perc Endo Approach Reattachment of Left Fallopian Tube, Open Approach Reattachment of Left Fallopian Tube, Perc Endo Approach Reattachment of Bilateral Fallopian Tubes, Open Approach Reattachment of Bi Fallopian Tube, Perc Endo Approach Reattachment of Uterus, Open Approach Reattachment of Uterus, Percutaneous Endoscopic Approach Reattachment of Cervix, Open Approach Reattachment of Cervix, Percutaneous Endoscopic Approach Reattachment of Cul-de-sac, Open Approach Reattachment of Cul-de-sac, Percutaneous Endoscopic Approach Reattachment of Vagina, Open Approach Reattachment of Vagina, Percutaneous Endoscopic Approach Reattachment of Clitoris, External Approach Reattachment of Hymen, Open Approach Reattachment of Hymen, Percutaneous Endoscopic Approach

1.112 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0UMMXZZ 0UN00ZZ 0UN03ZZ 0UN04ZZ 0UN10ZZ 0UN13ZZ 0UN14ZZ 0UN20ZZ 0UN23ZZ 0UN24ZZ 0UN40ZZ 0UN43ZZ 0UN44ZZ 0UN50ZZ 0UN53ZZ 0UN54ZZ 0UN57ZZ 0UN58ZZ 0UN60ZZ 0UN63ZZ 0UN64ZZ 0UN67ZZ 0UN68ZZ 0UN70ZZ 0UN73ZZ 0UN74ZZ 0UN77ZZ 0UN78ZZ 0UN90ZZ 0UN93ZZ 0UN94ZZ 0UN97ZZ 0UN98ZZ 0UNC0ZZ 0UNC3ZZ 0UNC4ZZ 0UNC7ZZ 0UNC8ZZ 0UNF0ZZ 0UNF3ZZ 0UNF4ZZ 0UNF7ZZ 0UNF8ZZ 0UNG0ZZ 0UNG3ZZ 0UNG4ZZ 0UNG7ZZ 0UNG8ZZ 0UNGXZZ 0UNJ0ZZ 0UNJXZZ 0UNK0ZZ 0UNK3ZZ 0UNK4ZZ 0UNK7ZZ 0UNK8ZZ 0UNL0ZZ 0UNLXZZ 0UNM0ZZ 0UNMXZZ 0UP300Z 0UP303Z 0UP330Z 0UP333Z 0UP340Z 0UP343Z 0UP3X0Z 0UP3X3Z

Reattachment of Vulva, External Approach Release Right Ovary, Open Approach Release Right Ovary, Percutaneous Approach Release Right Ovary, Percutaneous Endoscopic Approach Release Left Ovary, Open Approach Release Left Ovary, Percutaneous Approach Release Left Ovary, Percutaneous Endoscopic Approach Release Bilateral Ovaries, Open Approach Release Bilateral Ovaries, Percutaneous Approach Release Bilateral Ovaries, Percutaneous Endoscopic Approach Release Uterine Supporting Structure, Open Approach Release Uterine Supporting Structure, Percutaneous Approach Release Uterine Supporting Structure, Perc Endo Approach Release Right Fallopian Tube, Open Approach Release Right Fallopian Tube, Percutaneous Approach Release Right Fallopian Tube, Perc Endo Approach Release Right Fallopian Tube, Via Opening Release Right Fallopian Tube, Endo Release Left Fallopian Tube, Open Approach Release Left Fallopian Tube, Percutaneous Approach Release Left Fallopian Tube, Perc Endo Approach Release Left Fallopian Tube, Via Opening Release Left Fallopian Tube, Endo Release Bilateral Fallopian Tubes, Open Approach Release Bilateral Fallopian Tubes, Percutaneous Approach Release Bilateral Fallopian Tubes, Perc Endo Approach Release Bilateral Fallopian Tubes, Via Opening Release Bilateral Fallopian Tubes, Endo Release Uterus, Open Approach Release Uterus, Percutaneous Approach Release Uterus, Percutaneous Endoscopic Approach Release Uterus, Via Natural or Artificial Opening Release Uterus, Via Natural or Artificial Opening Endoscopic Release Cervix, Open Approach Release Cervix, Percutaneous Approach Release Cervix, Percutaneous Endoscopic Approach Release Cervix, Via Natural or Artificial Opening Release Cervix, Via Natural or Artificial Opening Endoscopic Release Cul-de-sac, Open Approach Release Cul-de-sac, Percutaneous Approach Release Cul-de-sac, Percutaneous Endoscopic Approach Release Cul-de-sac, Via Natural or Artificial Opening Release Cul-de-sac, Endo Release Vagina, Open Approach Release Vagina, Percutaneous Approach Release Vagina, Percutaneous Endoscopic Approach Release Vagina, Via Natural or Artificial Opening Release Vagina, Via Natural or Artificial Opening Endoscopic Release Vagina, External Approach Release Clitoris, Open Approach Release Clitoris, External Approach Release Hymen, Open Approach Release Hymen, Percutaneous Approach Release Hymen, Percutaneous Endoscopic Approach Release Hymen, Via Natural or Artificial Opening Release Hymen, Via Natural or Artificial Opening Endoscopic Release Vestibular Gland, Open Approach Release Vestibular Gland, External Approach Release Vulva, Open Approach Release Vulva, External Approach Removal of Drainage Device from Ovary, Open Approach Removal of Infusion Device from Ovary, Open Approach Removal of Drainage Device from Ovary, Percutaneous Approach Removal of Infusion Device from Ovary, Percutaneous Approach Removal of Drainage Device from Ovary, Perc Endo Approach Removal of Infusion Device from Ovary, Perc Endo Approach Removal of Drainage Device from Ovary, External Approach Removal of Infusion Device from Ovary, External Approach

September 2011

Edit code lists 1.113

Procedures allowed for females only

0UP800Z 0UP803Z 0UP807Z 0UP80CZ 0UP80DZ 0UP80JZ 0UP80KZ 0UP830Z 0UP833Z 0UP837Z 0UP83CZ 0UP83DZ 0UP83JZ 0UP83KZ 0UP840Z 0UP843Z 0UP847Z 0UP84CZ 0UP84DZ 0UP84JZ 0UP84KZ 0UP870Z 0UP873Z 0UP877Z 0UP87CZ 0UP87DZ 0UP87JZ 0UP87KZ 0UP880Z 0UP883Z 0UP887Z 0UP88CZ 0UP88DZ 0UP88JZ 0UP88KZ 0UP8X0Z 0UP8X3Z 0UP8XDZ 0UPD00Z 0UPD03Z 0UPD07Z 0UPD0CZ 0UPD0DZ 0UPD0HZ 0UPD0JZ 0UPD0KZ 0UPD30Z 0UPD33Z 0UPD37Z 0UPD3CZ 0UPD3DZ 0UPD3HZ 0UPD3JZ 0UPD3KZ 0UPD40Z 0UPD43Z 0UPD47Z 0UPD4CZ 0UPD4DZ 0UPD4HZ 0UPD4JZ 0UPD4KZ 0UPD70Z 0UPD73Z 0UPD77Z 0UPD7CZ 0UPD7DZ 0UPD7HZ

Removal of Drain Dev from Fallopian Tube, Open Approach Removal of Infusion Dev from Fallopian Tube, Open Approach Removal of Autol Sub from Fallopian Tube, Open Approach Removal of Extralum Dev from Fallopian Tube, Open Approach Removal of Intralum Dev from Fallopian Tube, Open Approach Removal of Synth Sub from Fallopian Tube, Open Approach Removal of Nonaut Sub from Fallopian Tube, Open Approach Removal of Drain Dev from Fallopian Tube, Perc Approach Removal of Infusion Dev from Fallopian Tube, Perc Approach Removal of Autol Sub from Fallopian Tube, Perc Approach Removal of Extralum Dev from Fallopian Tube, Perc Approach Removal of Intralum Dev from Fallopian Tube, Perc Approach Removal of Synth Sub from Fallopian Tube, Perc Approach Removal of Nonaut Sub from Fallopian Tube, Perc Approach Removal of Drain Dev from Fallopian Tube, Perc Endo Approach Remove Infusion Dev from Fallopian Tube, Perc Endo Removal of Autol Sub from Fallopian Tube, Perc Endo Approach Remove Extralum Dev from Fallopian Tube, Perc Endo Remove Intralum Dev from Fallopian Tube, Perc Endo Removal of Synth Sub from Fallopian Tube, Perc Endo Approach Remove of Nonaut Sub from Fallopian Tube, Perc Endo Approach Removal of Drainage Device from Fallopian Tube, Via Opening Removal of Infusion Device from Fallopian Tube, Via Opening Removal of Autol Sub from Fallopian Tube, Via Opening Removal of Extralum Dev from Fallopian Tube, Via Opening Removal of Intralum Dev from Fallopian Tube, Via Opening Removal of Synth Sub from Fallopian Tube, Via Opening Removal of Nonaut Sub from Fallopian Tube, Via Opening Removal of Drainage Device from Fallopian Tube, Endo Removal of Infusion Device from Fallopian Tube, Endo Removal of Autol Sub from Fallopian Tube, Endo Removal of Extraluminal Device from Fallopian Tube, Endo Removal of Intraluminal Device from Fallopian Tube, Endo Removal of Synthetic Substitute from Fallopian Tube, Endo Removal of Nonaut Sub from Fallopian Tube, Endo Removal of Drain Dev from Fallopian Tube, Extern Approach Removal of Infusion Dev from Fallopian Tube, Extern Approach Removal of Intralum Dev from Fallopian Tube, Extern Approach Removal of Drain Dev from Uterus & Cervix, Open Approach Removal of Infusion Dev from Uterus & Cervix, Open Approach Removal of Autol Sub from Uterus & Cervix, Open Approach Removal of Extralum Dev from Uterus & Cervix, Open Approach Removal of Intralum Dev from Uterus & Cervix, Open Approach Removal of Contracep Dev from Uterus & Cervix, Open Approach Removal of Synth Sub from Uterus & Cervix, Open Approach Removal of Nonaut Sub from Uterus & Cervix, Open Approach Removal of Drain Dev from Uterus & Cervix, Perc Approach Removal of Infusion Dev from Uterus & Cervix, Perc Approach Removal of Autol Sub from Uterus & Cervix, Perc Approach Removal of Extralum Dev from Uterus & Cervix, Perc Approach Removal of Intralum Dev from Uterus & Cervix, Perc Approach Removal of Contracep Dev from Uterus & Cervix, Perc Approach Removal of Synth Sub from Uterus & Cervix, Perc Approach Removal of Nonaut Sub from Uterus & Cervix, Perc Approach Remove of Drain Dev from Uterus & Cervix, Perc Endo Approach Remove Infusion Dev from Uterus & Cervix, Perc Endo Remove of Autol Sub from Uterus & Cervix, Perc Endo Approach Remove Extralum Dev from Uterus & Cervix, Perc Endo Remove Intralum Dev from Uterus & Cervix, Perc Endo Remove Contracep Dev from Uterus & Cervix, Perc Endo Remove of Synth Sub from Uterus & Cervix, Perc Endo Approach Remove Nonaut Sub from Uterus & Cervix, Perc Endo Removal of Drainage Device from Uterus & Cervix, Via Opening Removal of Infusion Device from Uterus & Cervix, Via Opening Removal of Autol Sub from Uterus & Cervix, Via Opening Removal of Extralum Dev from Uterus & Cervix, Via Opening Removal of Intralum Dev from Uterus & Cervix, Via Opening Removal of Contracep Dev from Uterus & Cervix, Via Opening

1.114 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0UPD7JZ 0UPD7KZ 0UPD80Z 0UPD83Z 0UPD87Z 0UPD8CZ 0UPD8DZ 0UPD8HZ 0UPD8JZ 0UPD8KZ 0UPDX0Z 0UPDX3Z 0UPDXDZ 0UPDXHZ 0UPH00Z 0UPH03Z 0UPH07Z 0UPH0DZ 0UPH0GZ 0UPH0JZ 0UPH0KZ 0UPH30Z 0UPH33Z 0UPH37Z 0UPH3DZ 0UPH3GZ 0UPH3JZ 0UPH3KZ 0UPH40Z 0UPH43Z 0UPH47Z 0UPH4DZ 0UPH4GZ 0UPH4JZ 0UPH4KZ 0UPH70Z 0UPH73Z 0UPH77Z 0UPH7DZ 0UPH7GZ 0UPH7JZ 0UPH7KZ 0UPH80Z 0UPH83Z 0UPH87Z 0UPH8DZ 0UPH8GZ 0UPH8JZ 0UPH8KZ 0UPHX0Z 0UPHX1Z 0UPHX3Z 0UPHXDZ 0UPHXGZ 0UPM00Z 0UPM07Z 0UPM0JZ 0UPM0KZ 0UPMX0Z 0UQ00ZZ 0UQ03ZZ 0UQ04ZZ 0UQ10ZZ 0UQ13ZZ 0UQ14ZZ 0UQ20ZZ 0UQ23ZZ 0UQ24ZZ

Removal of Synth Sub from Uterus & Cervix, Via Opening Removal of Nonaut Sub from Uterus & Cervix, Via Opening Removal of Drainage Device from Uterus and Cervix, Endo Removal of Infusion Device from Uterus and Cervix, Endo Removal of Autol Sub from Uterus & Cervix, Endo Removal of Extraluminal Device from Uterus and Cervix, Endo Removal of Intraluminal Device from Uterus and Cervix, Endo Removal of Contraceptive Device from Uterus and Cervix, Endo Removal of Synthetic Substitute from Uterus and Cervix, Endo Removal of Nonaut Sub from Uterus & Cervix, Endo Removal of Drain Dev from Uterus & Cervix, Extern Approach Remove of Infusion Dev from Uterus & Cervix, Extern Approach Remove of Intralum Dev from Uterus & Cervix, Extern Approach Remove Contracep Dev from Uterus & Cervix, Extern Removal of Drain Dev from Vagina & Cul-de-sac, Open Approach Remove Infusion Dev from Vagina & Cul-de-sac, Open Removal of Autol Sub from Vagina & Cul-de-sac, Open Approach Remove Intralum Dev from Vagina & Cul-de-sac, Open Removal of Pessary from Vagina and Cul-de-sac, Open Approach Removal of Synth Sub from Vagina & Cul-de-sac, Open Approach Remove of Nonaut Sub from Vagina & Cul-de-sac, Open Approach Removal of Drain Dev from Vagina & Cul-de-sac, Perc Approach Remove Infusion Dev from Vagina & Cul-de-sac, Perc Removal of Autol Sub from Vagina & Cul-de-sac, Perc Approach Remove Intralum Dev from Vagina & Cul-de-sac, Perc Removal of Pessary from Vagina and Cul-de-sac, Perc Approach Removal of Synth Sub from Vagina & Cul-de-sac, Perc Approach Remove of Nonaut Sub from Vagina & Cul-de-sac, Perc Approach Remove Drain Dev from Vagina & Cul-de-sac, Perc Endo Remove Infusion Dev from Vagina & Cul-de-sac, Perc Endo Remove Autol Sub from Vagina & Cul-de-sac, Perc Endo Remove Intralum Dev from Vagina & Cul-de-sac, Perc Endo Remove Pessary from Vagina & Cul-de-sac, Perc Endo Remove Synth Sub from Vagina & Cul-de-sac, Perc Endo Remove Nonaut Sub from Vagina & Cul-de-sac, Perc Endo Removal of Drain Dev from Vagina & Cul-de-sac, Via Opening Remove of Infusion Dev from Vagina & Cul-de-sac, Via Opening Removal of Autol Sub from Vagina & Cul-de-sac, Via Opening Remove of Intralum Dev from Vagina & Cul-de-sac, Via Opening Removal of Pessary from Vagina and Cul-de-sac, Via Opening Removal of Synth Sub from Vagina & Cul-de-sac, Via Opening Removal of Nonaut Sub from Vagina & Cul-de-sac, Via Opening Removal of Drainage Device from Vagina and Cul-de-sac, Endo Removal of Infusion Device from Vagina and Cul-de-sac, Endo Removal of Autol Sub from Vagina & Cul-de-sac, Endo Removal of Intralum Dev from Vagina & Cul-de-sac, Endo Removal of Pessary from Vagina and Cul-de-sac, Endo Removal of Synth Sub from Vagina & Cul-de-sac, Endo Removal of Nonaut Sub from Vagina & Cul-de-sac, Endo Remove Drain Dev from Vagina & Cul-de-sac, Extern Remove Radioact Elem from Vagina & Cul-de-sac, Extern Remove Infusion Dev from Vagina & Cul-de-sac, Extern Remove Intralum Dev from Vagina & Cul-de-sac, Extern Removal of Pessary from Vagina & Cul-de-sac, Extern Approach Removal of Drainage Device from Vulva, Open Approach Removal of Autol Sub from Vulva, Open Approach Removal of Synthetic Substitute from Vulva, Open Approach Removal of Nonaut Sub from Vulva, Open Approach Removal of Drainage Device from Vulva, External Approach Repair Right Ovary, Open Approach Repair Right Ovary, Percutaneous Approach Repair Right Ovary, Percutaneous Endoscopic Approach Repair Left Ovary, Open Approach Repair Left Ovary, Percutaneous Approach Repair Left Ovary, Percutaneous Endoscopic Approach Repair Bilateral Ovaries, Open Approach Repair Bilateral Ovaries, Percutaneous Approach Repair Bilateral Ovaries, Percutaneous Endoscopic Approach

September 2011

Edit code lists 1.115

Procedures allowed for females only

0UQ40ZZ 0UQ43ZZ 0UQ44ZZ 0UQ50ZZ 0UQ53ZZ 0UQ54ZZ 0UQ57ZZ 0UQ58ZZ 0UQ60ZZ 0UQ63ZZ 0UQ64ZZ 0UQ67ZZ 0UQ68ZZ 0UQ70ZZ 0UQ73ZZ 0UQ74ZZ 0UQ77ZZ 0UQ78ZZ 0UQ90ZZ 0UQ93ZZ 0UQ94ZZ 0UQ97ZZ 0UQ98ZZ 0UQC0ZZ 0UQC3ZZ 0UQC4ZZ 0UQC7ZZ 0UQC8ZZ 0UQF0ZZ 0UQF3ZZ 0UQF4ZZ 0UQF7ZZ 0UQF8ZZ 0UQG0ZZ 0UQG3ZZ 0UQG4ZZ 0UQG7ZZ 0UQG8ZZ 0UQGXZZ 0UQJ0ZZ 0UQJXZZ 0UQK0ZZ 0UQK3ZZ 0UQK4ZZ 0UQK7ZZ 0UQK8ZZ 0UQL0ZZ 0UQLXZZ 0UQM0ZZ 0UQMXZZ 0US00ZZ 0US04ZZ 0US10ZZ 0US14ZZ 0US20ZZ 0US24ZZ 0US40ZZ 0US44ZZ 0US50ZZ 0US54ZZ 0US60ZZ 0US64ZZ 0US70ZZ 0US74ZZ 0US90ZZ 0US94ZZ 0US9XZZ 0USC0ZZ

Repair Uterine Supporting Structure, Open Approach Repair Uterine Supporting Structure, Percutaneous Approach Repair Uterine Supporting Structure, Perc Endo Approach Repair Right Fallopian Tube, Open Approach Repair Right Fallopian Tube, Percutaneous Approach Repair Right Fallopian Tube, Perc Endo Approach Repair Right Fallopian Tube, Via Opening Repair Right Fallopian Tube, Endo Repair Left Fallopian Tube, Open Approach Repair Left Fallopian Tube, Percutaneous Approach Repair Left Fallopian Tube, Percutaneous Endoscopic Approach Repair Left Fallopian Tube, Via Opening Repair Left Fallopian Tube, Endo Repair Bilateral Fallopian Tubes, Open Approach Repair Bilateral Fallopian Tubes, Percutaneous Approach Repair Bilateral Fallopian Tubes, Perc Endo Approach Repair Bilateral Fallopian Tubes, Via Opening Repair Bilateral Fallopian Tubes, Endo Repair Uterus, Open Approach Repair Uterus, Percutaneous Approach Repair Uterus, Percutaneous Endoscopic Approach Repair Uterus, Via Natural or Artificial Opening Repair Uterus, Via Natural or Artificial Opening Endoscopic Repair Cervix, Open Approach Repair Cervix, Percutaneous Approach Repair Cervix, Percutaneous Endoscopic Approach Repair Cervix, Via Natural or Artificial Opening Repair Cervix, Via Natural or Artificial Opening Endoscopic Repair Cul-de-sac, Open Approach Repair Cul-de-sac, Percutaneous Approach Repair Cul-de-sac, Percutaneous Endoscopic Approach Repair Cul-de-sac, Via Natural or Artificial Opening Repair Cul-de-sac, Endo Repair Vagina, Open Approach Repair Vagina, Percutaneous Approach Repair Vagina, Percutaneous Endoscopic Approach Repair Vagina, Via Natural or Artificial Opening Repair Vagina, Via Natural or Artificial Opening Endoscopic Repair Vagina, External Approach Repair Clitoris, Open Approach Repair Clitoris, External Approach Repair Hymen, Open Approach Repair Hymen, Percutaneous Approach Repair Hymen, Percutaneous Endoscopic Approach Repair Hymen, Via Natural or Artificial Opening Repair Hymen, Via Natural or Artificial Opening Endoscopic Repair Vestibular Gland, Open Approach Repair Vestibular Gland, External Approach Repair Vulva, Open Approach Repair Vulva, External Approach Reposition Right Ovary, Open Approach Reposition Right Ovary, Percutaneous Endoscopic Approach Reposition Left Ovary, Open Approach Reposition Left Ovary, Percutaneous Endoscopic Approach Reposition Bilateral Ovaries, Open Approach Reposition Bilateral Ovaries, Perc Endo Approach Reposition Uterine Supporting Structure, Open Approach Reposition Uterine Supporting Structure, Perc Endo Approach Reposition Right Fallopian Tube, Open Approach Reposition Right Fallopian Tube, Perc Endo Approach Reposition Left Fallopian Tube, Open Approach Reposition Left Fallopian Tube, Perc Endo Approach Reposition Bilateral Fallopian Tubes, Open Approach Reposition Bilateral Fallopian Tubes, Perc Endo Approach Reposition Uterus, Open Approach Reposition Uterus, Percutaneous Endoscopic Approach Reposition Uterus, External Approach Reposition Cervix, Open Approach

1.116 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0USC4ZZ 0USF0ZZ 0USF4ZZ 0USG0ZZ 0USG4ZZ 0USGXZZ 0UT00ZZ 0UT04ZZ 0UT07ZZ 0UT08ZZ 0UT0FZZ 0UT10ZZ 0UT14ZZ 0UT17ZZ 0UT18ZZ 0UT1FZZ 0UT20ZZ 0UT24ZZ 0UT27ZZ 0UT28ZZ 0UT2FZZ 0UT40ZZ 0UT44ZZ 0UT47ZZ 0UT48ZZ 0UT50ZZ 0UT54ZZ 0UT57ZZ 0UT58ZZ 0UT5FZZ 0UT60ZZ 0UT64ZZ 0UT67ZZ 0UT68ZZ 0UT6FZZ 0UT70ZZ 0UT74ZZ 0UT77ZZ 0UT78ZZ 0UT7FZZ 0UT90ZZ 0UT94ZZ 0UT97ZZ 0UT98ZZ 0UT9FZZ 0UTC0ZZ 0UTC4ZZ 0UTC7ZZ 0UTC8ZZ 0UTF0ZZ 0UTF4ZZ 0UTF7ZZ 0UTF8ZZ 0UTG0ZZ 0UTG4ZZ 0UTG7ZZ 0UTG8ZZ 0UTJ0ZZ 0UTJXZZ 0UTK0ZZ 0UTK4ZZ 0UTK7ZZ 0UTK8ZZ 0UTL0ZZ 0UTLXZZ 0UTM0ZZ 0UTMXZZ 0UU407Z

Reposition Cervix, Percutaneous Endoscopic Approach Reposition Cul-de-sac, Open Approach Reposition Cul-de-sac, Percutaneous Endoscopic Approach Reposition Vagina, Open Approach Reposition Vagina, Percutaneous Endoscopic Approach Reposition Vagina, External Approach Resection of Right Ovary, Open Approach Resection of Right Ovary, Percutaneous Endoscopic Approach Resection of Right Ovary, Via Natural or Artificial Opening Resection of Right Ovary, Endo Resection of Right Ovary, Via Opening w Perc Endo Resection of Left Ovary, Open Approach Resection of Left Ovary, Percutaneous Endoscopic Approach Resection of Left Ovary, Via Natural or Artificial Opening Resection of Left Ovary, Endo Resection of Left Ovary, Via Opening w Perc Endo Resection of Bilateral Ovaries, Open Approach Resection of Bilateral Ovaries, Perc Endo Approach Resection of Bilateral Ovaries, Via Opening Resection of Bilateral Ovaries, Endo Resection of Bilateral Ovaries, Via Opening w Perc Endo Resection of Uterine Supporting Structure, Open Approach Resection of Uterine Support Struct, Perc Endo Approach Resection of Uterine Supporting Structure, Via Opening Resection of Uterine Supporting Structure, Endo Resection of Right Fallopian Tube, Open Approach Resection of Right Fallopian Tube, Perc Endo Approach Resection of Right Fallopian Tube, Via Opening Resection of Right Fallopian Tube, Endo Resection of Right Fallopian Tube, Via Opening w Perc Endo Resection of Left Fallopian Tube, Open Approach Resection of Left Fallopian Tube, Perc Endo Approach Resection of Left Fallopian Tube, Via Opening Resection of Left Fallopian Tube, Endo Resection of Left Fallopian Tube, Via Opening w Perc Endo Resection of Bilateral Fallopian Tubes, Open Approach Resection of Bilateral Fallopian Tubes, Perc Endo Approach Resection of Bilateral Fallopian Tubes, Via Opening Resection of Bilateral Fallopian Tubes, Endo Resection of Bi Fallopian Tube, Via Opening w Perc Endo Resection of Uterus, Open Approach Resection of Uterus, Percutaneous Endoscopic Approach Resection of Uterus, Via Natural or Artificial Opening Resection of Uterus, Endo Resection of Uterus, Via Opening w Perc Endo Resection of Cervix, Open Approach Resection of Cervix, Percutaneous Endoscopic Approach Resection of Cervix, Via Natural or Artificial Opening Resection of Cervix, Endo Resection of Cul-de-sac, Open Approach Resection of Cul-de-sac, Percutaneous Endoscopic Approach Resection of Cul-de-sac, Via Natural or Artificial Opening Resection of Cul-de-sac, Endo Resection of Vagina, Open Approach Resection of Vagina, Percutaneous Endoscopic Approach Resection of Vagina, Via Natural or Artificial Opening Resection of Vagina, Endo Resection of Clitoris, Open Approach Resection of Clitoris, External Approach Resection of Hymen, Open Approach Resection of Hymen, Percutaneous Endoscopic Approach Resection of Hymen, Via Natural or Artificial Opening Resection of Hymen, Endo Resection of Vestibular Gland, Open Approach Resection of Vestibular Gland, External Approach Resection of Vulva, Open Approach Resection of Vulva, External Approach Supplement Uterine Support Struct w Autol Sub, Open

September 2011

Edit code lists 1.117

Procedures allowed for females only

0UU40JZ 0UU40KZ 0UU447Z 0UU44JZ 0UU44KZ 0UU507Z 0UU50JZ 0UU50KZ 0UU547Z 0UU54JZ 0UU54KZ 0UU577Z 0UU57JZ 0UU57KZ 0UU587Z 0UU58JZ 0UU58KZ 0UU607Z 0UU60JZ 0UU60KZ 0UU647Z 0UU64JZ 0UU64KZ 0UU677Z 0UU67JZ 0UU67KZ 0UU687Z 0UU68JZ 0UU68KZ 0UU707Z 0UU70JZ 0UU70KZ 0UU747Z 0UU74JZ 0UU74KZ 0UU777Z 0UU77JZ 0UU77KZ 0UU787Z 0UU78JZ 0UU78KZ 0UUF07Z 0UUF0JZ 0UUF0KZ 0UUF47Z 0UUF4JZ 0UUF4KZ 0UUF77Z 0UUF7JZ 0UUF7KZ 0UUF87Z 0UUF8JZ 0UUF8KZ 0UUG07Z 0UUG0JZ 0UUG0KZ 0UUG47Z 0UUG4JZ 0UUG4KZ 0UUG77Z 0UUG7JZ 0UUG7KZ 0UUG87Z 0UUG8JZ 0UUG8KZ 0UUGX7Z 0UUGXJZ 0UUGXKZ

Supplement Uterine Support Struct w Synth Sub, Open Supplement Uterine Support Struct w Nonaut Sub, Open Supplement Uterine Support Struct w Autol Sub, Perc Endo Supplement Uterine Support Struct w Synth Sub, Perc Endo Supplement Uterine Support Struct w Nonaut Sub, Perc Endo Supplement R Fallopian Tube with Autol Sub, Open Approach Supplement R Fallopian Tube with Synth Sub, Open Approach Supplement R Fallopian Tube with Nonaut Sub, Open Approach Supplement R Fallopian Tube w Autol Sub, Perc Endo Supplement R Fallopian Tube w Synth Sub, Perc Endo Supplement R Fallopian Tube w Nonaut Sub, Perc Endo Supplement Right Fallopian Tube with Autol Sub, Via Opening Supplement Right Fallopian Tube with Synth Sub, Via Opening Supplement Right Fallopian Tube with Nonaut Sub, Via Opening Supplement Right Fallopian Tube with Autol Sub, Endo Supplement Right Fallopian Tube with Synth Sub, Endo Supplement Right Fallopian Tube with Nonaut Sub, Endo Supplement Left Fallopian Tube with Autol Sub, Open Approach Supplement Left Fallopian Tube with Synth Sub, Open Approach Supplement L Fallopian Tube with Nonaut Sub, Open Approach Supplement L Fallopian Tube w Autol Sub, Perc Endo Supplement L Fallopian Tube w Synth Sub, Perc Endo Supplement L Fallopian Tube w Nonaut Sub, Perc Endo Supplement Left Fallopian Tube with Autol Sub, Via Opening Supplement Left Fallopian Tube with Synth Sub, Via Opening Supplement Left Fallopian Tube with Nonaut Sub, Via Opening Supplement Left Fallopian Tube with Autol Sub, Endo Supplement Left Fallopian Tube with Synth Sub, Endo Supplement Left Fallopian Tube with Nonaut Sub, Endo Supplement Bi Fallopian Tube with Autol Sub, Open Approach Supplement Bi Fallopian Tube with Synth Sub, Open Approach Supplement Bi Fallopian Tube with Nonaut Sub, Open Approach Supplement Bi Fallopian Tube w Autol Sub, Perc Endo Supplement Bi Fallopian Tube w Synth Sub, Perc Endo Supplement Bi Fallopian Tube w Nonaut Sub, Perc Endo Supplement Bi Fallopian Tube with Autol Sub, Via Opening Supplement Bi Fallopian Tube with Synth Sub, Via Opening Supplement Bi Fallopian Tube with Nonaut Sub, Via Opening Supplement Bilateral Fallopian Tubes with Autol Sub, Endo Supplement Bilateral Fallopian Tubes with Synth Sub, Endo Supplement Bilateral Fallopian Tubes with Nonaut Sub, Endo Supplement Cul-de-sac with Autol Sub, Open Approach Supplement Cul-de-sac with Synth Sub, Open Approach Supplement Cul-de-sac with Nonaut Sub, Open Approach Supplement Cul-de-sac with Autol Sub, Perc Endo Approach Supplement Cul-de-sac with Synth Sub, Perc Endo Approach Supplement Cul-de-sac with Nonaut Sub, Perc Endo Approach Supplement Cul-de-sac with Autol Sub, Via Opening Supplement Cul-de-sac with Synthetic Substitute, Via Opening Supplement Cul-de-sac with Nonaut Sub, Via Opening Supplement Cul-de-sac with Autol Sub, Endo Supplement Cul-de-sac with Synthetic Substitute, Endo Supplement Cul-de-sac with Nonaut Sub, Endo Supplement Vagina with Autol Sub, Open Approach Supplement Vagina with Synthetic Substitute, Open Approach Supplement Vagina with Nonaut Sub, Open Approach Supplement Vagina with Autol Sub, Perc Endo Approach Supplement Vagina with Synth Sub, Perc Endo Approach Supplement Vagina with Nonaut Sub, Perc Endo Approach Supplement Vagina with Autol Sub, Via Opening Supplement Vagina with Synthetic Substitute, Via Opening Supplement Vagina with Nonaut Sub, Via Opening Supplement Vagina with Autologous Tissue Substitute, Endo Supplement Vagina with Synthetic Substitute, Endo Supplement Vagina with Nonautologous Tissue Substitute, Endo Supplement Vagina with Autol Sub, Extern Approach Supplement Vagina with Synthetic Substitute, Extern Approach Supplement Vagina with Nonaut Sub, Extern Approach

1.118 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0UUJ07Z 0UUJ0JZ 0UUJ0KZ 0UUJX7Z 0UUJXJZ 0UUJXKZ 0UUK07Z 0UUK0JZ 0UUK0KZ 0UUK47Z 0UUK4JZ 0UUK4KZ 0UUK77Z 0UUK7JZ 0UUK7KZ 0UUK87Z 0UUK8JZ 0UUK8KZ 0UUM07Z 0UUM0JZ 0UUM0KZ 0UUMX7Z 0UUMXJZ 0UUMXKZ 0UVC0CZ 0UVC0DZ 0UVC0ZZ 0UVC3CZ 0UVC3DZ 0UVC3ZZ 0UVC4CZ 0UVC4DZ 0UVC4ZZ 0UVC7DZ 0UVC7ZZ 0UVC8DZ 0UVC8ZZ 0UW300Z 0UW303Z 0UW330Z 0UW333Z 0UW340Z 0UW343Z 0UW3X0Z 0UW3X3Z 0UW800Z 0UW803Z 0UW807Z 0UW80CZ 0UW80DZ 0UW80JZ 0UW80KZ 0UW830Z 0UW833Z 0UW837Z 0UW83CZ 0UW83DZ 0UW83JZ 0UW83KZ 0UW840Z 0UW843Z 0UW847Z 0UW84CZ 0UW84DZ 0UW84JZ 0UW84KZ 0UW870Z 0UW873Z

Supplement Clitoris with Autol Sub, Open Approach Supplement Clitoris with Synthetic Substitute, Open Approach Supplement Clitoris with Nonaut Sub, Open Approach Supplement Clitoris with Autol Sub, Extern Approach Supplement Clitoris with Synth Sub, Extern Approach Supplement Clitoris with Nonaut Sub, Extern Approach Supplement Hymen with Autol Sub, Open Approach Supplement Hymen with Synthetic Substitute, Open Approach Supplement Hymen with Nonaut Sub, Open Approach Supplement Hymen with Autol Sub, Perc Endo Approach Supplement Hymen with Synth Sub, Perc Endo Approach Supplement Hymen with Nonaut Sub, Perc Endo Approach Supplement Hymen with Autol Sub, Via Opening Supplement Hymen with Synthetic Substitute, Via Opening Supplement Hymen with Nonaut Sub, Via Opening Supplement Hymen with Autologous Tissue Substitute, Endo Supplement Hymen with Synthetic Substitute, Endo Supplement Hymen with Nonautologous Tissue Substitute, Endo Supplement Vulva with Autol Sub, Open Approach Supplement Vulva with Synthetic Substitute, Open Approach Supplement Vulva with Nonaut Sub, Open Approach Supplement Vulva with Autol Sub, Extern Approach Supplement Vulva with Synthetic Substitute, Extern Approach Supplement Vulva with Nonaut Sub, Extern Approach Restriction of Cervix with Extralum Dev, Open Approach Restriction of Cervix with Intralum Dev, Open Approach Restriction of Cervix, Open Approach Restriction of Cervix with Extralum Dev, Perc Approach Restriction of Cervix with Intralum Dev, Perc Approach Restriction of Cervix, Percutaneous Approach Restriction of Cervix with Extralum Dev, Perc Endo Approach Restriction of Cervix with Intralum Dev, Perc Endo Approach Restriction of Cervix, Percutaneous Endoscopic Approach Restriction of Cervix with Intraluminal Device, Via Opening Restriction of Cervix, Via Natural or Artificial Opening Restriction of Cervix with Intraluminal Device, Endo Restriction of Cervix, Endo Revision of Drainage Device in Ovary, Open Approach Revision of Infusion Device in Ovary, Open Approach Revision of Drainage Device in Ovary, Percutaneous Approach Revision of Infusion Device in Ovary, Percutaneous Approach Revision of Drainage Device in Ovary, Perc Endo Approach Revision of Infusion Device in Ovary, Perc Endo Approach Revision of Drainage Device in Ovary, External Approach Revision of Infusion Device in Ovary, External Approach Revision of Drainage Device in Fallopian Tube, Open Approach Revision of Infusion Device in Fallopian Tube, Open Approach Revision of Autol Sub in Fallopian Tube, Open Approach Revision of Extralum Dev in Fallopian Tube, Open Approach Revision of Intralum Dev in Fallopian Tube, Open Approach Revision of Synth Sub in Fallopian Tube, Open Approach Revision of Nonaut Sub in Fallopian Tube, Open Approach Revision of Drainage Device in Fallopian Tube, Perc Approach Revision of Infusion Device in Fallopian Tube, Perc Approach Revision of Autol Sub in Fallopian Tube, Perc Approach Revision of Extralum Dev in Fallopian Tube, Perc Approach Revision of Intralum Dev in Fallopian Tube, Perc Approach Revision of Synth Sub in Fallopian Tube, Perc Approach Revision of Nonaut Sub in Fallopian Tube, Perc Approach Revision of Drain Dev in Fallopian Tube, Perc Endo Approach Revise of Infusion Dev in Fallopian Tube, Perc Endo Approach Revision of Autol Sub in Fallopian Tube, Perc Endo Approach Revise of Extralum Dev in Fallopian Tube, Perc Endo Approach Revise of Intralum Dev in Fallopian Tube, Perc Endo Approach Revision of Synth Sub in Fallopian Tube, Perc Endo Approach Revision of Nonaut Sub in Fallopian Tube, Perc Endo Approach Revision of Drainage Device in Fallopian Tube, Via Opening Revision of Infusion Device in Fallopian Tube, Via Opening

September 2011

Edit code lists 1.119

Procedures allowed for females only

0UW877Z 0UW87CZ 0UW87DZ 0UW87JZ 0UW87KZ 0UW880Z 0UW883Z 0UW887Z 0UW88CZ 0UW88DZ 0UW88JZ 0UW88KZ 0UW8X0Z 0UW8X3Z 0UW8X7Z 0UW8XCZ 0UW8XDZ 0UW8XJZ 0UW8XKZ 0UWD00Z 0UWD03Z 0UWD07Z 0UWD0CZ 0UWD0DZ 0UWD0HZ 0UWD0JZ 0UWD0KZ 0UWD30Z 0UWD33Z 0UWD37Z 0UWD3CZ 0UWD3DZ 0UWD3HZ 0UWD3JZ 0UWD3KZ 0UWD40Z 0UWD43Z 0UWD47Z 0UWD4CZ 0UWD4DZ 0UWD4HZ 0UWD4JZ 0UWD4KZ 0UWD70Z 0UWD73Z 0UWD77Z 0UWD7CZ 0UWD7DZ 0UWD7HZ 0UWD7JZ 0UWD7KZ 0UWD80Z 0UWD83Z 0UWD87Z 0UWD8CZ 0UWD8DZ 0UWD8HZ 0UWD8JZ 0UWD8KZ 0UWDX0Z 0UWDX3Z 0UWDX7Z 0UWDXCZ 0UWDXDZ 0UWDXHZ 0UWDXJZ 0UWDXKZ 0UWH00Z

Revision of Autol Sub in Fallopian Tube, Via Opening Revision of Extralum Dev in Fallopian Tube, Via Opening Revision of Intralum Dev in Fallopian Tube, Via Opening Revision of Synth Sub in Fallopian Tube, Via Opening Revision of Nonaut Sub in Fallopian Tube, Via Opening Revision of Drainage Device in Fallopian Tube, Endo Revision of Infusion Device in Fallopian Tube, Endo Revision of Autol Sub in Fallopian Tube, Endo Revision of Extraluminal Device in Fallopian Tube, Endo Revision of Intraluminal Device in Fallopian Tube, Endo Revision of Synthetic Substitute in Fallopian Tube, Endo Revision of Nonaut Sub in Fallopian Tube, Endo Revision of Drain Dev in Fallopian Tube, Extern Approach Revision of Infusion Dev in Fallopian Tube, Extern Approach Revision of Autol Sub in Fallopian Tube, Extern Approach Revision of Extralum Dev in Fallopian Tube, Extern Approach Revision of Intralum Dev in Fallopian Tube, Extern Approach Revision of Synth Sub in Fallopian Tube, Extern Approach Revision of Nonaut Sub in Fallopian Tube, Extern Approach Revision of Drain Dev in Uterus & Cervix, Open Approach Revision of Infusion Dev in Uterus & Cervix, Open Approach Revision of Autol Sub in Uterus & Cervix, Open Approach Revision of Extralum Dev in Uterus & Cervix, Open Approach Revision of Intralum Dev in Uterus & Cervix, Open Approach Revision of Contracep Dev in Uterus & Cervix, Open Approach Revision of Synth Sub in Uterus & Cervix, Open Approach Revision of Nonaut Sub in Uterus & Cervix, Open Approach Revision of Drain Dev in Uterus & Cervix, Perc Approach Revision of Infusion Dev in Uterus & Cervix, Perc Approach Revision of Autol Sub in Uterus & Cervix, Perc Approach Revision of Extralum Dev in Uterus & Cervix, Perc Approach Revision of Intralum Dev in Uterus & Cervix, Perc Approach Revision of Contracep Dev in Uterus & Cervix, Perc Approach Revision of Synth Sub in Uterus & Cervix, Perc Approach Revision of Nonaut Sub in Uterus & Cervix, Perc Approach Revision of Drain Dev in Uterus & Cervix, Perc Endo Approach Revise Infusion Dev in Uterus & Cervix, Perc Endo Revision of Autol Sub in Uterus & Cervix, Perc Endo Approach Revise Extralum Dev in Uterus & Cervix, Perc Endo Revise Intralum Dev in Uterus & Cervix, Perc Endo Revise Contracep Dev in Uterus & Cervix, Perc Endo Revision of Synth Sub in Uterus & Cervix, Perc Endo Approach Revise of Nonaut Sub in Uterus & Cervix, Perc Endo Approach Revision of Drainage Device in Uterus & Cervix, Via Opening Revision of Infusion Device in Uterus & Cervix, Via Opening Revision of Autol Sub in Uterus & Cervix, Via Opening Revision of Extralum Dev in Uterus & Cervix, Via Opening Revision of Intralum Dev in Uterus & Cervix, Via Opening Revision of Contracep Dev in Uterus & Cervix, Via Opening Revision of Synth Sub in Uterus & Cervix, Via Opening Revision of Nonaut Sub in Uterus & Cervix, Via Opening Revision of Drainage Device in Uterus and Cervix, Endo Revision of Infusion Device in Uterus and Cervix, Endo Revision of Autol Sub in Uterus & Cervix, Endo Revision of Extraluminal Device in Uterus and Cervix, Endo Revision of Intraluminal Device in Uterus and Cervix, Endo Revision of Contraceptive Device in Uterus and Cervix, Endo Revision of Synthetic Substitute in Uterus and Cervix, Endo Revision of Nonaut Sub in Uterus & Cervix, Endo Revision of Drain Dev in Uterus & Cervix, Extern Approach Revision of Infusion Dev in Uterus & Cervix, Extern Approach Revision of Autol Sub in Uterus & Cervix, Extern Approach Revision of Extralum Dev in Uterus & Cervix, Extern Approach Revision of Intralum Dev in Uterus & Cervix, Extern Approach Revise of Contracep Dev in Uterus & Cervix, Extern Approach Revision of Synth Sub in Uterus & Cervix, Extern Approach Revision of Nonaut Sub in Uterus & Cervix, Extern Approach Revision of Drain Dev in Vagina & Cul-de-sac, Open Approach

1.120 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0UWH03Z 0UWH07Z 0UWH0DZ 0UWH0GZ 0UWH0JZ 0UWH0KZ 0UWH30Z 0UWH33Z 0UWH37Z 0UWH3DZ 0UWH3GZ 0UWH3JZ 0UWH3KZ 0UWH40Z 0UWH43Z 0UWH47Z 0UWH4DZ 0UWH4GZ 0UWH4JZ 0UWH4KZ 0UWH70Z 0UWH73Z 0UWH77Z 0UWH7DZ 0UWH7GZ 0UWH7JZ 0UWH7KZ 0UWH80Z 0UWH83Z 0UWH87Z 0UWH8DZ 0UWH8GZ 0UWH8JZ 0UWH8KZ 0UWHX0Z 0UWHX3Z 0UWHX7Z 0UWHXDZ 0UWHXGZ 0UWHXJZ 0UWHXKZ 0UWM00Z 0UWM07Z 0UWM0JZ 0UWM0KZ 0UWMX0Z 0UWMX7Z 0UWMXJZ 0UWMXKZ 0UY00Z0 0UY00Z1 0UY00Z2 0UY10Z0 0UY10Z1 0UY10Z2 0W0N07Z 0W0N0JZ 0W0N0KZ 0W0N0ZZ 0W0N37Z 0W0N3JZ 0W0N3KZ 0W0N3ZZ 0W0N47Z 0W0N4JZ 0W0N4KZ 0W0N4ZZ 0W1J0J9

Revise of Infusion Dev in Vagina & Cul-de-sac, Open Approach Revision of Autol Sub in Vagina & Cul-de-sac, Open Approach Revise of Intralum Dev in Vagina & Cul-de-sac, Open Approach Revision of Pessary in Vagina and Cul-de-sac, Open Approach Revision of Synth Sub in Vagina & Cul-de-sac, Open Approach Revision of Nonaut Sub in Vagina & Cul-de-sac, Open Approach Revision of Drain Dev in Vagina & Cul-de-sac, Perc Approach Revise of Infusion Dev in Vagina & Cul-de-sac, Perc Approach Revision of Autol Sub in Vagina & Cul-de-sac, Perc Approach Revise of Intralum Dev in Vagina & Cul-de-sac, Perc Approach Revision of Pessary in Vagina and Cul-de-sac, Perc Approach Revision of Synth Sub in Vagina & Cul-de-sac, Perc Approach Revision of Nonaut Sub in Vagina & Cul-de-sac, Perc Approach Revise Drain Dev in Vagina & Cul-de-sac, Perc Endo Revise Infusion Dev in Vagina & Cul-de-sac, Perc Endo Revise Autol Sub in Vagina & Cul-de-sac, Perc Endo Revise Intralum Dev in Vagina & Cul-de-sac, Perc Endo Revise of Pessary in Vagina & Cul-de-sac, Perc Endo Approach Revise Synth Sub in Vagina & Cul-de-sac, Perc Endo Revise Nonaut Sub in Vagina & Cul-de-sac, Perc Endo Revision of Drain Dev in Vagina & Cul-de-sac, Via Opening Revision of Infusion Dev in Vagina & Cul-de-sac, Via Opening Revision of Autol Sub in Vagina & Cul-de-sac, Via Opening Revision of Intralum Dev in Vagina & Cul-de-sac, Via Opening Revision of Pessary in Vagina and Cul-de-sac, Via Opening Revision of Synth Sub in Vagina & Cul-de-sac, Via Opening Revision of Nonaut Sub in Vagina & Cul-de-sac, Via Opening Revision of Drainage Device in Vagina and Cul-de-sac, Endo Revision of Infusion Device in Vagina and Cul-de-sac, Endo Revision of Autol Sub in Vagina & Cul-de-sac, Endo Revision of Intraluminal Device in Vagina & Cul-de-sac, Endo Revision of Pessary in Vagina and Cul-de-sac, Endo Revision of Synth Sub in Vagina & Cul-de-sac, Endo Revision of Nonaut Sub in Vagina & Cul-de-sac, Endo Revise of Drain Dev in Vagina & Cul-de-sac, Extern Approach Revise Infusion Dev in Vagina & Cul-de-sac, Extern Revise of Autol Sub in Vagina & Cul-de-sac, Extern Approach Revise Intralum Dev in Vagina & Cul-de-sac, Extern Revision of Pessary in Vagina & Cul-de-sac, Extern Approach Revise of Synth Sub in Vagina & Cul-de-sac, Extern Approach Revise of Nonaut Sub in Vagina & Cul-de-sac, Extern Approach Revision of Drainage Device in Vulva, Open Approach Revision of Autol Sub in Vulva, Open Approach Revision of Synthetic Substitute in Vulva, Open Approach Revision of Nonaut Sub in Vulva, Open Approach Revision of Drainage Device in Vulva, External Approach Revision of Autol Sub in Vulva, Extern Approach Revision of Synthetic Substitute in Vulva, External Approach Revision of Nonaut Sub in Vulva, Extern Approach Transplantation of Right Ovary, Allogeneic, Open Approach Transplantation of Right Ovary, Syngeneic, Open Approach Transplantation of Right Ovary, Zooplastic, Open Approach Transplantation of Left Ovary, Allogeneic, Open Approach Transplantation of Left Ovary, Syngeneic, Open Approach Transplantation of Left Ovary, Zooplastic, Open Approach Alteration of Female Perineum with Autol Sub, Open Approach Alteration of Female Perineum with Synth Sub, Open Approach Alteration of Female Perineum with Nonaut Sub, Open Approach Alteration of Female Perineum, Open Approach Alteration of Female Perineum with Autol Sub, Perc Approach Alteration of Female Perineum with Synth Sub, Perc Approach Alteration of Female Perineum with Nonaut Sub, Perc Approach Alteration of Female Perineum, Percutaneous Approach Alter of Fem Perineum with Autol Sub, Perc Endo Approach Alter of Fem Perineum with Synth Sub, Perc Endo Approach Alter of Fem Perineum with Nonaut Sub, Perc Endo Approach Alteration of Female Perineum, Perc Endo Approach Bypass Pelvic Cav to R Pleural Cav w Synth Sub, Open

September 2011

Edit code lists 1.121

Procedures allowed for females only

0W1J0JB 0W1J0JG 0W1J0JJ 0W1J4J9 0W1J4JB 0W1J4JG 0W1J4JJ 0W8NXZZ 0W9N00Z 0W9N0ZZ 0W9N30Z 0W9N3ZZ 0W9N40Z 0W9N4ZZ 0WBN0ZX 0WBN0ZZ 0WBN3ZX 0WBN3ZZ 0WBN4ZX 0WBN4ZZ 0WBNXZX 0WBNXZZ 0WHN03Z 0WHN0YZ 0WHN33Z 0WHN3YZ 0WHN43Z 0WHN4YZ 0WJN0ZZ 0WJN3ZZ 0WJN4ZZ 0WMN0ZZ 0WPN00Z 0WPN01Z 0WPN03Z 0WPN07Z 0WPN0JZ 0WPN0KZ 0WPN0YZ 0WPN30Z 0WPN31Z 0WPN33Z 0WPN37Z 0WPN3JZ 0WPN3KZ 0WPN3YZ 0WPN40Z 0WPN41Z 0WPN43Z 0WPN47Z 0WPN4JZ 0WPN4KZ 0WPN4YZ 0WQN0ZZ 0WQN3ZZ 0WQN4ZZ 0WQNXZZ 0WUN07Z 0WUN0JZ 0WUN0KZ 0WUN47Z 0WUN4JZ 0WUN4KZ 0WWN00Z 0WWN01Z 0WWN03Z 0WWN07Z 0WWN0JZ

Bypass Pelvic Cav to L Pleural Cav w Synth Sub, Open Bypass Pelvic Cav to Periton Cav w Synth Sub, Open Bypass Pelvic Cav to Pelvic Cav w Synth Sub, Open Bypass Pelvic Cav to R Pleural Cav w Synth Sub, Perc Endo Bypass Pelvic Cav to L Pleural Cav w Synth Sub, Perc Endo Bypass Pelvic Cav to Periton Cav w Synth Sub, Perc Endo Bypass Pelvic Cav to Pelvic Cav w Synth Sub, Perc Endo Division of Female Perineum, External Approach Drainage of Female Perineum with Drain Dev, Open Approach Drainage of Female Perineum, Open Approach Drainage of Female Perineum with Drain Dev, Perc Approach Drainage of Female Perineum, Percutaneous Approach Drainage of Fem Perineum with Drain Dev, Perc Endo Approach Drainage of Female Perineum, Perc Endo Approach Excision of Female Perineum, Open Approach, Diagnostic Excision of Female Perineum, Open Approach Excision of Female Perineum, Percutaneous Approach, Diagn Excision of Female Perineum, Percutaneous Approach Excision of Female Perineum, Perc Endo Approach, Diagn Excision of Female Perineum, Perc Endo Approach Excision of Female Perineum, External Approach, Diagnostic Excision of Female Perineum, External Approach Insertion of Infusion Dev into Fem Perineum, Open Approach Insertion of Other Device into Fem Perineum, Open Approach Insertion of Infusion Dev into Fem Perineum, Perc Approach Insertion of Other Device into Fem Perineum, Perc Approach Insert of Infusion Dev into Fem Perineum, Perc Endo Approach Insertion of Oth Dev into Fem Perineum, Perc Endo Approach Inspection of Female Perineum, Open Approach Inspection of Female Perineum, Percutaneous Approach Inspection of Female Perineum, Perc Endo Approach Reattachment of Female Perineum, Open Approach Removal of Drainage Device from Fem Perineum, Open Approach Removal of Radioact Elem from Fem Perineum, Open Approach Removal of Infusion Device from Fem Perineum, Open Approach Removal of Autol Sub from Fem Perineum, Open Approach Removal of Synth Sub from Fem Perineum, Open Approach Removal of Nonaut Sub from Fem Perineum, Open Approach Removal of Other Device from Female Perineum, Open Approach Removal of Drainage Device from Fem Perineum, Perc Approach Removal of Radioact Elem from Fem Perineum, Perc Approach Removal of Infusion Device from Fem Perineum, Perc Approach Removal of Autol Sub from Fem Perineum, Perc Approach Removal of Synth Sub from Fem Perineum, Perc Approach Removal of Nonaut Sub from Fem Perineum, Perc Approach Removal of Other Device from Female Perineum, Perc Approach Removal of Drain Dev from Fem Perineum, Perc Endo Approach Remove Radioact Elem from Fem Perineum, Perc Endo Remove of Infusion Dev from Fem Perineum, Perc Endo Approach Removal of Autol Sub from Fem Perineum, Perc Endo Approach Removal of Synth Sub from Fem Perineum, Perc Endo Approach Removal of Nonaut Sub from Fem Perineum, Perc Endo Approach Removal of Oth Dev from Fem Perineum, Perc Endo Approach Repair Female Perineum, Open Approach Repair Female Perineum, Percutaneous Approach Repair Female Perineum, Percutaneous Endoscopic Approach Repair Female Perineum, External Approach Supplement Female Perineum with Autol Sub, Open Approach Supplement Female Perineum with Synth Sub, Open Approach Supplement Female Perineum with Nonaut Sub, Open Approach Supplement Fem Perineum with Autol Sub, Perc Endo Approach Supplement Fem Perineum with Synth Sub, Perc Endo Approach Supplement Fem Perineum with Nonaut Sub, Perc Endo Approach Revision of Drainage Device in Fem Perineum, Open Approach Revision of Radioact Elem in Fem Perineum, Open Approach Revision of Infusion Device in Fem Perineum, Open Approach Revision of Autol Sub in Fem Perineum, Open Approach Revision of Synth Sub in Fem Perineum, Open Approach

1.122 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

0WWN0KZ 0WWN0YZ 0WWN30Z 0WWN31Z 0WWN33Z 0WWN37Z 0WWN3JZ 0WWN3KZ 0WWN3YZ 0WWN40Z 0WWN41Z 0WWN43Z 0WWN47Z 0WWN4JZ 0WWN4KZ 0WWN4YZ 102073Z 10207YZ 10900Z9 10900ZA 10900ZB 10900ZC 10900ZD 10900ZU 10903Z9 10903ZA 10903ZB 10903ZC 10903ZD 10903ZU 10904Z9 10904ZA 10904ZB 10904ZC 10904ZD 10904ZU 10907Z9 10907ZA 10907ZB 10907ZC 10907ZD 10907ZU 10908Z9 10908ZA 10908ZB 10908ZC 10908ZD 10908ZU 10A00ZZ 10A03ZZ 10A04ZZ 10A07Z6 10A07ZW 10A07ZX 10A07ZZ 10A08ZZ 10D00Z0 10D00Z1 10D00Z2 10D07Z3 10D07Z4 10D07Z5 10D07Z6 10D07Z7 10D07Z8 10D17ZZ 10D18ZZ 10D27ZZ

Revision of Nonaut Sub in Fem Perineum, Open Approach Revision of Other Device in Female Perineum, Open Approach Revision of Drainage Device in Fem Perineum, Perc Approach Revision of Radioact Elem in Fem Perineum, Perc Approach Revision of Infusion Device in Fem Perineum, Perc Approach Revision of Autol Sub in Fem Perineum, Perc Approach Revision of Synth Sub in Fem Perineum, Perc Approach Revision of Nonaut Sub in Fem Perineum, Perc Approach Revision of Other Device in Female Perineum, Perc Approach Revision of Drain Dev in Fem Perineum, Perc Endo Approach Revise of Radioact Elem in Fem Perineum, Perc Endo Approach Revision of Infusion Dev in Fem Perineum, Perc Endo Approach Revision of Autol Sub in Fem Perineum, Perc Endo Approach Revision of Synth Sub in Fem Perineum, Perc Endo Approach Revision of Nonaut Sub in Fem Perineum, Perc Endo Approach Revision of Other Device in Fem Perineum, Perc Endo Approach Change Monitoring Electrode in POC, Via Opening Change Other Device in Products of Conception, Via Opening Drainage of Fetal Blood from POC, Open Approach Drainage of Fetal CSF from POC, Open Approach Drainage of Other Fetal Fluid from POC, Open Approach Drainage of Amniotic Fl, Therap from POC, Open Approach Drainage of Other Fluid from POC, Open Approach Drainage of Amniotic Fl, Diagn from POC, Open Approach Drainage of Fetal Blood from POC, Perc Approach Drainage of Fetal CSF from POC, Perc Approach Drainage of Other Fetal Fluid from POC, Perc Approach Drainage of Amniotic Fl, Therap from POC, Perc Approach Drainage of Other Fluid from POC, Perc Approach Drainage of Amniotic Fl, Diagn from POC, Perc Approach Drainage of Fetal Blood from POC, Perc Endo Approach Drainage of Fetal CSF from POC, Perc Endo Approach Drainage of Other Fetal Fluid from POC, Perc Endo Approach Drainage of Amniotic Fl, Therap from POC, Perc Endo Approach Drainage of Other Fluid from POC, Perc Endo Approach Drainage of Amniotic Fl, Diagn from POC, Perc Endo Approach Drainage of Fetal Blood from POC, Via Opening Drainage of Fetal Cerebrospinal Fluid from POC, Via Opening Drainage of Other Fetal Fluid from POC, Via Opening Drainage of Amniotic Fl, Therap from POC, Via Opening Drainage of Other Fluid from POC, Via Opening Drainage of Amniotic Fluid, Diagnostic from POC, Via Opening Drainage of Fetal Blood from Products of Conception, Endo Drainage of Fetal Cerebrospinal Fluid from POC, Endo Drainage of Other Fetal Fluid from POC, Endo Drainage of Amniotic Fluid, Therapeutic from POC, Endo Drainage of Other Fluid from Products of Conception, Endo Drainage of Amniotic Fluid, Diagnostic from POC, Endo Abortion of Products of Conception, Open Approach Abortion of Products of Conception, Percutaneous Approach Abortion of Products of Conception, Perc Endo Approach Abortion of Products of Conception, Vacuum, Via Opening Abortion of Products of Conception, Laminaria, Via Opening Abortion of POC, Abortifacient, Via Opening Abortion of Products of Conception, Via Opening Abortion of Products of Conception, Endo Extraction of POC, Classical, Open Approach Extraction of POC, Low Cervical, Open Approach Extraction of POC, Extraperitoneal, Open Approach Extraction of POC, Low Forceps, Via Opening Extraction of POC, Mid Forceps, Via Opening Extraction of POC, High Forceps, Via Opening Extraction of Products of Conception, Vacuum, Via Opening Extraction of POC, Int Version, Via Opening Extraction of Products of Conception, Other, Via Opening Extraction of Products of Conception, Retained, Via Opening Extraction of Products of Conception, Retained, Endo Extraction of Products of Conception, Ectopic, Via Opening

September 2011

Edit code lists 1.123

Procedures allowed for females only

10D28ZZ 10E0XZZ 10H003Z 10H00YZ 10H073Z 10H07YZ 10J00ZZ 10J03ZZ 10J04ZZ 10J07ZZ 10J08ZZ 10J0XZZ 10J10ZZ 10J13ZZ 10J14ZZ 10J17ZZ 10J18ZZ 10J1XZZ 10J20ZZ 10J23ZZ 10J24ZZ 10J27ZZ 10J28ZZ 10J2XZZ 10P003Z 10P00YZ 10P073Z 10P07YZ 10Q00YE 10Q00YF 10Q00YG 10Q00YH 10Q00YJ 10Q00YK 10Q00YL 10Q00YM 10Q00YN 10Q00YP 10Q00YQ 10Q00YR 10Q00YS 10Q00YT 10Q00YV 10Q00YY 10Q00ZE 10Q00ZF 10Q00ZG 10Q00ZH 10Q00ZJ 10Q00ZK 10Q00ZL 10Q00ZM 10Q00ZN 10Q00ZP 10Q00ZQ 10Q00ZR 10Q00ZS 10Q00ZT 10Q00ZV 10Q00ZY 10Q03YE 10Q03YF 10Q03YG 10Q03YH 10Q03YJ 10Q03YK 10Q03YL 10Q03YM

Extraction of Products of Conception, Ectopic, Endo Delivery of Products of Conception, External Approach Insertion of Monitoring Electrode into POC, Open Approach Insertion of Other Device into POC, Open Approach Insertion of Monitoring Electrode into POC, Via Opening Insertion of Other Device into POC, Via Opening Inspection of Products of Conception, Open Approach Inspection of Products of Conception, Percutaneous Approach Inspection of Products of Conception, Perc Endo Approach Inspection of Products of Conception, Via Opening Inspection of Products of Conception, Endo Inspection of Products of Conception, External Approach Inspection of Retained POC, Open Approach Inspection of Retained POC, Perc Approach Inspection of Retained POC, Perc Endo Approach Inspection of Products of Conception, Retained, Via Opening Inspection of Products of Conception, Retained, Endo Inspection of Retained POC, Extern Approach Inspection of Products of Conception, Ectopic, Open Approach Inspection of Products of Conception, Ectopic, Perc Approach Inspection of Ectopic POC, Perc Endo Approach Inspection of Products of Conception, Ectopic, Via Opening Inspection of Products of Conception, Ectopic, Endo Inspection of Ectopic POC, Extern Approach Removal of Monitoring Electrode from POC, Open Approach Removal of Other Device from POC, Open Approach Removal of Monitoring Electrode from POC, Via Opening Removal of Other Device from POC, Via Opening Repair Nervous System in POC with Oth Dev, Open Approach Repair Cardiovascular Sys in POC with Oth Dev, Open Approach Repair Lymph & Hemic in POC with Oth Dev, Open Approach Repair Eye in POC with Oth Dev, Open Approach Repair Ear, Nose & Sinus in POC with Oth Dev, Open Approach Repair Respiratory System in POC with Oth Dev, Open Approach Repair Mouth and Throat in POC with Oth Dev, Open Approach Repair GI Sys in POC with Oth Dev, Open Approach Repair Hepatobil & Pancr in POC with Oth Dev, Open Approach Repair Endocrine System in POC with Oth Dev, Open Approach Repair Skin in POC with Oth Dev, Open Approach Repair Musculoskel Sys in POC with Oth Dev, Open Approach Repair Urinary System in POC with Oth Dev, Open Approach Repair Fem Reprod Sys in POC with Oth Dev, Open Approach Repair Male Reprod Sys in POC with Oth Dev, Open Approach Repair Other Body System in POC with Oth Dev, Open Approach Repair Nervous System in POC, Open Approach Repair Cardiovascular System in POC, Open Approach Repair Lymphatics and Hemic in POC, Open Approach Repair Eye in Products of Conception, Open Approach Repair Ear, Nose and Sinus in POC, Open Approach Repair Respiratory System in POC, Open Approach Repair Mouth and Throat in POC, Open Approach Repair Gastrointestinal System in POC, Open Approach Repair Hepatobiliary and Pancreas in POC, Open Approach Repair Endocrine System in POC, Open Approach Repair Skin in Products of Conception, Open Approach Repair Musculoskeletal System in POC, Open Approach Repair Urinary System in POC, Open Approach Repair Female Reproductive System in POC, Open Approach Repair Male Reproductive System in POC, Open Approach Repair Other Body System in POC, Open Approach Repair Nervous System in POC with Oth Dev, Perc Approach Repair Cardiovascular Sys in POC with Oth Dev, Perc Approach Repair Lymph & Hemic in POC with Oth Dev, Perc Approach Repair Eye in POC with Oth Dev, Perc Approach Repair Ear, Nose & Sinus in POC with Oth Dev, Perc Approach Repair Respiratory System in POC with Oth Dev, Perc Approach Repair Mouth and Throat in POC with Oth Dev, Perc Approach Repair GI Sys in POC with Oth Dev, Perc Approach

1.124 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

10Q03YN 10Q03YP 10Q03YQ 10Q03YR 10Q03YS 10Q03YT 10Q03YV 10Q03YY 10Q03ZE 10Q03ZF 10Q03ZG 10Q03ZH 10Q03ZJ 10Q03ZK 10Q03ZL 10Q03ZM 10Q03ZN 10Q03ZP 10Q03ZQ 10Q03ZR 10Q03ZS 10Q03ZT 10Q03ZV 10Q03ZY 10Q04YE 10Q04YF 10Q04YG 10Q04YH 10Q04YJ 10Q04YK 10Q04YL 10Q04YM 10Q04YN 10Q04YP 10Q04YQ 10Q04YR 10Q04YS 10Q04YT 10Q04YV 10Q04YY 10Q04ZE 10Q04ZF 10Q04ZG 10Q04ZH 10Q04ZJ 10Q04ZK 10Q04ZL 10Q04ZM 10Q04ZN 10Q04ZP 10Q04ZQ 10Q04ZR 10Q04ZS 10Q04ZT 10Q04ZV 10Q04ZY 10Q07YE 10Q07YF 10Q07YG 10Q07YH 10Q07YJ 10Q07YK 10Q07YL 10Q07YM 10Q07YN 10Q07YP 10Q07YQ 10Q07YR

Repair Hepatobil & Pancr in POC with Oth Dev, Perc Approach Repair Endocrine System in POC with Oth Dev, Perc Approach Repair Skin in POC with Oth Dev, Perc Approach Repair Musculoskel Sys in POC with Oth Dev, Perc Approach Repair Urinary System in POC with Oth Dev, Perc Approach Repair Fem Reprod Sys in POC with Oth Dev, Perc Approach Repair Male Reprod Sys in POC with Oth Dev, Perc Approach Repair Other Body System in POC with Oth Dev, Perc Approach Repair Nervous System in POC, Perc Approach Repair Cardiovascular System in POC, Perc Approach Repair Lymphatics and Hemic in POC, Perc Approach Repair Eye in Products of Conception, Percutaneous Approach Repair Ear, Nose and Sinus in POC, Perc Approach Repair Respiratory System in POC, Perc Approach Repair Mouth and Throat in POC, Perc Approach Repair Gastrointestinal System in POC, Perc Approach Repair Hepatobiliary and Pancreas in POC, Perc Approach Repair Endocrine System in POC, Perc Approach Repair Skin in Products of Conception, Percutaneous Approach Repair Musculoskeletal System in POC, Perc Approach Repair Urinary System in POC, Perc Approach Repair Female Reproductive System in POC, Perc Approach Repair Male Reproductive System in POC, Perc Approach Repair Other Body System in POC, Perc Approach Repair Nervous Sys in POC with Oth Dev, Perc Endo Approach Repair Cardiovascular Sys in POC w Oth Dev, Perc Endo Repair Lymph & Hemic in POC with Oth Dev, Perc Endo Approach Repair Eye in POC with Oth Dev, Perc Endo Approach Repair Ear, Nose & Sinus in POC w Oth Dev, Perc Endo Repair Resp Sys in POC with Oth Dev, Perc Endo Approach Repair Mouth/Throat in POC with Oth Dev, Perc Endo Approach Repair GI Sys in POC with Oth Dev, Perc Endo Approach Repair Hepatobil & Pancr in POC w Oth Dev, Perc Endo Repair Endocrine Sys in POC with Oth Dev, Perc Endo Approach Repair Skin in POC with Oth Dev, Perc Endo Approach Repair Musculoskel Sys in POC w Oth Dev, Perc Endo Repair Urinary Sys in POC with Oth Dev, Perc Endo Approach Repair Fem Reprod Sys in POC w Oth Dev, Perc Endo Repair Male Reprod Sys in POC w Oth Dev, Perc Endo Repair Oth Body Sys in POC with Oth Dev, Perc Endo Approach Repair Nervous System in POC, Perc Endo Approach Repair Cardiovascular System in POC, Perc Endo Approach Repair Lymphatics and Hemic in POC, Perc Endo Approach Repair Eye in Products of Conception, Perc Endo Approach Repair Ear, Nose and Sinus in POC, Perc Endo Approach Repair Respiratory System in POC, Perc Endo Approach Repair Mouth and Throat in POC, Perc Endo Approach Repair Gastrointestinal System in POC, Perc Endo Approach Repair Hepatobiliary and Pancreas in POC, Perc Endo Approach Repair Endocrine System in POC, Perc Endo Approach Repair Skin in Products of Conception, Perc Endo Approach Repair Musculoskeletal System in POC, Perc Endo Approach Repair Urinary System in POC, Perc Endo Approach Repair Female Reproductive System in POC, Perc Endo Approach Repair Male Reproductive System in POC, Perc Endo Approach Repair Other Body System in POC, Perc Endo Approach Repair Nervous System in POC with Oth Dev, Via Opening Repair Cardiovascular Sys in POC with Oth Dev, Via Opening Repair Lymphatics and Hemic in POC with Oth Dev, Via Opening Repair Eye in POC with Oth Dev, Via Opening Repair Ear, Nose and Sinus in POC with Oth Dev, Via Opening Repair Respiratory System in POC with Oth Dev, Via Opening Repair Mouth and Throat in POC with Oth Dev, Via Opening Repair GI Sys in POC with Oth Dev, Via Opening Repair Hepatobil & Pancr in POC with Oth Dev, Via Opening Repair Endocrine System in POC with Oth Dev, Via Opening Repair Skin in POC with Oth Dev, Via Opening Repair Musculoskel Sys in POC with Oth Dev, Via Opening

September 2011

Edit code lists 1.125

Procedures allowed for females only

10Q07YS 10Q07YT 10Q07YV 10Q07YY 10Q07ZE 10Q07ZF 10Q07ZG 10Q07ZH 10Q07ZJ 10Q07ZK 10Q07ZL 10Q07ZM 10Q07ZN 10Q07ZP 10Q07ZQ 10Q07ZR 10Q07ZS 10Q07ZT 10Q07ZV 10Q07ZY 10Q08YE 10Q08YF 10Q08YG 10Q08YH 10Q08YJ 10Q08YK 10Q08YL 10Q08YM 10Q08YN 10Q08YP 10Q08YQ 10Q08YR 10Q08YS 10Q08YT 10Q08YV 10Q08YY 10Q08ZE 10Q08ZF 10Q08ZG 10Q08ZH 10Q08ZJ 10Q08ZK 10Q08ZL 10Q08ZM 10Q08ZN 10Q08ZP 10Q08ZQ 10Q08ZR 10Q08ZS 10Q08ZT 10Q08ZV 10Q08ZY 10S07ZZ 10S0XZZ 10S20ZZ 10S23ZZ 10S24ZZ 10S27ZZ 10S28ZZ 10T20ZZ 10T23ZZ 10T24ZZ 10T27ZZ 10T28ZZ 10Y03ZE 10Y03ZF 10Y03ZG 10Y03ZH

Repair Urinary System in POC with Oth Dev, Via Opening Repair Fem Reprod Sys in POC with Oth Dev, Via Opening Repair Male Reprod Sys in POC with Oth Dev, Via Opening Repair Other Body System in POC with Oth Dev, Via Opening Repair Nervous System in Products of Conception, Via Opening Repair Cardiovascular System in POC, Via Opening Repair Lymphatics and Hemic in POC, Via Opening Repair Eye in Products of Conception, Via Opening Repair Ear, Nose and Sinus in POC, Via Opening Repair Respiratory System in POC, Via Opening Repair Mouth and Throat in POC, Via Opening Repair Gastrointestinal System in POC, Via Opening Repair Hepatobiliary and Pancreas in POC, Via Opening Repair Endocrine System in POC, Via Opening Repair Skin in Products of Conception, Via Opening Repair Musculoskeletal System in POC, Via Opening Repair Urinary System in Products of Conception, Via Opening Repair Female Reproductive System in POC, Via Opening Repair Male Reproductive System in POC, Via Opening Repair Other Body System in POC, Via Opening Repair Nervous System in POC with Oth Dev, Endo Repair Cardiovascular System in POC with Oth Dev, Endo Repair Lymphatics and Hemic in POC with Oth Dev, Endo Repair Eye in Products of Conception with Other Device, Endo Repair Ear, Nose and Sinus in POC with Oth Dev, Endo Repair Respiratory System in POC with Oth Dev, Endo Repair Mouth and Throat in POC with Oth Dev, Endo Repair Gastrointestinal System in POC with Oth Dev, Endo Repair Hepatobiliary and Pancreas in POC with Oth Dev, Endo Repair Endocrine System in POC with Oth Dev, Endo Repair Skin in Products of Conception with Oth Dev, Endo Repair Musculoskeletal System in POC with Oth Dev, Endo Repair Urinary System in POC with Oth Dev, Endo Repair Female Reproductive System in POC with Oth Dev, Endo Repair Male Reproductive System in POC with Oth Dev, Endo Repair Other Body System in POC with Oth Dev, Endo Repair Nervous System in Products of Conception, Endo Repair Cardiovascular System in Products of Conception, Endo Repair Lymphatics and Hemic in Products of Conception, Endo Repair Eye in Products of Conception, Endo Repair Ear, Nose and Sinus in Products of Conception, Endo Repair Respiratory System in Products of Conception, Endo Repair Mouth and Throat in Products of Conception, Endo Repair Gastrointestinal System in POC, Endo Repair Hepatobiliary and Pancreas in POC, Endo Repair Endocrine System in Products of Conception, Endo Repair Skin in Products of Conception, Endo Repair Musculoskeletal System in POC, Endo Repair Urinary System in Products of Conception, Endo Repair Female Reproductive System in POC, Endo Repair Male Reproductive System in POC, Endo Repair Other Body System in Products of Conception, Endo Reposition Products of Conception, Via Opening Reposition Products of Conception, External Approach Reposition Products of Conception, Ectopic, Open Approach Reposition Products of Conception, Ectopic, Perc Approach Reposition Ectopic POC, Perc Endo Approach Reposition Products of Conception, Ectopic, Via Opening Reposition Products of Conception, Ectopic, Endo Resection of Products of Conception, Ectopic, Open Approach Resection of Products of Conception, Ectopic, Perc Approach Resection of Ectopic POC, Perc Endo Approach Resection of Products of Conception, Ectopic, Via Opening Resection of Products of Conception, Ectopic, Endo Transplantation of Nervous System into POC, Perc Approach Transplant of Cardiovascular Sys into POC, Perc Approach Transplantation of Lymph & Hemic into POC, Perc Approach Transplantation of Eye into POC, Perc Approach

1.126 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

10Y03ZJ 10Y03ZK 10Y03ZL 10Y03ZM 10Y03ZN 10Y03ZP 10Y03ZQ 10Y03ZR 10Y03ZS 10Y03ZT 10Y03ZV 10Y03ZY 10Y04ZE 10Y04ZF 10Y04ZG 10Y04ZH 10Y04ZJ 10Y04ZK 10Y04ZL 10Y04ZM 10Y04ZN 10Y04ZP 10Y04ZQ 10Y04ZR 10Y04ZS 10Y04ZT 10Y04ZV 10Y04ZY 10Y07ZE 10Y07ZF 10Y07ZG 10Y07ZH 10Y07ZJ 10Y07ZK 10Y07ZL 10Y07ZM 10Y07ZN 10Y07ZP 10Y07ZQ 10Y07ZR 10Y07ZS 10Y07ZT 10Y07ZV 10Y07ZY 2Y04X5Z 2Y44X5Z 2Y54X5Z 30273H1 30273J1 30273K1 30273L1 30273M1 30273N1 30273P1 30273Q1 30273R1 30273S1 30273T1 30273V1 30273W1 30277H1 30277J1 30277K1 30277L1 30277M1 30277N1 30277P1 30277Q1

Transplantation of Ear, Nose & Sinus into POC, Perc Approach Transplantation of Resp Sys into POC, Perc Approach Transplantation of Mouth and Throat into POC, Perc Approach Transplantation of GI Sys into POC, Perc Approach Transplantation of Hepatobil & Pancr into POC, Perc Approach Transplantation of Endocrine System into POC, Perc Approach Transplantation of Skin into POC, Perc Approach Transplantation of Musculoskel Sys into POC, Perc Approach Transplantation of Urinary System into POC, Perc Approach Transplantation of Fem Reprod Sys into POC, Perc Approach Transplantation of Male Reprod Sys into POC, Perc Approach Transplantation of Other Body System into POC, Perc Approach Transplantation of Nervous Sys into POC, Perc Endo Approach Transplant Cardiovascular Sys in POC, Perc Endo Transplant of Lymph & Hemic into POC, Perc Endo Approach Transplantation of Eye into POC, Perc Endo Approach Transplant of Ear, Nose & Sinus into POC, Perc Endo Approach Transplantation of Resp Sys into POC, Perc Endo Approach Transplantation of Mouth/Throat into POC, Perc Endo Approach Transplantation of GI Sys into POC, Perc Endo Approach Transplant of Hepatobil & Pancr into POC, Perc Endo Approach Transplant of Endocrine Sys into POC, Perc Endo Approach Transplantation of Skin into POC, Perc Endo Approach Transplant of Musculoskel Sys into POC, Perc Endo Approach Transplantation of Urinary Sys into POC, Perc Endo Approach Transplant of Fem Reprod Sys into POC, Perc Endo Approach Transplant of Male Reprod Sys into POC, Perc Endo Approach Transplantation of Oth Body Sys into POC, Perc Endo Approach Transplantation of Nervous System into POC, Via Opening Transplantation of Cardiovascular Sys into POC, Via Opening Transplantation of Lymph & Hemic into POC, Via Opening Transplantation of Eye into POC, Via Opening Transplantation of Ear, Nose and Sinus into POC, Via Opening Transplantation of Respiratory System into POC, Via Opening Transplantation of Mouth and Throat into POC, Via Opening Transplantation of GI Sys into POC, Via Opening Transplantation of Hepatobil & Pancr into POC, Via Opening Transplantation of Endocrine System into POC, Via Opening Transplantation of Skin into POC, Via Opening Transplantation of Musculoskel Sys into POC, Via Opening Transplantation of Urinary System into POC, Via Opening Transplantation of Fem Reprod Sys into POC, Via Opening Transplantation of Male Reprod Sys into POC, Via Opening Transplantation of Other Body System into POC, Via Opening Change Female Genital Tract Packing Material Packing of Female Genital Tract using Packing Material Removal of Female Genital Tract Packing Material Transfuse Nonaut Whole Blood in POC, Circ, Perc Transfuse Nonaut Serum Albumin in POC, Circ, Perc Transfuse Nonaut Frozen Plasma in POC, Circ, Perc Transfuse Nonaut Fresh Plasma in POC, Circ, Perc Transfuse Nonaut Plasma Cryoprecip in POC, Circ, Perc Transfuse Nonaut Red Blood Cells in POC, Circ, Perc Transfuse Nonaut Frozen Red Cells in POC, Circ, Perc Transfusion of Nonaut WBC into POC, Circ, Perc Approach Transfuse of Nonaut Platelets into POC, Circ, Perc Approach Transfusion of Nonaut Globulin into POC, Circ, Perc Approach Transfuse of Nonaut Fibrinogen into POC, Circ, Perc Approach Transfuse Nonaut Antihemophilic in POC, Circ, Perc Transfuse of Nonaut Factor IX into POC, Circ, Perc Approach Transfuse of Nonaut Whole Blood into POC, Circ, Via Opening Transfuse Nonaut Serum Albumin in POC, Circ, Via Opening Transfuse Nonaut Frozen Plasma in POC, Circ, Via Opening Transfuse of Nonaut Fresh Plasma into POC, Circ, Via Opening Transfuse Nonaut Plasma Cryoprecip in POC, Circ, Via Opening Transfuse Nonaut Red Blood Cells in POC, Circ, Via Opening Transfuse Nonaut Frozen Red Cells in POC, Circ, Via Opening Transfusion of Nonautologous WBC into POC, Circ, Via Opening

September 2011

Edit code lists 1.127

Procedures allowed for females only

30277R1 30277S1 30277T1 30277V1 30277W1 3E0E305 3E0E329 3E0E33Z 3E0E36Z 3E0E37Z 3E0E3BZ 3E0E3GC 3E0E3HZ 3E0E3JZ 3E0E3KZ 3E0E3NZ 3E0E3SF 3E0E3TZ 3E0E705 3E0E729 3E0E73Z 3E0E76Z 3E0E77Z 3E0E7BZ 3E0E7GC 3E0E7HZ 3E0E7JZ 3E0E7KZ 3E0E7NZ 3E0E7SF 3E0E7TZ 3E0E805 3E0E829 3E0E83Z 3E0E86Z 3E0E87Z 3E0E8BZ 3E0E8GC 3E0E8HZ 3E0E8JZ 3E0E8KZ 3E0E8NZ 3E0E8SF 3E0E8TZ 3E0P3LZ 3E0P3Q0 3E0P3Q1 3E0P73Z 3E0P76Z 3E0P77Z 3E0P7GC 3E0P7LZ 3E0P7Q0 3E0P7Q1 3E0P7SF 3E0P83Z 3E0P86Z 3E0P87Z 3E0P8GC 3E0P8SF 3E1P38X 3E1P38Z 3E1P78X 3E1P78Z 3E1P88X 3E1P88Z 4A0H74Z 4A0H7CZ

Transfusion of Nonaut Platelets into POC, Circ, Via Opening Transfusion of Nonaut Globulin into POC, Circ, Via Opening Transfusion of Nonaut Fibrinogen into POC, Circ, Via Opening Transfuse Nonaut Antihemophilic in POC, Circ, Via Opening Transfusion of Nonaut Factor IX into POC, Circ, Via Opening Introduction of Other Antineoplastic into POC, Perc Approach Introduction of Other Anti-infective into POC, Perc Approach Introduction of Anti-inflammatory into POC, Perc Approach Introduction of Nutritional into POC, Perc Approach Introduction of Electrol/Water Bal into POC, Perc Approach Introduction of Local Anesthetic into POC, Perc Approach Introduction of Oth Therap Subst into POC, Perc Approach Introduction of Radioact Subst into POC, Perc Approach Introduction of Contrast Agent into POC, Perc Approach Introduction of Oth Diagn Subst into POC, Perc Approach Introduction of Analg/Hypnot/Sedat into POC, Perc Approach Introduction of Other Gas into POC, Perc Approach Introduction of Destructive Agent into POC, Perc Approach Introduction of Other Antineoplastic into POC, Via Opening Introduction of Other Anti-infective into POC, Via Opening Introduction of Anti-inflammatory into POC, Via Opening Introduction of Nutritional Substance into POC, Via Opening Introduction of Electrol/Water Bal into POC, Via Opening Introduction of Local Anesthetic into POC, Via Opening Introduction of Oth Therap Subst into POC, Via Opening Introduction of Radioactive Substance into POC, Via Opening Introduction of Contrast Agent into POC, Via Opening Introduction of Oth Diagn Subst into POC, Via Opening Introduction of Analg/Hypnot/Sedat into POC, Via Opening Introduction of Other Gas into POC, Via Opening Introduction of Destructive Agent into POC, Via Opening Introduction of Other Antineoplastic into POC, Endo Introduction of Other Anti-infective into POC, Endo Introduction of Anti-inflammatory into POC, Endo Introduction of Nutritional Substance into POC, Endo Introduction of Electrol/Water Bal into POC, Endo Introduction of Local Anesthetic into POC, Endo Introduction of Other Therapeutic Substance into POC, Endo Introduction of Radioactive Substance into POC, Endo Introduction of Contrast Agent into POC, Endo Introduction of Other Diagnostic Substance into POC, Endo Introduction of Analg/Hypnot/Sedat into POC, Endo Introduction of Other Gas into Products of Conception, Endo Introduction of Destructive Agent into POC, Endo Introduction of Sperm into Fem Reprod, Perc Approach Introduce Autol Fertilized Ovum in Fem Reprod, Perc Introduce Nonaut Fertilized Ovum in Fem Reprod, Perc Introduction of Anti-inflam into Fem Reprod, Via Opening Introduction of Nutritional into Fem Reprod, Via Opening Introduce of Electrol/Water Bal into Fem Reprod, Via Opening Introduce of Oth Therap Subst into Fem Reprod, Via Opening Introduction of Sperm into Female Reproductive, Via Opening Introduce Autol Fertilized Ovum in Fem Reprod, Via Opening Introduce Nonaut Fertilized Ovum in Fem Reprod, Via Opening Introduction of Other Gas into Fem Reprod, Via Opening Introduction of Anti-inflammatory into Fem Reprod, Endo Introduction of Nutritional Substance into Fem Reprod, Endo Introduction of Electrol/Water Bal into Fem Reprod, Endo Introduction of Oth Therap Subst into Fem Reprod, Endo Introduction of Other Gas into Female Reproductive, Endo Irrigation of Fem Reprod using Irrigat, Perc Approach, Diagn Irrigation of Fem Reprod using Irrigat, Perc Approach Irrigation of Fem Reprod using Irrigat, Via Opening, Diagn Irrigation of Female Reproductive using Irrigat, Via Opening Irrigation of Female Reproductive using Irrigat, Endo, Diagn Irrigation of Female Reproductive using Irrigat, Endo Measurement of POC, Cardiac Electr Activity, Via Opening Measurement of POC, Cardiac Rate, Via Opening

1.128 Definitions of Medicare Code Edits

September 2011

Procedures allowed for females only

4A0H7FZ 4A0H7HZ 4A0H84Z 4A0H8CZ 4A0H8FZ 4A0H8HZ 4A0HX4Z 4A0HXCZ 4A0HXFZ 4A0HXHZ 4A0J72Z 4A0J74Z 4A0J7BZ 4A0J82Z 4A0J84Z 4A0J8BZ 4A0JX2Z 4A0JX4Z 4A0JXBZ 4A1H74Z 4A1H7CZ 4A1H7FZ 4A1H7HZ 4A1H84Z 4A1H8CZ 4A1H8FZ 4A1H8HZ 4A1HX4Z 4A1HXCZ 4A1HXFZ 4A1HXHZ 4A1J72Z 4A1J74Z 4A1J7BZ 4A1J82Z 4A1J84Z 4A1J8BZ 4A1JX2Z 4A1JX4Z 4A1JXBZ 8E0HX62 8E0UXY7 BU000ZZ BU001ZZ BU00YZZ BU010ZZ BU011ZZ BU01YZZ BU020ZZ BU021ZZ BU02YZZ BU060ZZ BU061ZZ BU06YZZ BU080ZZ BU081ZZ BU08YZZ BU090ZZ BU091ZZ BU09YZZ BU100ZZ BU101ZZ BU10YZZ BU10ZZZ BU110ZZ BU111ZZ BU11YZZ BU11ZZZ

Measurement of POC, Cardiac Rhythm, Via Opening Measurement of POC, Cardiac Sound, Via Opening Measurement of POC, Cardiac Electr Activity, Endo Measurement of Products of Conception, Cardiac Rate, Endo Measurement of Products of Conception, Cardiac Rhythm, Endo Measurement of Products of Conception, Cardiac Sound, Endo Measurement of POC, Cardiac Electr Activity, Extern Approach Measurement of POC, Cardiac Rate, Extern Approach Measurement of POC, Cardiac Rhythm, Extern Approach Measurement of POC, Cardiac Sound, Extern Approach Measurement of POC, Nervous Conductivity, Via Opening Measurement of POC, Nervous Electr Activity, Via Opening Measurement of POC, Nervous Pressure, Via Opening Measurement of POC, Nervous Conductivity, Endo Measurement of POC, Nervous Electr Activity, Endo Measurement of POC, Nervous Pressure, Endo Measurement of POC, Nervous Conductivity, Extern Approach Measurement of POC, Nervous Electr Activity, Extern Approach Measurement of POC, Nervous Pressure, Extern Approach Monitoring of POC, Cardiac Electr Activity, Via Opening Monitoring of POC, Cardiac Rate, Via Opening Monitoring of POC, Cardiac Rhythm, Via Opening Monitoring of POC, Cardiac Sound, Via Opening Monitoring of POC, Cardiac Electr Activity, Endo Monitoring of Products of Conception, Cardiac Rate, Endo Monitoring of Products of Conception, Cardiac Rhythm, Endo Monitoring of Products of Conception, Cardiac Sound, Endo Monitoring of POC, Cardiac Electr Activity, Extern Approach Monitoring of POC, Cardiac Rate, Extern Approach Monitoring of POC, Cardiac Rhythm, Extern Approach Monitoring of POC, Cardiac Sound, Extern Approach Monitoring of POC, Nervous Conductivity, Via Opening Monitoring of POC, Nervous Electr Activity, Via Opening Monitoring of POC, Nervous Pressure, Via Opening Monitoring of POC, Nervous Conductivity, Endo Monitoring of POC, Nervous Electr Activity, Endo Monitoring of Products of Conception, Nervous Pressure, Endo Monitoring of POC, Nervous Conductivity, Extern Approach Monitoring of POC, Nervous Electr Activity, Extern Approach Monitoring of POC, Nervous Pressure, Extern Approach Breast Milk Collection Examination of Female Reproductive System Plain Radiography of R Fallop Tube using H Osm Contrast Plain Radiography of R Fallop Tube using L Osm Contrast Plain Radiography of Right Fallopian Tube using Oth Contrast Plain Radiography of L Fallop Tube using H Osm Contrast Plain Radiography of L Fallop Tube using L Osm Contrast Plain Radiography of Left Fallopian Tube using Oth Contrast Plain Radiography of Bi Fallop Tube using H Osm Contrast Plain Radiography of Bi Fallop Tube using L Osm Contrast Plain Radiography of Bi Fallop Tube using Oth Contrast Plain Radiography of Uterus using High Osmolar Contrast Plain Radiography of Uterus using Low Osmolar Contrast Plain Radiography of Uterus using Other Contrast Plain Radiography of Uterus & Fallopian using H Osm Contrast Plain Radiography of Uterus & Fallopian using L Osm Contrast Plain Radiography of Uterus & Fallopian using Oth Contrast Plain Radiography of Vagina using High Osmolar Contrast Plain Radiography of Vagina using Low Osmolar Contrast Plain Radiography of Vagina using Other Contrast Fluoroscopy of Right Fallopian Tube using H Osm Contrast Fluoroscopy of Right Fallopian Tube using L Osm Contrast Fluoroscopy of Right Fallopian Tube using Other Contrast Fluoroscopy of Right Fallopian Tube Fluoroscopy of Left Fallopian Tube using H Osm Contrast Fluoroscopy of Left Fallopian Tube using L Osm Contrast Fluoroscopy of Left Fallopian Tube using Other Contrast Fluoroscopy of Left Fallopian Tube

September 2011

Edit code lists 1.129

Procedures allowed for females only

BU120ZZ BU121ZZ BU12YZZ BU12ZZZ BU160ZZ BU161ZZ BU16YZZ BU16ZZZ BU180ZZ BU181ZZ BU18YZZ BU18ZZZ BU190ZZ BU191ZZ BU19YZZ BU19ZZZ BU40YZZ BU40ZZZ BU41YZZ BU41ZZZ BU42YZZ BU42ZZZ BU46YZZ BU46ZZZ BY47ZZZ BY48ZZZ BY49ZZZ BY4BZZZ BY4CZZZ BY4DZZZ BY4FZZZ BY4GZZZ

Fluoroscopy of Bi Fallop Tube using H Osm Contrast Fluoroscopy of Bi Fallop Tube using L Osm Contrast Fluoroscopy of Bilateral Fallopian Tubes using Oth Contrast Fluoroscopy of Bilateral Fallopian Tubes Fluoroscopy of Uterus using High Osmolar Contrast Fluoroscopy of Uterus using Low Osmolar Contrast Fluoroscopy of Uterus using Other Contrast Fluoroscopy of Uterus Fluoroscopy of Uterus & Fallopian using H Osm Contrast Fluoroscopy of Uterus & Fallopian using L Osm Contrast Fluoroscopy of Uterus and Fallopian Tubes using Oth Contrast Fluoroscopy of Uterus and Fallopian Tubes Fluoroscopy of Vagina using High Osmolar Contrast Fluoroscopy of Vagina using Low Osmolar Contrast Fluoroscopy of Vagina using Other Contrast Fluoroscopy of Vagina Ultrasonography of Right Fallopian Tube using Other Contrast Ultrasonography of Right Fallopian Tube Ultrasonography of Left Fallopian Tube using Other Contrast Ultrasonography of Left Fallopian Tube Ultrasonography of Bi Fallop Tube using Oth Contrast Ultrasonography of Bilateral Fallopian Tubes Ultrasonography of Uterus using Other Contrast Ultrasonography of Uterus Ultrasonography of Fetal Umbilical Cord Ultrasonography of Placenta Ultrasonography of First Trimester, Single Fetus Ultrasonography of First Trimester, Multiple Gestation Ultrasonography of Second Trimester, Single Fetus Ultrasonography of Second Trimester, Multiple Gestation Ultrasonography of Third Trimester, Single Fetus Ultrasonography of Third Trimester, Multiple Gestation

1.130 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for males only


A1814 A1815 A5422 A5423 A5902 A6001 A6002 B260 B3881 C50021 C50022 C50029 C50121 C50122 C50129 C50221 C50222 C50229 C50321 C50322 C50329 C50421 C50422 C50429 C50521 C50522 C50529 C50621 C50622 C50629 C50821 C50822 C50829 C50921 C50922 C50929 C600 C601 C602 C608 C609 C61 C6200 C6201 C6202 C6210 C6211 C6212 C6290 C6291 C6292 C6300 C6301 C6302 C6310 C6311 C6312 C632 C637 C638 C639 D074 D075 D0760 D0761 Tuberculosis of prostate Tuberculosis of other male genital organs Gonococcal prostatitis Gonococcal infection of other male genital organs Trichomonal prostatitis Herpesviral infection of penis Herpesviral infection of other male genital organs Mumps orchitis Prostatic coccidioidomycosis Malignant neoplasm of nipple and areola, right male breast Malignant neoplasm of nipple and areola, left male breast Malignant neoplasm of nipple and areola, unsp male breast Malignant neoplasm of central portion of right male breast Malignant neoplasm of central portion of left male breast Malignant neoplasm of central portion of unsp male breast Malig neoplasm of upper-inner quadrant of right male breast Malig neoplasm of upper-inner quadrant of left male breast Malig neoplasm of upper-inner quadrant of unsp male breast Malig neoplasm of lower-inner quadrant of right male breast Malig neoplasm of lower-inner quadrant of left male breast Malig neoplasm of lower-inner quadrant of unsp male breast Malig neoplasm of upper-outer quadrant of right male breast Malig neoplasm of upper-outer quadrant of left male breast Malig neoplasm of upper-outer quadrant of unsp male breast Malig neoplasm of lower-outer quadrant of right male breast Malig neoplasm of lower-outer quadrant of left male breast Malig neoplasm of lower-outer quadrant of unsp male breast Malignant neoplasm of axillary tail of right male breast Malignant neoplasm of axillary tail of left male breast Malignant neoplasm of axillary tail of unsp male breast Malignant neoplasm of overlapping sites of right male breast Malignant neoplasm of overlapping sites of left male breast Malignant neoplasm of overlapping sites of unsp male breast Malignant neoplasm of unspecified site of right male breast Malignant neoplasm of unspecified site of left male breast Malignant neoplasm of unsp site of unspecified male breast Malignant neoplasm of prepuce Malignant neoplasm of glans penis Malignant neoplasm of body of penis Malignant neoplasm of overlapping sites of penis Malignant neoplasm of penis, unspecified Malignant neoplasm of prostate Malignant neoplasm of unspecified undescended testis Malignant neoplasm of undescended right testis Malignant neoplasm of undescended left testis Malignant neoplasm of unspecified descended testis Malignant neoplasm of descended right testis Malignant neoplasm of descended left testis Malig neoplasm of unsp testis, unsp descended or undescended Malig neoplm of right testis, unsp descended or undescended Malig neoplasm of left testis, unsp descended or undescended Malignant neoplasm of unspecified epididymis Malignant neoplasm of right epididymis Malignant neoplasm of left epididymis Malignant neoplasm of unspecified spermatic cord Malignant neoplasm of right spermatic cord Malignant neoplasm of left spermatic cord Malignant neoplasm of scrotum Malignant neoplasm of other specified male genital organs Malignant neoplasm of ovrlp sites of male genital organs Malignant neoplasm of male genital organ, unspecified Carcinoma in situ of penis Carcinoma in situ of prostate Carcinoma in situ of unspecified male genital organs Carcinoma in situ of scrotum

September 2011

Edit code lists 1.131

Diagnoses allowed for males only

D0769 D176 D290 D291 D2920 D2921 D2922 D2930 D2931 D2932 D294 D298 D299 D400 D4010 D4011 D4012 D408 D409 E290 E291 E298 E299 E895 F5221 F5232 F524 I861 L291 N35010 N35014 N35111 N35119 N400 N401 N4100 N4101 N4110 N4111 N412 N413 N414 N418 N419 N420 N421 N423 N4281 N4282 N4289 N429 N430 N431 N432 N433 N4340 N4341 N4342 N4400 N4401 N4402 N4403 N4404 N441 N442 N448 N451 N452

Carcinoma in situ of other male genital organs Benign lipomatous neoplasm of spermatic cord Benign neoplasm of penis Benign neoplasm of prostate Benign neoplasm of unspecified testis Benign neoplasm of right testis Benign neoplasm of left testis Benign neoplasm of unspecified epididymis Benign neoplasm of right epididymis Benign neoplasm of left epididymis Benign neoplasm of scrotum Benign neoplasm of other specified male genital organs Benign neoplasm of male genital organ, unspecified Neoplasm of uncertain behavior of prostate Neoplasm of uncertain behavior of unspecified testis Neoplasm of uncertain behavior of right testis Neoplasm of uncertain behavior of left testis Neoplasm of uncertain behavior of oth male genital organs Neoplasm of uncertain behavior of male genital organ, unsp Testicular hyperfunction Testicular hypofunction Other testicular dysfunction Testicular dysfunction, unspecified Postprocedural testicular hypofunction Male erectile disorder Male orgasmic disorder Premature ejaculation Scrotal varices Pruritus scroti Post-traumatic urethral stricture, male, meatal Post-traumatic urethral stricture, male, unspecified Postinfective urethral stricture, NEC, male, meatal Postinfective urethral stricture, NEC, male, unsp Enlarged prostate w/o lower urinary tract symptoms (LUTS) Enlarged prostate with lower urinary tract symptoms (LUTS) Acute prostatitis without hematuria Acute prostatitis with hematuria Chronic prostatitis without hematuria Chronic prostatitis with hematuria Abscess of prostate Prostatocystitis Granulomatous prostatitis Other inflammatory diseases of prostate Inflammatory disease of prostate, unspecified Calculus of prostate Congestion and hemorrhage of prostate Dysplasia of prostate Prostatodynia syndrome Prostatosis syndrome Other specified disorders of prostate Disorder of prostate, unspecified Encysted hydrocele Infected hydrocele Other hydrocele Hydrocele, unspecified Spermatocele of epididymis, unspecified Spermatocele of epididymis, single Spermatocele of epididymis, multiple Torsion of testis, unspecified Extravaginal torsion of spermatic cord Intravaginal torsion of spermatic cord Torsion of appendix testis Torsion of appendix epididymis Cyst of tunica albuginea testis Benign cyst of testis Other noninflammatory disorders of the testis Epididymitis Orchitis

1.132 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for males only

N453 N454 N4601 N46021 N46022 N46023 N46024 N46025 N46029 N4611 N46121 N46122 N46123 N46124 N46125 N46129 N468 N469 N470 N471 N472 N473 N474 N475 N476 N477 N478 N480 N481 N4821 N4822 N4829 N4830 N4831 N4832 N4833 N4839 N485 N486 N4881 N4889 N489 N490 N491 N492 N493 N498 N499 N500 N501 N508 N509 N51 N5201 N5202 N5203 N521 N522 N5231 N5232 N5233 N5234 N5239 N528 N529 N5311 N5312 N5313

Epididymo-orchitis Abscess of epididymis or testis Organic azoospermia Azoospermia due to drug therapy Azoospermia due to infection Azoospermia due to obstruction of efferent ducts Azoospermia due to radiation Azoospermia due to systemic disease Azoospermia due to other extratesticular causes Organic oligospermia Oligospermia due to drug therapy Oligospermia due to infection Oligospermia due to obstruction of efferent ducts Oligospermia due to radiation Oligospermia due to systemic disease Oligospermia due to other extratesticular causes Other male infertility Male infertility, unspecified Adherent prepuce, newborn Phimosis Paraphimosis Deficient foreskin Benign cyst of prepuce Adhesions of prepuce and glans penis Balanoposthitis Other inflammatory diseases of prepuce Other disorders of prepuce Leukoplakia of penis Balanitis Abscess of corpus cavernosum and penis Cellulitis of corpus cavernosum and penis Other inflammatory disorders of penis Priapism, unspecified Priapism due to trauma Priapism due to disease classified elsewhere Priapism, drug-induced Other priapism Ulcer of penis Induration penis plastica Thrombosis of superficial vein of penis Other specified disorders of penis Disorder of penis, unspecified Inflammatory disorders of seminal vesicle Inflam disorders of sperm cord, tunica vaginalis and vas def Inflammatory disorders of scrotum Fournier gangrene Inflammatory disorders of oth male genital organs Inflammatory disorder of unspecified male genital organ Atrophy of testis Vascular disorders of male genital organs Other specified disorders of male genital organs Disorder of male genital organs, unspecified Disorders of male genital organs in diseases classd elswhr Erectile dysfunction due to arterial insufficiency Corporo-venous occlusive erectile dysfunction Comb artrl insuff & corporo-venous occlusv erectile dysfnct Erectile dysfunction due to diseases classified elsewhere Drug-induced erectile dysfunction Erectile dysfunction following radical prostatectomy Erectile dysfunction following radical cystectomy Erectile dysfunction following urethral surgery Erectile dysfunction following simple prostatectomy Other post-surgical erectile dysfunction Other male erectile dysfunction Male erectile dysfunction, unspecified Retarded ejaculation Painful ejaculation Anejaculatory orgasm

September 2011

Edit code lists 1.133

Diagnoses allowed for males only

N5314 N5319 N538 N539 N99110 N99114 P835 Q5300 Q5301 Q5302 Q5310 Q5311 Q5312 Q5320 Q5321 Q5322 Q539 Q540 Q541 Q542 Q543 Q544 Q548 Q549 Q550 Q551 Q5520 Q5521 Q5522 Q5523 Q5529 Q553 Q554 Q555 Q5561 Q5562 Q5569 Q557 Q558 Q559 Q561 Q640 Q980 Q981 Q983 Q984 Q986 Q987 Q988 Q989 R361 R860 R861 R862 R863 R864 R865 R866 R867 R868 R869 R972 S30201A S30201D S30201S S3021XA S3021XD S3021XS

Retrograde ejaculation Other ejaculatory dysfunction Other male sexual dysfunction Unspecified male sexual dysfunction Postprocedural urethral stricture, male, meatal Postprocedural urethral stricture, male, unspecified Congenital hydrocele Ectopic testis, unspecified Ectopic testis, unilateral Ectopic testes, bilateral Unspecified undescended testicle, unilateral Abdominal testis, unilateral Ectopic perineal testis, unilateral Undescended testicle, unspecified, bilateral Abdominal testis, bilateral Ectopic perineal testis, bilateral Undescended testicle, unspecified Hypospadias, balanic Hypospadias, penile Hypospadias, penoscrotal Hypospadias, perineal Congenital chordee Other hypospadias Hypospadias, unspecified Absence and aplasia of testis Hypoplasia of testis and scrotum Unspecified congenital malformations of testis and scrotum Polyorchism Retractile testis Scrotal transposition Other congenital malformations of testis and scrotum Atresia of vas deferens Oth congen malform of vas def,epidid, semnl vescl & prostate Congenital absence and aplasia of penis Curvature of penis (lateral) Hypoplasia of penis Other congenital malformation of penis Congenital vasocutaneous fistula Oth congenital malformations of male genital organs Congenital malformation of male genital organ, unspecified Male pseudohermaphroditism, not elsewhere classified Epispadias Klinefelter syndrome karyotype 47, XXY Klinefelter syndrome, male with more than two X chromosomes Other male with 46, XX karyotype Klinefelter syndrome, unspecified Male with structurally abnormal sex chromosome Male with sex chromosome mosaicism Other specified sex chromosome abnormalities, male phenotype Sex chromosome abnormality, male phenotype, unspecified Hematospermia Abn lev enzymes in specimens from male genital organs Abn lev hormones in specimens from male genital organs Abn lev drug/meds/biol subst in specmn from male gntl organs Abn lev substnc nonmed source in specmn from male gntl org Abn immunolog findings in specmn from male genital organs Abn microbiolog findings in specmn from male genital organs Abnormal cytolog findings in specmn from male genital organs Abn histolog findings in specmn from male genital organs Oth abnormal findings in specimens from male genital organs Unsp abnormal finding in specimens from male genital organs Elevated prostate specific antigen [PSA] Contusion of unsp external genital organ, male, init encntr Contusion of unsp external genital organ, male, subs encntr Contusion of unsp external genital organ, male, sequela Contusion of penis, initial encounter Contusion of penis, subsequent encounter Contusion of penis, sequela

1.134 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for males only

S3022XA S3022XD S3022XS S30812A S30812D S30812S S30813A S30813D S30813S S30815A S30815D S30815S S30822A S30822D S30822S S30823A S30823D S30823S S30825A S30825D S30825S S30842A S30842D S30842S S30843A S30843D S30843S S30845A S30845D S30845S S30852A S30852D S30852S S30853A S30853D S30853S S30855A S30855D S30855S S30862A S30862D S30862S S30863A S30863D S30863S S30865A S30865D S30865S S30872A S30872D S30872S S30873A S30873D S30873S S30875A S30875D S30875S S3093XA S3093XD S3093XS S3094XA S3094XD S3094XS S3096XA S3096XD S3096XS S3120XA S3120XD

Contusion of scrotum and testes, initial encounter Contusion of scrotum and testes, subsequent encounter Contusion of scrotum and testes, sequela Abrasion of penis, initial encounter Abrasion of penis, subsequent encounter Abrasion of penis, sequela Abrasion of scrotum and testes, initial encounter Abrasion of scrotum and testes, subsequent encounter Abrasion of scrotum and testes, sequela Abrasion of unsp external genital organs, male, init encntr Abrasion of unsp external genital organs, male, subs encntr Abrasion of unsp external genital organs, male, sequela Blister (nonthermal) of penis, initial encounter Blister (nonthermal) of penis, subsequent encounter Blister (nonthermal) of penis, sequela Blister (nonthermal) of scrotum and testes, init encntr Blister (nonthermal) of scrotum and testes, subs encntr Blister (nonthermal) of scrotum and testes, sequela Blister of unsp external genital organs, male, init Blister of unsp external genital organs, male, subs Blister of unsp external genital organs, male, sequela External constriction of penis, initial encounter External constriction of penis, subsequent encounter External constriction of penis, sequela External constriction of scrotum and testes, init encntr External constriction of scrotum and testes, subs encntr External constriction of scrotum and testes, sequela Extrn constrict of unsp external genital organs, male, init Extrn constrict of unsp external genital organs, male, subs Extrn constrict of unsp extrn genital organs, male, sequela Superficial foreign body of penis, initial encounter Superficial foreign body of penis, subsequent encounter Superficial foreign body of penis, sequela Superficial foreign body of scrotum and testes, init encntr Superficial foreign body of scrotum and testes, subs encntr Superficial foreign body of scrotum and testes, sequela Superficial fb of unsp external genital organs, male, init Superficial fb of unsp external genital organs, male, subs Superfic fb of unsp external genital organs, male, sequela Insect bite (nonvenomous) of penis, initial encounter Insect bite (nonvenomous) of penis, subsequent encounter Insect bite (nonvenomous) of penis, sequela Insect bite (nonvenomous) of scrotum and testes, init encntr Insect bite (nonvenomous) of scrotum and testes, subs encntr Insect bite (nonvenomous) of scrotum and testes, sequela Insect bite of unsp external genital organs, male, init Insect bite of unsp external genital organs, male, subs Insect bite of unsp external genital organs, male, sequela Other superficial bite of penis, initial encounter Other superficial bite of penis, subsequent encounter Other superficial bite of penis, sequela Other superficial bite of scrotum and testes, init encntr Other superficial bite of scrotum and testes, subs encntr Other superficial bite of scrotum and testes, sequela Oth superfic bite of unsp extrn genital organs, male, init Oth superfic bite of unsp extrn genital organs, male, subs Oth superfic bite of unsp extrn gntl organs, male, sequela Unspecified superficial injury of penis, initial encounter Unspecified superficial injury of penis, subs encntr Unspecified superficial injury of penis, sequela Unsp superficial injury of scrotum and testes, init encntr Unsp superficial injury of scrotum and testes, subs encntr Unsp superficial injury of scrotum and testes, sequela Unsp superfic inj unsp external genital organs, male, init Unsp superfic inj unsp external genital organs, male, subs Unsp superfic inj unsp extrn genital organs, male, sequela Unspecified open wound of penis, initial encounter Unspecified open wound of penis, subsequent encounter

September 2011

Edit code lists 1.135

Diagnoses allowed for males only

S3120XS S3121XA S3121XD S3121XS S3122XA S3122XD S3122XS S3123XA S3123XD S3123XS S3124XA S3124XD S3124XS S3125XA S3125XD S3125XS S3130XA S3130XD S3130XS S3131XA S3131XD S3131XS S3132XA S3132XD S3132XS S3133XA S3133XD S3133XS S3134XA S3134XD S3134XS S3135XA S3135XD S3135XS S31501A S31501D S31501S S31511A S31511D S31511S S31521A S31521D S31521S S31531A S31531D S31531S S31541A S31541D S31541S S31551A S31551D S31551S S37822A S37822D S37822S S37823A S37823D S37823S S37828A S37828D S37828S S37829A S37829D S37829S S38001A S38001D S38001S S3801XA

Unspecified open wound of penis, sequela Laceration without foreign body of penis, initial encounter Laceration without foreign body of penis, subs encntr Laceration without foreign body of penis, sequela Laceration with foreign body of penis, initial encounter Laceration with foreign body of penis, subsequent encounter Laceration with foreign body of penis, sequela Puncture wound without foreign body of penis, init encntr Puncture wound without foreign body of penis, subs encntr Puncture wound without foreign body of penis, sequela Puncture wound with foreign body of penis, initial encounter Puncture wound with foreign body of penis, subs encntr Puncture wound with foreign body of penis, sequela Open bite of penis, initial encounter Open bite of penis, subsequent encounter Open bite of penis, sequela Unspecified open wound of scrotum and testes, init encntr Unspecified open wound of scrotum and testes, subs encntr Unspecified open wound of scrotum and testes, sequela Laceration w/o foreign body of scrotum and testes, init Laceration w/o foreign body of scrotum and testes, subs Laceration w/o foreign body of scrotum and testes, sequela Laceration w foreign body of scrotum and testes, init encntr Laceration w foreign body of scrotum and testes, subs encntr Laceration with foreign body of scrotum and testes, sequela Puncture wound w/o foreign body of scrotum and testes, init Puncture wound w/o foreign body of scrotum and testes, subs Pnctr w/o foreign body of scrotum and testes, sequela Puncture wound w foreign body of scrotum and testes, init Puncture wound w foreign body of scrotum and testes, subs Puncture wound w foreign body of scrotum and testes, sequela Open bite of scrotum and testes, initial encounter Open bite of scrotum and testes, subsequent encounter Open bite of scrotum and testes, sequela Unsp open wound of unsp external genital organs, male, init Unsp open wound of unsp external genital organs, male, subs Unsp opn wnd unsp external genital organs, male, sequela Lac w/o fb of unsp external genital organs, male, init Lac w/o fb of unsp external genital organs, male, subs Lac w/o fb of unsp external genital organs, male, sequela Laceration w fb of unsp external genital organs, male, init Laceration w fb of unsp external genital organs, male, subs Lac w fb of unsp external genital organs, male, sequela Pnctr w/o fb of unsp external genital organs, male, init Pnctr w/o fb of unsp external genital organs, male, subs Pnctr w/o fb of unsp external genital organs, male, sequela Pnctr w fb of unsp external genital organs, male, init Pnctr w fb of unsp external genital organs, male, subs Pnctr w fb of unsp external genital organs, male, sequela Open bite of unsp external genital organs, male, init encntr Open bite of unsp external genital organs, male, subs encntr Open bite of unsp external genital organs, male, sequela Contusion of prostate, initial encounter Contusion of prostate, subsequent encounter Contusion of prostate, sequela Laceration of prostate, initial encounter Laceration of prostate, subsequent encounter Laceration of prostate, sequela Other injury of prostate, initial encounter Other injury of prostate, subsequent encounter Other injury of prostate, sequela Unspecified injury of prostate, initial encounter Unspecified injury of prostate, subsequent encounter Unspecified injury of prostate, sequela Crushing injury of unsp external genital organs, male, init Crushing injury of unsp external genital organs, male, subs Crushing inj unsp external genital organs, male, sequela Crushing injury of penis, initial encounter

1.136 Definitions of Medicare Code Edits

September 2011

Diagnoses allowed for males only

S3801XD S3801XS S3802XA S3802XD S3802XS S38221A S38221D S38221S S38222A S38222D S38222S S38231A S38231D S38231S S38232A S38232D S38232S S39840A S39840D S39840S T194XXA T194XXD T194XXS T2106XA T2106XD T2106XS T2116XA T2116XD T2116XS T2126XA T2126XD T2126XS T2136XA T2136XD T2136XS T2146XA T2146XD T2146XS T2156XA T2156XD T2156XS T2166XA T2166XD T2166XS T2176XA T2176XD T2176XS T83410A T83410D T83410S T83420A T83420D T83420S T83490A T83490D T83490S Y0701 Y0703 Y0711 Y0713 Y07410 Y07420 Y07430 Y07432 Y07435 Y07490 Z125 Z1271

Crushing injury of penis, subsequent encounter Crushing injury of penis, sequela Crushing injury of scrotum and testis, initial encounter Crushing injury of scrotum and testis, subsequent encounter Crushing injury of scrotum and testis, sequela Complete traumatic amputation of penis, initial encounter Complete traumatic amputation of penis, subsequent encounter Complete traumatic amputation of penis, sequela Partial traumatic amputation of penis, initial encounter Partial traumatic amputation of penis, subsequent encounter Partial traumatic amputation of penis, sequela Complete traumatic amputation of scrotum and testis, init Complete traumatic amputation of scrotum and testis, subs Complete traumatic amputation of scrotum and testis, sequela Partial traumatic amputation of scrotum and testis, init Partial traumatic amputation of scrotum and testis, subs Partial traumatic amputation of scrotum and testis, sequela Fracture of corpus cavernosum penis, initial encounter Fracture of corpus cavernosum penis, subsequent encounter Fracture of corpus cavernosum penis, sequela Foreign body in penis, initial encounter Foreign body in penis, subsequent encounter Foreign body in penis, sequela Burn of unsp degree of male genital region, init encntr Burn of unsp degree of male genital region, subs encntr Burn of unspecified degree of male genital region, sequela Burn of first degree of male genital region, init encntr Burn of first degree of male genital region, subs encntr Burn of first degree of male genital region, sequela Burn of second degree of male genital region, init encntr Burn of second degree of male genital region, subs encntr Burn of second degree of male genital region, sequela Burn of third degree of male genital region, init encntr Burn of third degree of male genital region, subs encntr Burn of third degree of male genital region, sequela Corrosion of unsp degree of male genital region, init encntr Corrosion of unsp degree of male genital region, subs encntr Corrosion of unsp degree of male genital region, sequela Corrosion of first degree of male genital region, init Corrosion of first degree of male genital region, subs Corrosion of first degree of male genital region, sequela Corrosion of second degree of male genital region, init Corrosion of second degree of male genital region, subs Corrosion of second degree of male genital region, sequela Corrosion of third degree of male genital region, init Corrosion of third degree of male genital region, subs Corrosion of third degree of male genital region, sequela Breakdown of penile (implanted) prosthesis, init Breakdown of penile (implanted) prosthesis, subs Breakdown of penile (implanted) prosthesis, sequela Displacement of penile (implanted) prosthesis, init encntr Displacement of penile (implanted) prosthesis, subs encntr Displacement of penile (implanted) prosthesis, sequela Mech compl of penile (implanted) prosthesis, init encntr Mech compl of penile (implanted) prosthesis, subs encntr Mech compl of penile (implanted) prosthesis, sequela Husband, perpetrator of maltreatment and neglect Male partner, perpetrator of maltreatment and neglect Biological father, perpetrator of maltreatment and neglect Adoptive father, perpetrator of maltreatment and neglect Brother, perpetrator of maltreatment and neglect Foster father, perpetrator of maltreatment and neglect Stepfather, perpetrator of maltreatment and neglect Male friend of parent, perpetrator of maltreat and neglect Stepbrother, perpetrator or maltreatment and neglect Male cousin, perpetrator of maltreatment and neglect Encounter for screening for malignant neoplasm of prostate Encounter for screening for malignant neoplasm of testis

September 2011

Edit code lists 1.137

Diagnoses allowed for males only

Z1503 Z31440 Z31441 Z31448 Z412 Z8042 Z8043 Z8545 Z8546 Z8547 Z8548 Z8549 Z87710 Z9852

Genetic susceptibility to malignant neoplasm of prostate Encntr male test for genetic dis carrier status for pro mgmt Encntr for testing of male prtnr of pt w recur preg loss Encounter for oth genetic testing of male for pro mgmt Encounter for routine and ritual male circumcision Family history of malignant neoplasm of prostate Family history of malignant neoplasm of testis Personal history of malig neoplm of unsp male genital organ Personal history of malignant neoplasm of prostate Personal history of malignant neoplasm of testis Personal history of malignant neoplasm of epididymis Personal history of malig neoplasm of male genital organs Personal history of (corrected) hypospadias Vasectomy status

1.138 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only


0V1N07J 0V1N07K 0V1N07N 0V1N07P 0V1N0JJ 0V1N0JK 0V1N0JN 0V1N0JP 0V1N0KJ 0V1N0KK 0V1N0KN 0V1N0KP 0V1N0ZJ 0V1N0ZK 0V1N0ZN 0V1N0ZP 0V1N47J 0V1N47K 0V1N47N 0V1N47P 0V1N4JJ 0V1N4JK 0V1N4JN 0V1N4JP 0V1N4KJ 0V1N4KK 0V1N4KN 0V1N4KP 0V1N4ZJ 0V1N4ZK 0V1N4ZN 0V1N4ZP 0V1P07J 0V1P07K 0V1P07N 0V1P07P 0V1P0JJ 0V1P0JK 0V1P0JN 0V1P0JP 0V1P0KJ 0V1P0KK 0V1P0KN 0V1P0KP 0V1P0ZJ 0V1P0ZK 0V1P0ZN 0V1P0ZP 0V1P47J 0V1P47K 0V1P47N 0V1P47P 0V1P4JJ 0V1P4JK 0V1P4JN 0V1P4JP 0V1P4KJ 0V1P4KK 0V1P4KN 0V1P4KP 0V1P4ZJ 0V1P4ZK 0V1P4ZN 0V1P4ZP 0V1Q07J Bypass R Vas Deferens to R Epidid w Autol Sub, Open Bypass R Vas Deferens to L Epidid w Autol Sub, Open Bypass R Vas Deferens to R Vas Def w Autol Sub, Open Bypass R Vas Deferens to L Vas Def w Autol Sub, Open Bypass R Vas Deferens to R Epidid w Synth Sub, Open Bypass R Vas Deferens to L Epidid w Synth Sub, Open Bypass R Vas Deferens to R Vas Def w Synth Sub, Open Bypass R Vas Deferens to L Vas Def w Synth Sub, Open Bypass R Vas Deferens to R Epidid w Nonaut Sub, Open Bypass R Vas Deferens to L Epidid w Nonaut Sub, Open Bypass R Vas Deferens to R Vas Def w Nonaut Sub, Open Bypass R Vas Deferens to L Vas Def w Nonaut Sub, Open Bypass Right Vas Deferens to Right Epididymis, Open Approach Bypass Right Vas Deferens to Left Epididymis, Open Approach Bypass Right Vas Deferens to R Vas Def, Open Approach Bypass Right Vas Deferens to L Vas Def, Open Approach Bypass R Vas Deferens to R Epidid w Autol Sub, Perc Endo Bypass R Vas Deferens to L Epidid w Autol Sub, Perc Endo Bypass R Vas Deferens to R Vas Def w Autol Sub, Perc Endo Bypass R Vas Deferens to L Vas Def w Autol Sub, Perc Endo Bypass R Vas Deferens to R Epidid w Synth Sub, Perc Endo Bypass R Vas Deferens to L Epidid w Synth Sub, Perc Endo Bypass R Vas Deferens to R Vas Def w Synth Sub, Perc Endo Bypass R Vas Deferens to L Vas Def w Synth Sub, Perc Endo Bypass R Vas Deferens to R Epidid w Nonaut Sub, Perc Endo Bypass R Vas Deferens to L Epidid w Nonaut Sub, Perc Endo Bypass R Vas Deferens to R Vas Def w Nonaut Sub, Perc Endo Bypass R Vas Deferens to L Vas Def w Nonaut Sub, Perc Endo Bypass Right Vas Deferens to R Epidid, Perc Endo Approach Bypass Right Vas Deferens to L Epidid, Perc Endo Approach Bypass Right Vas Deferens to R Vas Def, Perc Endo Approach Bypass Right Vas Deferens to L Vas Def, Perc Endo Approach Bypass L Vas Deferens to R Epidid w Autol Sub, Open Bypass L Vas Deferens to L Epidid w Autol Sub, Open Bypass L Vas Deferens to R Vas Def w Autol Sub, Open Bypass L Vas Deferens to L Vas Def w Autol Sub, Open Bypass L Vas Deferens to R Epidid w Synth Sub, Open Bypass L Vas Deferens to L Epidid w Synth Sub, Open Bypass L Vas Deferens to R Vas Def w Synth Sub, Open Bypass L Vas Deferens to L Vas Def w Synth Sub, Open Bypass L Vas Deferens to R Epidid w Nonaut Sub, Open Bypass L Vas Deferens to L Epidid w Nonaut Sub, Open Bypass L Vas Deferens to R Vas Def w Nonaut Sub, Open Bypass L Vas Deferens to L Vas Def w Nonaut Sub, Open Bypass Left Vas Deferens to Right Epididymis, Open Approach Bypass Left Vas Deferens to Left Epididymis, Open Approach Bypass Left Vas Deferens to R Vas Def, Open Approach Bypass Left Vas Deferens to Left Vas Deferens, Open Approach Bypass L Vas Deferens to R Epidid w Autol Sub, Perc Endo Bypass L Vas Deferens to L Epidid w Autol Sub, Perc Endo Bypass L Vas Deferens to R Vas Def w Autol Sub, Perc Endo Bypass L Vas Deferens to L Vas Def w Autol Sub, Perc Endo Bypass L Vas Deferens to R Epidid w Synth Sub, Perc Endo Bypass L Vas Deferens to L Epidid w Synth Sub, Perc Endo Bypass L Vas Deferens to R Vas Def w Synth Sub, Perc Endo Bypass L Vas Deferens to L Vas Def w Synth Sub, Perc Endo Bypass L Vas Deferens to R Epidid w Nonaut Sub, Perc Endo Bypass L Vas Deferens to L Epidid w Nonaut Sub, Perc Endo Bypass L Vas Deferens to R Vas Def w Nonaut Sub, Perc Endo Bypass L Vas Deferens to L Vas Def w Nonaut Sub, Perc Endo Bypass Left Vas Deferens to R Epidid, Perc Endo Approach Bypass Left Vas Deferens to L Epidid, Perc Endo Approach Bypass Left Vas Deferens to R Vas Def, Perc Endo Approach Bypass Left Vas Deferens to L Vas Def, Perc Endo Approach Bypass Bi Vas Deferens to R Epidid w Autol Sub, Open

September 2011

Edit code lists 1.139

Procedures allowed for males only

0V1Q07K 0V1Q07N 0V1Q07P 0V1Q0JJ 0V1Q0JK 0V1Q0JN 0V1Q0JP 0V1Q0KJ 0V1Q0KK 0V1Q0KN 0V1Q0KP 0V1Q0ZJ 0V1Q0ZK 0V1Q0ZN 0V1Q0ZP 0V1Q47J 0V1Q47K 0V1Q47N 0V1Q47P 0V1Q4JJ 0V1Q4JK 0V1Q4JN 0V1Q4JP 0V1Q4KJ 0V1Q4KK 0V1Q4KN 0V1Q4KP 0V1Q4ZJ 0V1Q4ZK 0V1Q4ZN 0V1Q4ZP 0V500ZZ 0V503ZZ 0V504ZZ 0V507ZZ 0V508ZZ 0V510ZZ 0V513ZZ 0V514ZZ 0V520ZZ 0V523ZZ 0V524ZZ 0V530ZZ 0V533ZZ 0V534ZZ 0V550ZZ 0V553ZZ 0V554ZZ 0V55XZZ 0V560ZZ 0V563ZZ 0V564ZZ 0V570ZZ 0V573ZZ 0V574ZZ 0V590ZZ 0V593ZZ 0V594ZZ 0V5B0ZZ 0V5B3ZZ 0V5B4ZZ 0V5C0ZZ 0V5C3ZZ 0V5C4ZZ 0V5F0ZZ 0V5F3ZZ 0V5F4ZZ 0V5G0ZZ

Bypass Bi Vas Deferens to L Epidid w Autol Sub, Open Bypass Bi Vas Deferens to R Vas Def w Autol Sub, Open Bypass Bi Vas Deferens to L Vas Def w Autol Sub, Open Bypass Bi Vas Deferens to R Epidid w Synth Sub, Open Bypass Bi Vas Deferens to L Epidid w Synth Sub, Open Bypass Bi Vas Deferens to R Vas Def w Synth Sub, Open Bypass Bi Vas Deferens to L Vas Def w Synth Sub, Open Bypass Bi Vas Deferens to R Epidid w Nonaut Sub, Open Bypass Bi Vas Deferens to L Epidid w Nonaut Sub, Open Bypass Bi Vas Deferens to R Vas Def w Nonaut Sub, Open Bypass Bi Vas Deferens to L Vas Def w Nonaut Sub, Open Bypass Bilateral Vas Deferens to R Epidid, Open Approach Bypass Bilateral Vas Deferens to L Epidid, Open Approach Bypass Bilateral Vas Deferens to R Vas Def, Open Approach Bypass Bilateral Vas Deferens to L Vas Def, Open Approach Bypass Bi Vas Deferens to R Epidid w Autol Sub, Perc Endo Bypass Bi Vas Deferens to L Epidid w Autol Sub, Perc Endo Bypass Bi Vas Deferens to R Vas Def w Autol Sub, Perc Endo Bypass Bi Vas Deferens to L Vas Def w Autol Sub, Perc Endo Bypass Bi Vas Deferens to R Epidid w Synth Sub, Perc Endo Bypass Bi Vas Deferens to L Epidid w Synth Sub, Perc Endo Bypass Bi Vas Deferens to R Vas Def w Synth Sub, Perc Endo Bypass Bi Vas Deferens to L Vas Def w Synth Sub, Perc Endo Bypass Bi Vas Deferens to R Epidid w Nonaut Sub, Perc Endo Bypass Bi Vas Deferens to L Epidid w Nonaut Sub, Perc Endo Bypass Bi Vas Deferens to R Vas Def w Nonaut Sub, Perc Endo Bypass Bi Vas Deferens to L Vas Def w Nonaut Sub, Perc Endo Bypass Bi Vas Deferens to R Epidid, Perc Endo Approach Bypass Bi Vas Deferens to L Epidid, Perc Endo Approach Bypass Bi Vas Deferens to R Vas Def, Perc Endo Approach Bypass Bi Vas Deferens to L Vas Def, Perc Endo Approach Destruction of Prostate, Open Approach Destruction of Prostate, Percutaneous Approach Destruction of Prostate, Percutaneous Endoscopic Approach Destruction of Prostate, Via Natural or Artificial Opening Destruction of Prostate, Endo Destruction of Right Seminal Vesicle, Open Approach Destruction of Right Seminal Vesicle, Percutaneous Approach Destruction of Right Seminal Vesicle, Perc Endo Approach Destruction of Left Seminal Vesicle, Open Approach Destruction of Left Seminal Vesicle, Percutaneous Approach Destruction of Left Seminal Vesicle, Perc Endo Approach Destruction of Bilateral Seminal Vesicles, Open Approach Destruction of Bilateral Seminal Vesicles, Perc Approach Destruction of Bi Seminal Vesicle, Perc Endo Approach Destruction of Scrotum, Open Approach Destruction of Scrotum, Percutaneous Approach Destruction of Scrotum, Percutaneous Endoscopic Approach Destruction of Scrotum, External Approach Destruction of Right Tunica Vaginalis, Open Approach Destruction of Right Tunica Vaginalis, Percutaneous Approach Destruction of Right Tunica Vaginalis, Perc Endo Approach Destruction of Left Tunica Vaginalis, Open Approach Destruction of Left Tunica Vaginalis, Percutaneous Approach Destruction of Left Tunica Vaginalis, Perc Endo Approach Destruction of Right Testis, Open Approach Destruction of Right Testis, Percutaneous Approach Destruction of Right Testis, Perc Endo Approach Destruction of Left Testis, Open Approach Destruction of Left Testis, Percutaneous Approach Destruction of Left Testis, Percutaneous Endoscopic Approach Destruction of Bilateral Testes, Open Approach Destruction of Bilateral Testes, Percutaneous Approach Destruction of Bilateral Testes, Perc Endo Approach Destruction of Right Spermatic Cord, Open Approach Destruction of Right Spermatic Cord, Percutaneous Approach Destruction of Right Spermatic Cord, Perc Endo Approach Destruction of Left Spermatic Cord, Open Approach

1.140 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0V5G3ZZ 0V5G4ZZ 0V5H0ZZ 0V5H3ZZ 0V5H4ZZ 0V5J0ZZ 0V5J3ZZ 0V5J4ZZ 0V5K0ZZ 0V5K3ZZ 0V5K4ZZ 0V5L0ZZ 0V5L3ZZ 0V5L4ZZ 0V5N0ZZ 0V5N3ZZ 0V5N4ZZ 0V5P0ZZ 0V5P3ZZ 0V5P4ZZ 0V5Q0ZZ 0V5Q3ZZ 0V5Q4ZZ 0V5S0ZZ 0V5S3ZZ 0V5S4ZZ 0V5SXZZ 0V5T0ZZ 0V5T3ZZ 0V5T4ZZ 0V5TXZZ 0V7N0DZ 0V7N0ZZ 0V7N3DZ 0V7N3ZZ 0V7N4DZ 0V7N4ZZ 0V7P0DZ 0V7P0ZZ 0V7P3DZ 0V7P3ZZ 0V7P4DZ 0V7P4ZZ 0V7Q0DZ 0V7Q0ZZ 0V7Q3DZ 0V7Q3ZZ 0V7Q4DZ 0V7Q4ZZ 0V9000Z 0V900ZX 0V900ZZ 0V9030Z 0V903ZX 0V903ZZ 0V9040Z 0V904ZX 0V904ZZ 0V9070Z 0V907ZX 0V907ZZ 0V9080Z 0V908ZX 0V908ZZ 0V9100Z 0V910ZX 0V910ZZ 0V9130Z

Destruction of Left Spermatic Cord, Percutaneous Approach Destruction of Left Spermatic Cord, Perc Endo Approach Destruction of Bilateral Spermatic Cords, Open Approach Destruction of Bilateral Spermatic Cords, Perc Approach Destruction of Bilateral Spermatic Cords, Perc Endo Approach Destruction of Right Epididymis, Open Approach Destruction of Right Epididymis, Percutaneous Approach Destruction of Right Epididymis, Perc Endo Approach Destruction of Left Epididymis, Open Approach Destruction of Left Epididymis, Percutaneous Approach Destruction of Left Epididymis, Perc Endo Approach Destruction of Bilateral Epididymis, Open Approach Destruction of Bilateral Epididymis, Percutaneous Approach Destruction of Bilateral Epididymis, Perc Endo Approach Destruction of Right Vas Deferens, Open Approach Destruction of Right Vas Deferens, Percutaneous Approach Destruction of Right Vas Deferens, Perc Endo Approach Destruction of Left Vas Deferens, Open Approach Destruction of Left Vas Deferens, Percutaneous Approach Destruction of Left Vas Deferens, Perc Endo Approach Destruction of Bilateral Vas Deferens, Open Approach Destruction of Bilateral Vas Deferens, Percutaneous Approach Destruction of Bilateral Vas Deferens, Perc Endo Approach Destruction of Penis, Open Approach Destruction of Penis, Percutaneous Approach Destruction of Penis, Percutaneous Endoscopic Approach Destruction of Penis, External Approach Destruction of Prepuce, Open Approach Destruction of Prepuce, Percutaneous Approach Destruction of Prepuce, Percutaneous Endoscopic Approach Destruction of Prepuce, External Approach Dilation of R Vas Deferens with Intralum Dev, Open Approach Dilation of Right Vas Deferens, Open Approach Dilation of R Vas Deferens with Intralum Dev, Perc Approach Dilation of Right Vas Deferens, Percutaneous Approach Dilate R Vas Deferens w Intralum Dev, Perc Endo Dilation of Right Vas Deferens, Perc Endo Approach Dilation of L Vas Deferens with Intralum Dev, Open Approach Dilation of Left Vas Deferens, Open Approach Dilation of L Vas Deferens with Intralum Dev, Perc Approach Dilation of Left Vas Deferens, Percutaneous Approach Dilate L Vas Deferens w Intralum Dev, Perc Endo Dilation of Left Vas Deferens, Perc Endo Approach Dilation of Bi Vas Deferens with Intralum Dev, Open Approach Dilation of Bilateral Vas Deferens, Open Approach Dilation of Bi Vas Deferens with Intralum Dev, Perc Approach Dilation of Bilateral Vas Deferens, Percutaneous Approach Dilate Bi Vas Deferens w Intralum Dev, Perc Endo Dilation of Bilateral Vas Deferens, Perc Endo Approach Drainage of Prostate with Drainage Device, Open Approach Drainage of Prostate, Open Approach, Diagnostic Drainage of Prostate, Open Approach Drainage of Prostate with Drainage Device, Perc Approach Drainage of Prostate, Percutaneous Approach, Diagnostic Drainage of Prostate, Percutaneous Approach Drainage of Prostate with Drain Dev, Perc Endo Approach Drainage of Prostate, Perc Endo Approach, Diagn Drainage of Prostate, Percutaneous Endoscopic Approach Drainage of Prostate with Drainage Device, Via Opening Drainage of Prostate, Via Opening, Diagn Drainage of Prostate, Via Natural or Artificial Opening Drainage of Prostate with Drainage Device, Endo Drainage of Prostate, Endo, Diagn Drainage of Prostate, Endo Drainage of R Seminal Vesicle with Drain Dev, Open Approach Drainage of Right Seminal Vesicle, Open Approach, Diagnostic Drainage of Right Seminal Vesicle, Open Approach Drainage of R Seminal Vesicle with Drain Dev, Perc Approach

September 2011

Edit code lists 1.141

Procedures allowed for males only

0V913ZX 0V913ZZ 0V9140Z 0V914ZX 0V914ZZ 0V9200Z 0V920ZX 0V920ZZ 0V9230Z 0V923ZX 0V923ZZ 0V9240Z 0V924ZX 0V924ZZ 0V9300Z 0V930ZX 0V930ZZ 0V9330Z 0V933ZX 0V933ZZ 0V9340Z 0V934ZX 0V934ZZ 0V9500Z 0V950ZX 0V950ZZ 0V9530Z 0V953ZX 0V953ZZ 0V9540Z 0V954ZX 0V954ZZ 0V95X0Z 0V95XZX 0V95XZZ 0V9600Z 0V960ZX 0V960ZZ 0V9630Z 0V963ZX 0V963ZZ 0V9640Z 0V964ZX 0V964ZZ 0V9700Z 0V970ZX 0V970ZZ 0V9730Z 0V973ZX 0V973ZZ 0V9740Z 0V974ZX 0V974ZZ 0V9900Z 0V990ZX 0V990ZZ 0V9930Z 0V993ZX 0V993ZZ 0V9940Z 0V994ZX 0V994ZZ 0V9B00Z 0V9B0ZX 0V9B0ZZ 0V9B30Z 0V9B3ZX 0V9B3ZZ

Drainage of Right Seminal Vesicle, Perc Approach, Diagn Drainage of Right Seminal Vesicle, Percutaneous Approach Drain R Seminal Vesicle w Drain Dev, Perc Endo Drainage of Right Seminal Vesicle, Perc Endo Approach, Diagn Drainage of Right Seminal Vesicle, Perc Endo Approach Drainage of L Seminal Vesicle with Drain Dev, Open Approach Drainage of Left Seminal Vesicle, Open Approach, Diagnostic Drainage of Left Seminal Vesicle, Open Approach Drainage of L Seminal Vesicle with Drain Dev, Perc Approach Drainage of Left Seminal Vesicle, Perc Approach, Diagn Drainage of Left Seminal Vesicle, Percutaneous Approach Drain L Seminal Vesicle w Drain Dev, Perc Endo Drainage of Left Seminal Vesicle, Perc Endo Approach, Diagn Drainage of Left Seminal Vesicle, Perc Endo Approach Drainage of Bi Seminal Vesicle with Drain Dev, Open Approach Drainage of Bilateral Seminal Vesicles, Open Approach, Diagn Drainage of Bilateral Seminal Vesicles, Open Approach Drainage of Bi Seminal Vesicle with Drain Dev, Perc Approach Drainage of Bilateral Seminal Vesicles, Perc Approach, Diagn Drainage of Bilateral Seminal Vesicles, Perc Approach Drain Bi Seminal Vesicle w Drain Dev, Perc Endo Drainage of Bi Seminal Vesicle, Perc Endo Approach, Diagn Drainage of Bilateral Seminal Vesicles, Perc Endo Approach Drainage of Scrotum with Drainage Device, Open Approach Drainage of Scrotum, Open Approach, Diagnostic Drainage of Scrotum, Open Approach Drainage of Scrotum with Drainage Device, Perc Approach Drainage of Scrotum, Percutaneous Approach, Diagnostic Drainage of Scrotum, Percutaneous Approach Drainage of Scrotum with Drainage Device, Perc Endo Approach Drainage of Scrotum, Percutaneous Endoscopic Approach, Diagn Drainage of Scrotum, Percutaneous Endoscopic Approach Drainage of Scrotum with Drainage Device, External Approach Drainage of Scrotum, External Approach, Diagnostic Drainage of Scrotum, External Approach Drainage of R Tunica Vaginalis with Drain Dev, Open Approach Drainage of Right Tunica Vaginalis, Open Approach, Diagn Drainage of Right Tunica Vaginalis, Open Approach Drainage of R Tunica Vaginalis with Drain Dev, Perc Approach Drainage of Right Tunica Vaginalis, Perc Approach, Diagn Drainage of Right Tunica Vaginalis, Percutaneous Approach Drain R Tunica Vaginalis w Drain Dev, Perc Endo Drainage of R Tunica Vaginalis, Perc Endo Approach, Diagn Drainage of Right Tunica Vaginalis, Perc Endo Approach Drainage of L Tunica Vaginalis with Drain Dev, Open Approach Drainage of Left Tunica Vaginalis, Open Approach, Diagnostic Drainage of Left Tunica Vaginalis, Open Approach Drainage of L Tunica Vaginalis with Drain Dev, Perc Approach Drainage of Left Tunica Vaginalis, Perc Approach, Diagn Drainage of Left Tunica Vaginalis, Percutaneous Approach Drain L Tunica Vaginalis w Drain Dev, Perc Endo Drainage of Left Tunica Vaginalis, Perc Endo Approach, Diagn Drainage of Left Tunica Vaginalis, Perc Endo Approach Drainage of Right Testis with Drainage Device, Open Approach Drainage of Right Testis, Open Approach, Diagnostic Drainage of Right Testis, Open Approach Drainage of Right Testis with Drainage Device, Perc Approach Drainage of Right Testis, Percutaneous Approach, Diagnostic Drainage of Right Testis, Percutaneous Approach Drainage of Right Testis with Drain Dev, Perc Endo Approach Drainage of Right Testis, Perc Endo Approach, Diagn Drainage of Right Testis, Percutaneous Endoscopic Approach Drainage of Left Testis with Drainage Device, Open Approach Drainage of Left Testis, Open Approach, Diagnostic Drainage of Left Testis, Open Approach Drainage of Left Testis with Drainage Device, Perc Approach Drainage of Left Testis, Percutaneous Approach, Diagnostic Drainage of Left Testis, Percutaneous Approach

1.142 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0V9B40Z 0V9B4ZX 0V9B4ZZ 0V9C00Z 0V9C0ZX 0V9C0ZZ 0V9C30Z 0V9C3ZX 0V9C3ZZ 0V9C40Z 0V9C4ZX 0V9C4ZZ 0V9F00Z 0V9F0ZX 0V9F0ZZ 0V9F30Z 0V9F3ZX 0V9F3ZZ 0V9F40Z 0V9F4ZX 0V9F4ZZ 0V9G00Z 0V9G0ZX 0V9G0ZZ 0V9G30Z 0V9G3ZX 0V9G3ZZ 0V9G40Z 0V9G4ZX 0V9G4ZZ 0V9H00Z 0V9H0ZX 0V9H0ZZ 0V9H30Z 0V9H3ZX 0V9H3ZZ 0V9H40Z 0V9H4ZX 0V9H4ZZ 0V9J00Z 0V9J0ZX 0V9J0ZZ 0V9J30Z 0V9J3ZX 0V9J3ZZ 0V9J40Z 0V9J4ZX 0V9J4ZZ 0V9K00Z 0V9K0ZX 0V9K0ZZ 0V9K30Z 0V9K3ZX 0V9K3ZZ 0V9K40Z 0V9K4ZX 0V9K4ZZ 0V9L00Z 0V9L0ZX 0V9L0ZZ 0V9L30Z 0V9L3ZX 0V9L3ZZ 0V9L40Z 0V9L4ZX 0V9L4ZZ 0V9N00Z 0V9N0ZX

Drainage of Left Testis with Drain Dev, Perc Endo Approach Drainage of Left Testis, Perc Endo Approach, Diagn Drainage of Left Testis, Percutaneous Endoscopic Approach Drainage of Bilateral Testes with Drain Dev, Open Approach Drainage of Bilateral Testes, Open Approach, Diagnostic Drainage of Bilateral Testes, Open Approach Drainage of Bilateral Testes with Drain Dev, Perc Approach Drainage of Bilateral Testes, Percutaneous Approach, Diagn Drainage of Bilateral Testes, Percutaneous Approach Drainage of Bi Testis with Drain Dev, Perc Endo Approach Drainage of Bilateral Testes, Perc Endo Approach, Diagn Drainage of Bilateral Testes, Perc Endo Approach Drainage of R Sperm Cord with Drain Dev, Open Approach Drainage of Right Spermatic Cord, Open Approach, Diagnostic Drainage of Right Spermatic Cord, Open Approach Drainage of R Sperm Cord with Drain Dev, Perc Approach Drainage of Right Spermatic Cord, Perc Approach, Diagn Drainage of Right Spermatic Cord, Percutaneous Approach Drainage of R Sperm Cord with Drain Dev, Perc Endo Approach Drainage of Right Spermatic Cord, Perc Endo Approach, Diagn Drainage of Right Spermatic Cord, Perc Endo Approach Drainage of L Sperm Cord with Drain Dev, Open Approach Drainage of Left Spermatic Cord, Open Approach, Diagnostic Drainage of Left Spermatic Cord, Open Approach Drainage of L Sperm Cord with Drain Dev, Perc Approach Drainage of Left Spermatic Cord, Perc Approach, Diagn Drainage of Left Spermatic Cord, Percutaneous Approach Drainage of L Sperm Cord with Drain Dev, Perc Endo Approach Drainage of Left Spermatic Cord, Perc Endo Approach, Diagn Drainage of Left Spermatic Cord, Perc Endo Approach Drainage of Bi Sperm Cord with Drain Dev, Open Approach Drainage of Bilateral Spermatic Cords, Open Approach, Diagn Drainage of Bilateral Spermatic Cords, Open Approach Drainage of Bi Sperm Cord with Drain Dev, Perc Approach Drainage of Bilateral Spermatic Cords, Perc Approach, Diagn Drainage of Bilateral Spermatic Cords, Percutaneous Approach Drainage of Bi Sperm Cord with Drain Dev, Perc Endo Approach Drainage of Bi Sperm Cord, Perc Endo Approach, Diagn Drainage of Bilateral Spermatic Cords, Perc Endo Approach Drainage of Right Epididymis with Drain Dev, Open Approach Drainage of Right Epididymis, Open Approach, Diagnostic Drainage of Right Epididymis, Open Approach Drainage of Right Epididymis with Drain Dev, Perc Approach Drainage of Right Epididymis, Percutaneous Approach, Diagn Drainage of Right Epididymis, Percutaneous Approach Drainage of R Epididymis with Drain Dev, Perc Endo Approach Drainage of Right Epididymis, Perc Endo Approach, Diagn Drainage of Right Epididymis, Perc Endo Approach Drainage of Left Epididymis with Drain Dev, Open Approach Drainage of Left Epididymis, Open Approach, Diagnostic Drainage of Left Epididymis, Open Approach Drainage of Left Epididymis with Drain Dev, Perc Approach Drainage of Left Epididymis, Percutaneous Approach, Diagn Drainage of Left Epididymis, Percutaneous Approach Drainage of L Epididymis with Drain Dev, Perc Endo Approach Drainage of Left Epididymis, Perc Endo Approach, Diagn Drainage of Left Epididymis, Perc Endo Approach Drainage of B Epididymis with Drain Dev, Open Approach Drainage of Bilateral Epididymis, Open Approach, Diagnostic Drainage of Bilateral Epididymis, Open Approach Drainage of B Epididymis with Drain Dev, Perc Approach Drainage of Bilateral Epididymis, Perc Approach, Diagn Drainage of Bilateral Epididymis, Percutaneous Approach Drainage of B Epididymis with Drain Dev, Perc Endo Approach Drainage of Bilateral Epididymis, Perc Endo Approach, Diagn Drainage of Bilateral Epididymis, Perc Endo Approach Drainage of Right Vas Deferens with Drain Dev, Open Approach Drainage of Right Vas Deferens, Open Approach, Diagnostic

September 2011

Edit code lists 1.143

Procedures allowed for males only

0V9N0ZZ 0V9N30Z 0V9N3ZX 0V9N3ZZ 0V9N40Z 0V9N4ZX 0V9N4ZZ 0V9P00Z 0V9P0ZX 0V9P0ZZ 0V9P30Z 0V9P3ZX 0V9P3ZZ 0V9P40Z 0V9P4ZX 0V9P4ZZ 0V9Q00Z 0V9Q0ZX 0V9Q0ZZ 0V9Q30Z 0V9Q3ZX 0V9Q3ZZ 0V9Q40Z 0V9Q4ZX 0V9Q4ZZ 0V9S00Z 0V9S0ZX 0V9S0ZZ 0V9S30Z 0V9S3ZX 0V9S3ZZ 0V9S40Z 0V9S4ZX 0V9S4ZZ 0V9SX0Z 0V9SXZX 0V9SXZZ 0V9T00Z 0V9T0ZX 0V9T0ZZ 0V9T30Z 0V9T3ZX 0V9T3ZZ 0V9T40Z 0V9T4ZX 0V9T4ZZ 0V9TX0Z 0V9TXZX 0V9TXZZ 0VB00ZX 0VB00ZZ 0VB03ZX 0VB03ZZ 0VB04ZX 0VB04ZZ 0VB07ZX 0VB07ZZ 0VB08ZX 0VB08ZZ 0VB10ZX 0VB10ZZ 0VB13ZX 0VB13ZZ 0VB14ZX 0VB14ZZ 0VB20ZX 0VB20ZZ 0VB23ZX

Drainage of Right Vas Deferens, Open Approach Drainage of Right Vas Deferens with Drain Dev, Perc Approach Drainage of Right Vas Deferens, Percutaneous Approach, Diagn Drainage of Right Vas Deferens, Percutaneous Approach Drain of R Vas Deferens with Drain Dev, Perc Endo Approach Drainage of Right Vas Deferens, Perc Endo Approach, Diagn Drainage of Right Vas Deferens, Perc Endo Approach Drainage of Left Vas Deferens with Drain Dev, Open Approach Drainage of Left Vas Deferens, Open Approach, Diagnostic Drainage of Left Vas Deferens, Open Approach Drainage of Left Vas Deferens with Drain Dev, Perc Approach Drainage of Left Vas Deferens, Percutaneous Approach, Diagn Drainage of Left Vas Deferens, Percutaneous Approach Drain of L Vas Deferens with Drain Dev, Perc Endo Approach Drainage of Left Vas Deferens, Perc Endo Approach, Diagn Drainage of Left Vas Deferens, Perc Endo Approach Drainage of Bi Vas Deferens with Drain Dev, Open Approach Drainage of Bilateral Vas Deferens, Open Approach, Diagn Drainage of Bilateral Vas Deferens, Open Approach Drainage of Bi Vas Deferens with Drain Dev, Perc Approach Drainage of Bilateral Vas Deferens, Perc Approach, Diagn Drainage of Bilateral Vas Deferens, Percutaneous Approach Drain of Bi Vas Deferens with Drain Dev, Perc Endo Approach Drainage of Bi Vas Deferens, Perc Endo Approach, Diagn Drainage of Bilateral Vas Deferens, Perc Endo Approach Drainage of Penis with Drainage Device, Open Approach Drainage of Penis, Open Approach, Diagnostic Drainage of Penis, Open Approach Drainage of Penis with Drainage Device, Perc Approach Drainage of Penis, Percutaneous Approach, Diagnostic Drainage of Penis, Percutaneous Approach Drainage of Penis with Drainage Device, Perc Endo Approach Drainage of Penis, Percutaneous Endoscopic Approach, Diagn Drainage of Penis, Percutaneous Endoscopic Approach Drainage of Penis with Drainage Device, External Approach Drainage of Penis, External Approach, Diagnostic Drainage of Penis, External Approach Drainage of Prepuce with Drainage Device, Open Approach Drainage of Prepuce, Open Approach, Diagnostic Drainage of Prepuce, Open Approach Drainage of Prepuce with Drainage Device, Perc Approach Drainage of Prepuce, Percutaneous Approach, Diagnostic Drainage of Prepuce, Percutaneous Approach Drainage of Prepuce with Drainage Device, Perc Endo Approach Drainage of Prepuce, Percutaneous Endoscopic Approach, Diagn Drainage of Prepuce, Percutaneous Endoscopic Approach Drainage of Prepuce with Drainage Device, External Approach Drainage of Prepuce, External Approach, Diagnostic Drainage of Prepuce, External Approach Excision of Prostate, Open Approach, Diagnostic Excision of Prostate, Open Approach Excision of Prostate, Percutaneous Approach, Diagnostic Excision of Prostate, Percutaneous Approach Excision of Prostate, Perc Endo Approach, Diagn Excision of Prostate, Percutaneous Endoscopic Approach Excision of Prostate, Via Opening, Diagn Excision of Prostate, Via Natural or Artificial Opening Excision of Prostate, Endo, Diagn Excision of Prostate, Endo Excision of Right Seminal Vesicle, Open Approach, Diagnostic Excision of Right Seminal Vesicle, Open Approach Excision of Right Seminal Vesicle, Perc Approach, Diagn Excision of Right Seminal Vesicle, Percutaneous Approach Excision of Right Seminal Vesicle, Perc Endo Approach, Diagn Excision of Right Seminal Vesicle, Perc Endo Approach Excision of Left Seminal Vesicle, Open Approach, Diagnostic Excision of Left Seminal Vesicle, Open Approach Excision of Left Seminal Vesicle, Perc Approach, Diagn

1.144 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VB23ZZ 0VB24ZX 0VB24ZZ 0VB30ZX 0VB30ZZ 0VB33ZX 0VB33ZZ 0VB34ZX 0VB34ZZ 0VB50ZX 0VB50ZZ 0VB53ZX 0VB53ZZ 0VB54ZX 0VB54ZZ 0VB5XZX 0VB5XZZ 0VB60ZX 0VB60ZZ 0VB63ZX 0VB63ZZ 0VB64ZX 0VB64ZZ 0VB70ZX 0VB70ZZ 0VB73ZX 0VB73ZZ 0VB74ZX 0VB74ZZ 0VB90ZX 0VB90ZZ 0VB93ZX 0VB93ZZ 0VB94ZX 0VB94ZZ 0VBB0ZX 0VBB0ZZ 0VBB3ZX 0VBB3ZZ 0VBB4ZX 0VBB4ZZ 0VBC0ZX 0VBC0ZZ 0VBC3ZX 0VBC3ZZ 0VBC4ZX 0VBC4ZZ 0VBF0ZX 0VBF0ZZ 0VBF3ZX 0VBF3ZZ 0VBF4ZX 0VBF4ZZ 0VBG0ZX 0VBG0ZZ 0VBG3ZX 0VBG3ZZ 0VBG4ZX 0VBG4ZZ 0VBH0ZX 0VBH0ZZ 0VBH3ZX 0VBH3ZZ 0VBH4ZX 0VBH4ZZ 0VBJ0ZX 0VBJ0ZZ 0VBJ3ZX

Excision of Left Seminal Vesicle, Percutaneous Approach Excision of Left Seminal Vesicle, Perc Endo Approach, Diagn Excision of Left Seminal Vesicle, Perc Endo Approach Excision of Bilateral Seminal Vesicles, Open Approach, Diagn Excision of Bilateral Seminal Vesicles, Open Approach Excision of Bilateral Seminal Vesicles, Perc Approach, Diagn Excision of Bilateral Seminal Vesicles, Perc Approach Excision of Bi Seminal Vesicle, Perc Endo Approach, Diagn Excision of Bilateral Seminal Vesicles, Perc Endo Approach Excision of Scrotum, Open Approach, Diagnostic Excision of Scrotum, Open Approach Excision of Scrotum, Percutaneous Approach, Diagnostic Excision of Scrotum, Percutaneous Approach Excision of Scrotum, Percutaneous Endoscopic Approach, Diagn Excision of Scrotum, Percutaneous Endoscopic Approach Excision of Scrotum, External Approach, Diagnostic Excision of Scrotum, External Approach Excision of Right Tunica Vaginalis, Open Approach, Diagn Excision of Right Tunica Vaginalis, Open Approach Excision of Right Tunica Vaginalis, Perc Approach, Diagn Excision of Right Tunica Vaginalis, Percutaneous Approach Excision of R Tunica Vaginalis, Perc Endo Approach, Diagn Excision of Right Tunica Vaginalis, Perc Endo Approach Excision of Left Tunica Vaginalis, Open Approach, Diagnostic Excision of Left Tunica Vaginalis, Open Approach Excision of Left Tunica Vaginalis, Perc Approach, Diagn Excision of Left Tunica Vaginalis, Percutaneous Approach Excision of Left Tunica Vaginalis, Perc Endo Approach, Diagn Excision of Left Tunica Vaginalis, Perc Endo Approach Excision of Right Testis, Open Approach, Diagnostic Excision of Right Testis, Open Approach Excision of Right Testis, Percutaneous Approach, Diagnostic Excision of Right Testis, Percutaneous Approach Excision of Right Testis, Perc Endo Approach, Diagn Excision of Right Testis, Percutaneous Endoscopic Approach Excision of Left Testis, Open Approach, Diagnostic Excision of Left Testis, Open Approach Excision of Left Testis, Percutaneous Approach, Diagnostic Excision of Left Testis, Percutaneous Approach Excision of Left Testis, Perc Endo Approach, Diagn Excision of Left Testis, Percutaneous Endoscopic Approach Excision of Bilateral Testes, Open Approach, Diagnostic Excision of Bilateral Testes, Open Approach Excision of Bilateral Testes, Percutaneous Approach, Diagn Excision of Bilateral Testes, Percutaneous Approach Excision of Bilateral Testes, Perc Endo Approach, Diagn Excision of Bilateral Testes, Perc Endo Approach Excision of Right Spermatic Cord, Open Approach, Diagnostic Excision of Right Spermatic Cord, Open Approach Excision of Right Spermatic Cord, Perc Approach, Diagn Excision of Right Spermatic Cord, Percutaneous Approach Excision of Right Spermatic Cord, Perc Endo Approach, Diagn Excision of Right Spermatic Cord, Perc Endo Approach Excision of Left Spermatic Cord, Open Approach, Diagnostic Excision of Left Spermatic Cord, Open Approach Excision of Left Spermatic Cord, Perc Approach, Diagn Excision of Left Spermatic Cord, Percutaneous Approach Excision of Left Spermatic Cord, Perc Endo Approach, Diagn Excision of Left Spermatic Cord, Perc Endo Approach Excision of Bilateral Spermatic Cords, Open Approach, Diagn Excision of Bilateral Spermatic Cords, Open Approach Excision of Bilateral Spermatic Cords, Perc Approach, Diagn Excision of Bilateral Spermatic Cords, Percutaneous Approach Excision of Bi Sperm Cord, Perc Endo Approach, Diagn Excision of Bilateral Spermatic Cords, Perc Endo Approach Excision of Right Epididymis, Open Approach, Diagnostic Excision of Right Epididymis, Open Approach Excision of Right Epididymis, Percutaneous Approach, Diagn

September 2011

Edit code lists 1.145

Procedures allowed for males only

0VBJ3ZZ 0VBJ4ZX 0VBJ4ZZ 0VBK0ZX 0VBK0ZZ 0VBK3ZX 0VBK3ZZ 0VBK4ZX 0VBK4ZZ 0VBL0ZX 0VBL0ZZ 0VBL3ZX 0VBL3ZZ 0VBL4ZX 0VBL4ZZ 0VBN0ZX 0VBN0ZZ 0VBN3ZX 0VBN3ZZ 0VBN4ZX 0VBN4ZZ 0VBP0ZX 0VBP0ZZ 0VBP3ZX 0VBP3ZZ 0VBP4ZX 0VBP4ZZ 0VBQ0ZX 0VBQ0ZZ 0VBQ3ZX 0VBQ3ZZ 0VBQ4ZX 0VBQ4ZZ 0VBS0ZX 0VBS0ZZ 0VBS3ZX 0VBS3ZZ 0VBS4ZX 0VBS4ZZ 0VBSXZX 0VBSXZZ 0VBT0ZX 0VBT0ZZ 0VBT3ZX 0VBT3ZZ 0VBT4ZX 0VBT4ZZ 0VBTXZX 0VBTXZZ 0VC00ZZ 0VC03ZZ 0VC04ZZ 0VC07ZZ 0VC08ZZ 0VC10ZZ 0VC13ZZ 0VC14ZZ 0VC20ZZ 0VC23ZZ 0VC24ZZ 0VC30ZZ 0VC33ZZ 0VC34ZZ 0VC50ZZ 0VC53ZZ 0VC54ZZ 0VC5XZZ 0VC60ZZ

Excision of Right Epididymis, Percutaneous Approach Excision of Right Epididymis, Perc Endo Approach, Diagn Excision of Right Epididymis, Perc Endo Approach Excision of Left Epididymis, Open Approach, Diagnostic Excision of Left Epididymis, Open Approach Excision of Left Epididymis, Percutaneous Approach, Diagn Excision of Left Epididymis, Percutaneous Approach Excision of Left Epididymis, Perc Endo Approach, Diagn Excision of Left Epididymis, Perc Endo Approach Excision of Bilateral Epididymis, Open Approach, Diagnostic Excision of Bilateral Epididymis, Open Approach Excision of Bilateral Epididymis, Perc Approach, Diagn Excision of Bilateral Epididymis, Percutaneous Approach Excision of Bilateral Epididymis, Perc Endo Approach, Diagn Excision of Bilateral Epididymis, Perc Endo Approach Excision of Right Vas Deferens, Open Approach, Diagnostic Excision of Right Vas Deferens, Open Approach Excision of Right Vas Deferens, Percutaneous Approach, Diagn Excision of Right Vas Deferens, Percutaneous Approach Excision of Right Vas Deferens, Perc Endo Approach, Diagn Excision of Right Vas Deferens, Perc Endo Approach Excision of Left Vas Deferens, Open Approach, Diagnostic Excision of Left Vas Deferens, Open Approach Excision of Left Vas Deferens, Percutaneous Approach, Diagn Excision of Left Vas Deferens, Percutaneous Approach Excision of Left Vas Deferens, Perc Endo Approach, Diagn Excision of Left Vas Deferens, Perc Endo Approach Excision of Bilateral Vas Deferens, Open Approach, Diagn Excision of Bilateral Vas Deferens, Open Approach Excision of Bilateral Vas Deferens, Perc Approach, Diagn Excision of Bilateral Vas Deferens, Percutaneous Approach Excision of Bi Vas Deferens, Perc Endo Approach, Diagn Excision of Bilateral Vas Deferens, Perc Endo Approach Excision of Penis, Open Approach, Diagnostic Excision of Penis, Open Approach Excision of Penis, Percutaneous Approach, Diagnostic Excision of Penis, Percutaneous Approach Excision of Penis, Percutaneous Endoscopic Approach, Diagn Excision of Penis, Percutaneous Endoscopic Approach Excision of Penis, External Approach, Diagnostic Excision of Penis, External Approach Excision of Prepuce, Open Approach, Diagnostic Excision of Prepuce, Open Approach Excision of Prepuce, Percutaneous Approach, Diagnostic Excision of Prepuce, Percutaneous Approach Excision of Prepuce, Percutaneous Endoscopic Approach, Diagn Excision of Prepuce, Percutaneous Endoscopic Approach Excision of Prepuce, External Approach, Diagnostic Excision of Prepuce, External Approach Extirpation of Matter from Prostate, Open Approach Extirpation of Matter from Prostate, Percutaneous Approach Extirpation of Matter from Prostate, Perc Endo Approach Extirpation of Matter from Prostate, Via Opening Extirpation of Matter from Prostate, Endo Extirpation of Matter from R Seminal Vesicle, Open Approach Extirpation of Matter from R Seminal Vesicle, Perc Approach Extirpate matter from R Seminal Vesicle, Perc Endo Extirpation of Matter from L Seminal Vesicle, Open Approach Extirpation of Matter from L Seminal Vesicle, Perc Approach Extirpate matter from L Seminal Vesicle, Perc Endo Extirpation of Matter from Bi Seminal Vesicle, Open Approach Extirpation of Matter from Bi Seminal Vesicle, Perc Approach Extirpate matter from Bi Seminal Vesicle, Perc Endo Extirpation of Matter from Scrotum, Open Approach Extirpation of Matter from Scrotum, Percutaneous Approach Extirpation of Matter from Scrotum, Perc Endo Approach Extirpation of Matter from Scrotum, External Approach Extirpation of Matter from R Tunica Vaginalis, Open Approach

1.146 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VC63ZZ 0VC64ZZ 0VC70ZZ 0VC73ZZ 0VC74ZZ 0VC90ZZ 0VC93ZZ 0VC94ZZ 0VCB0ZZ 0VCB3ZZ 0VCB4ZZ 0VCC0ZZ 0VCC3ZZ 0VCC4ZZ 0VCF0ZZ 0VCF3ZZ 0VCF4ZZ 0VCG0ZZ 0VCG3ZZ 0VCG4ZZ 0VCH0ZZ 0VCH3ZZ 0VCH4ZZ 0VCJ0ZZ 0VCJ3ZZ 0VCJ4ZZ 0VCK0ZZ 0VCK3ZZ 0VCK4ZZ 0VCL0ZZ 0VCL3ZZ 0VCL4ZZ 0VCN0ZZ 0VCN3ZZ 0VCN4ZZ 0VCP0ZZ 0VCP3ZZ 0VCP4ZZ 0VCQ0ZZ 0VCQ3ZZ 0VCQ4ZZ 0VCS0ZZ 0VCS3ZZ 0VCS4ZZ 0VCSXZZ 0VCT0ZZ 0VCT3ZZ 0VCT4ZZ 0VCTXZZ 0VJ40ZZ 0VJ43ZZ 0VJ44ZZ 0VJ4XZZ 0VJ80ZZ 0VJ83ZZ 0VJ84ZZ 0VJ8XZZ 0VJD0ZZ 0VJD3ZZ 0VJD4ZZ 0VJDXZZ 0VJM0ZZ 0VJM3ZZ 0VJM4ZZ 0VJMXZZ 0VJR0ZZ 0VJR3ZZ 0VJR4ZZ

Extirpation of Matter from R Tunica Vaginalis, Perc Approach Extirpate matter from R Tunica Vaginalis, Perc Endo Extirpation of Matter from L Tunica Vaginalis, Open Approach Extirpation of Matter from L Tunica Vaginalis, Perc Approach Extirpate matter from L Tunica Vaginalis, Perc Endo Extirpation of Matter from Right Testis, Open Approach Extirpation of Matter from Right Testis, Perc Approach Extirpation of Matter from Right Testis, Perc Endo Approach Extirpation of Matter from Left Testis, Open Approach Extirpation of Matter from Left Testis, Perc Approach Extirpation of Matter from Left Testis, Perc Endo Approach Extirpation of Matter from Bilateral Testes, Open Approach Extirpation of Matter from Bilateral Testes, Perc Approach Extirpation of Matter from Bi Testis, Perc Endo Approach Extirpation of Matter from R Sperm Cord, Open Approach Extirpation of Matter from R Sperm Cord, Perc Approach Extirpation of Matter from R Sperm Cord, Perc Endo Approach Extirpation of Matter from L Sperm Cord, Open Approach Extirpation of Matter from L Sperm Cord, Perc Approach Extirpation of Matter from L Sperm Cord, Perc Endo Approach Extirpation of Matter from Bi Sperm Cord, Open Approach Extirpation of Matter from Bi Sperm Cord, Perc Approach Extirpation of Matter from Bi Sperm Cord, Perc Endo Approach Extirpation of Matter from Right Epididymis, Open Approach Extirpation of Matter from Right Epididymis, Perc Approach Extirpation of Matter from R Epididymis, Perc Endo Approach Extirpation of Matter from Left Epididymis, Open Approach Extirpation of Matter from Left Epididymis, Perc Approach Extirpation of Matter from L Epididymis, Perc Endo Approach Extirpation of Matter from B Epididymis, Open Approach Extirpation of Matter from B Epididymis, Perc Approach Extirpation of Matter from B Epididymis, Perc Endo Approach Extirpation of Matter from Right Vas Deferens, Open Approach Extirpation of Matter from Right Vas Deferens, Perc Approach Extirpate of Matter from R Vas Deferens, Perc Endo Approach Extirpation of Matter from Left Vas Deferens, Open Approach Extirpation of Matter from Left Vas Deferens, Perc Approach Extirpate of Matter from L Vas Deferens, Perc Endo Approach Extirpation of Matter from Bi Vas Deferens, Open Approach Extirpation of Matter from Bi Vas Deferens, Perc Approach Extirpate of Matter from Bi Vas Deferens, Perc Endo Approach Extirpation of Matter from Penis, Open Approach Extirpation of Matter from Penis, Percutaneous Approach Extirpation of Matter from Penis, Perc Endo Approach Extirpation of Matter from Penis, External Approach Extirpation of Matter from Prepuce, Open Approach Extirpation of Matter from Prepuce, Percutaneous Approach Extirpation of Matter from Prepuce, Perc Endo Approach Extirpation of Matter from Prepuce, External Approach Inspection of Prostate and Seminal Vesicles, Open Approach Inspection of Prostate and Seminal Vesicles, Perc Approach Inspection of Prostate/Seminal Ves, Perc Endo Approach Inspection of Prostate and Seminal Vesicles, Extern Approach Inspection of Scrotum and Tunica Vaginalis, Open Approach Inspection of Scrotum and Tunica Vaginalis, Perc Approach Inspection of Scrotum & Tunica, Perc Endo Approach Inspection of Scrotum and Tunica Vaginalis, Extern Approach Inspection of Testis, Open Approach Inspection of Testis, Percutaneous Approach Inspection of Testis, Percutaneous Endoscopic Approach Inspection of Testis, External Approach Inspection of Epididymis and Spermatic Cord, Open Approach Inspection of Epididymis and Spermatic Cord, Perc Approach Inspection of Epididymis/Sperm Cord, Perc Endo Approach Inspection of Epididymis and Spermatic Cord, Extern Approach Inspection of Vas Deferens, Open Approach Inspection of Vas Deferens, Percutaneous Approach Inspection of Vas Deferens, Percutaneous Endoscopic Approach

September 2011

Edit code lists 1.147

Procedures allowed for males only

0VJRXZZ 0VJS0ZZ 0VJS3ZZ 0VJS4ZZ 0VJSXZZ 0VLF0CZ 0VLF0DZ 0VLF0ZZ 0VLF3CZ 0VLF3DZ 0VLF3ZZ 0VLF4CZ 0VLF4DZ 0VLF4ZZ 0VLG0CZ 0VLG0DZ 0VLG0ZZ 0VLG3CZ 0VLG3DZ 0VLG3ZZ 0VLG4CZ 0VLG4DZ 0VLG4ZZ 0VLH0CZ 0VLH0DZ 0VLH0ZZ 0VLH3CZ 0VLH3DZ 0VLH3ZZ 0VLH4CZ 0VLH4DZ 0VLH4ZZ 0VLN0CZ 0VLN0DZ 0VLN0ZZ 0VLN3CZ 0VLN3DZ 0VLN3ZZ 0VLN4CZ 0VLN4DZ 0VLN4ZZ 0VLP0CZ 0VLP0DZ 0VLP0ZZ 0VLP3CZ 0VLP3DZ 0VLP3ZZ 0VLP4CZ 0VLP4DZ 0VLP4ZZ 0VLQ0CZ 0VLQ0DZ 0VLQ0ZZ 0VLQ3CZ 0VLQ3DZ 0VLQ3ZZ 0VLQ4CZ 0VLQ4DZ 0VLQ4ZZ 0VM5XZZ 0VM60ZZ 0VM64ZZ 0VM70ZZ 0VM74ZZ 0VM90ZZ 0VM94ZZ 0VMB0ZZ 0VMB4ZZ

Inspection of Vas Deferens, External Approach Inspection of Penis, Open Approach Inspection of Penis, Percutaneous Approach Inspection of Penis, Percutaneous Endoscopic Approach Inspection of Penis, External Approach Occlusion of R Sperm Cord with Extralum Dev, Open Approach Occlusion of R Sperm Cord with Intralum Dev, Open Approach Occlusion of Right Spermatic Cord, Open Approach Occlusion of R Sperm Cord with Extralum Dev, Perc Approach Occlusion of R Sperm Cord with Intralum Dev, Perc Approach Occlusion of Right Spermatic Cord, Percutaneous Approach Occlusion R Sperm Cord w Extralum Dev, Perc Endo Occlusion R Sperm Cord w Intralum Dev, Perc Endo Occlusion of Right Spermatic Cord, Perc Endo Approach Occlusion of L Sperm Cord with Extralum Dev, Open Approach Occlusion of L Sperm Cord with Intralum Dev, Open Approach Occlusion of Left Spermatic Cord, Open Approach Occlusion of L Sperm Cord with Extralum Dev, Perc Approach Occlusion of L Sperm Cord with Intralum Dev, Perc Approach Occlusion of Left Spermatic Cord, Percutaneous Approach Occlusion L Sperm Cord w Extralum Dev, Perc Endo Occlusion L Sperm Cord w Intralum Dev, Perc Endo Occlusion of Left Spermatic Cord, Perc Endo Approach Occlusion of Bi Sperm Cord with Extralum Dev, Open Approach Occlusion of Bi Sperm Cord with Intralum Dev, Open Approach Occlusion of Bilateral Spermatic Cords, Open Approach Occlusion of Bi Sperm Cord with Extralum Dev, Perc Approach Occlusion of Bi Sperm Cord with Intralum Dev, Perc Approach Occlusion of Bilateral Spermatic Cords, Perc Approach Occlusion Bi Sperm Cord w Extralum Dev, Perc Endo Occlusion Bi Sperm Cord w Intralum Dev, Perc Endo Occlusion of Bilateral Spermatic Cords, Perc Endo Approach Occlusion of R Vas Deferens with Extralum Dev, Open Approach Occlusion of R Vas Deferens with Intralum Dev, Open Approach Occlusion of Right Vas Deferens, Open Approach Occlusion of R Vas Deferens with Extralum Dev, Perc Approach Occlusion of R Vas Deferens with Intralum Dev, Perc Approach Occlusion of Right Vas Deferens, Percutaneous Approach Occlusion R Vas Deferens w Extralum Dev, Perc Endo Occlusion R Vas Deferens w Intralum Dev, Perc Endo Occlusion of Right Vas Deferens, Perc Endo Approach Occlusion of L Vas Deferens with Extralum Dev, Open Approach Occlusion of L Vas Deferens with Intralum Dev, Open Approach Occlusion of Left Vas Deferens, Open Approach Occlusion of L Vas Deferens with Extralum Dev, Perc Approach Occlusion of L Vas Deferens with Intralum Dev, Perc Approach Occlusion of Left Vas Deferens, Percutaneous Approach Occlusion L Vas Deferens w Extralum Dev, Perc Endo Occlusion L Vas Deferens w Intralum Dev, Perc Endo Occlusion of Left Vas Deferens, Perc Endo Approach Occlusion Bi Vas Deferens w Extralum Dev, Open Occlusion Bi Vas Deferens w Intralum Dev, Open Occlusion of Bilateral Vas Deferens, Open Approach Occlusion Bi Vas Deferens w Extralum Dev, Perc Occlusion Bi Vas Deferens w Intralum Dev, Perc Occlusion of Bilateral Vas Deferens, Percutaneous Approach Occlusion Bi Vas Deferens w Extralum Dev, Perc Endo Occlusion Bi Vas Deferens w Intralum Dev, Perc Endo Occlusion of Bilateral Vas Deferens, Perc Endo Approach Reattachment of Scrotum, External Approach Reattachment of Right Tunica Vaginalis, Open Approach Reattachment of Right Tunica Vaginalis, Perc Endo Approach Reattachment of Left Tunica Vaginalis, Open Approach Reattachment of Left Tunica Vaginalis, Perc Endo Approach Reattachment of Right Testis, Open Approach Reattachment of Right Testis, Perc Endo Approach Reattachment of Left Testis, Open Approach Reattachment of Left Testis, Perc Endo Approach

1.148 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VMC0ZZ 0VMC4ZZ 0VMF0ZZ 0VMF4ZZ 0VMG0ZZ 0VMG4ZZ 0VMH0ZZ 0VMH4ZZ 0VMSXZZ 0VN00ZZ 0VN03ZZ 0VN04ZZ 0VN07ZZ 0VN08ZZ 0VN10ZZ 0VN13ZZ 0VN14ZZ 0VN20ZZ 0VN23ZZ 0VN24ZZ 0VN30ZZ 0VN33ZZ 0VN34ZZ 0VN50ZZ 0VN53ZZ 0VN54ZZ 0VN5XZZ 0VN60ZZ 0VN63ZZ 0VN64ZZ 0VN70ZZ 0VN73ZZ 0VN74ZZ 0VN90ZZ 0VN93ZZ 0VN94ZZ 0VNB0ZZ 0VNB3ZZ 0VNB4ZZ 0VNC0ZZ 0VNC3ZZ 0VNC4ZZ 0VNF0ZZ 0VNF3ZZ 0VNF4ZZ 0VNG0ZZ 0VNG3ZZ 0VNG4ZZ 0VNH0ZZ 0VNH3ZZ 0VNH4ZZ 0VNJ0ZZ 0VNJ3ZZ 0VNJ4ZZ 0VNK0ZZ 0VNK3ZZ 0VNK4ZZ 0VNL0ZZ 0VNL3ZZ 0VNL4ZZ 0VNN0ZZ 0VNN3ZZ 0VNN4ZZ 0VNP0ZZ 0VNP3ZZ 0VNP4ZZ 0VNQ0ZZ 0VNQ3ZZ

Reattachment of Bilateral Testes, Open Approach Reattachment of Bilateral Testes, Perc Endo Approach Reattachment of Right Spermatic Cord, Open Approach Reattachment of Right Spermatic Cord, Perc Endo Approach Reattachment of Left Spermatic Cord, Open Approach Reattachment of Left Spermatic Cord, Perc Endo Approach Reattachment of Bilateral Spermatic Cords, Open Approach Reattachment of Bi Sperm Cord, Perc Endo Approach Reattachment of Penis, External Approach Release Prostate, Open Approach Release Prostate, Percutaneous Approach Release Prostate, Percutaneous Endoscopic Approach Release Prostate, Via Natural or Artificial Opening Release Prostate, Endo Release Right Seminal Vesicle, Open Approach Release Right Seminal Vesicle, Percutaneous Approach Release Right Seminal Vesicle, Perc Endo Approach Release Left Seminal Vesicle, Open Approach Release Left Seminal Vesicle, Percutaneous Approach Release Left Seminal Vesicle, Perc Endo Approach Release Bilateral Seminal Vesicles, Open Approach Release Bilateral Seminal Vesicles, Percutaneous Approach Release Bilateral Seminal Vesicles, Perc Endo Approach Release Scrotum, Open Approach Release Scrotum, Percutaneous Approach Release Scrotum, Percutaneous Endoscopic Approach Release Scrotum, External Approach Release Right Tunica Vaginalis, Open Approach Release Right Tunica Vaginalis, Percutaneous Approach Release Right Tunica Vaginalis, Perc Endo Approach Release Left Tunica Vaginalis, Open Approach Release Left Tunica Vaginalis, Percutaneous Approach Release Left Tunica Vaginalis, Perc Endo Approach Release Right Testis, Open Approach Release Right Testis, Percutaneous Approach Release Right Testis, Percutaneous Endoscopic Approach Release Left Testis, Open Approach Release Left Testis, Percutaneous Approach Release Left Testis, Percutaneous Endoscopic Approach Release Bilateral Testes, Open Approach Release Bilateral Testes, Percutaneous Approach Release Bilateral Testes, Percutaneous Endoscopic Approach Release Right Spermatic Cord, Open Approach Release Right Spermatic Cord, Percutaneous Approach Release Right Spermatic Cord, Perc Endo Approach Release Left Spermatic Cord, Open Approach Release Left Spermatic Cord, Percutaneous Approach Release Left Spermatic Cord, Perc Endo Approach Release Bilateral Spermatic Cords, Open Approach Release Bilateral Spermatic Cords, Percutaneous Approach Release Bilateral Spermatic Cords, Perc Endo Approach Release Right Epididymis, Open Approach Release Right Epididymis, Percutaneous Approach Release Right Epididymis, Percutaneous Endoscopic Approach Release Left Epididymis, Open Approach Release Left Epididymis, Percutaneous Approach Release Left Epididymis, Percutaneous Endoscopic Approach Release Bilateral Epididymis, Open Approach Release Bilateral Epididymis, Percutaneous Approach Release Bilateral Epididymis, Perc Endo Approach Release Right Vas Deferens, Open Approach Release Right Vas Deferens, Percutaneous Approach Release Right Vas Deferens, Percutaneous Endoscopic Approach Release Left Vas Deferens, Open Approach Release Left Vas Deferens, Percutaneous Approach Release Left Vas Deferens, Percutaneous Endoscopic Approach Release Bilateral Vas Deferens, Open Approach Release Bilateral Vas Deferens, Percutaneous Approach

September 2011

Edit code lists 1.149

Procedures allowed for males only

0VNQ4ZZ 0VNS0ZZ 0VNS3ZZ 0VNS4ZZ 0VNSXZZ 0VNT0ZZ 0VNT3ZZ 0VNT4ZZ 0VNTXZZ 0VP400Z 0VP401Z 0VP403Z 0VP407Z 0VP40JZ 0VP40KZ 0VP430Z 0VP431Z 0VP433Z 0VP437Z 0VP43JZ 0VP43KZ 0VP440Z 0VP441Z 0VP443Z 0VP447Z 0VP44JZ 0VP44KZ 0VP470Z 0VP471Z 0VP473Z 0VP477Z 0VP47JZ 0VP47KZ 0VP480Z 0VP481Z 0VP483Z 0VP487Z 0VP48JZ 0VP48KZ 0VP4X0Z 0VP4X1Z 0VP4X3Z 0VP800Z 0VP803Z 0VP807Z 0VP80JZ 0VP80KZ 0VP830Z 0VP833Z 0VP837Z 0VP83JZ 0VP83KZ 0VP840Z 0VP843Z 0VP847Z 0VP84JZ 0VP84KZ 0VP870Z 0VP873Z 0VP877Z 0VP87JZ 0VP87KZ 0VP880Z 0VP883Z 0VP887Z 0VP88JZ 0VP88KZ 0VP8X0Z

Release Bilateral Vas Deferens, Perc Endo Approach Release Penis, Open Approach Release Penis, Percutaneous Approach Release Penis, Percutaneous Endoscopic Approach Release Penis, External Approach Release Prepuce, Open Approach Release Prepuce, Percutaneous Approach Release Prepuce, Percutaneous Endoscopic Approach Release Prepuce, External Approach Remove of Drain Dev from Prostate/Seminal Ves, Open Approach Remove Radioact Elem from Prostate/Seminal Ves, Open Remove Infusion Dev from Prostate/Seminal Ves, Open Remove of Autol Sub from Prostate/Seminal Ves, Open Approach Remove of Synth Sub from Prostate/Seminal Ves, Open Approach Remove Nonaut Sub from Prostate/Seminal Ves, Open Remove of Drain Dev from Prostate/Seminal Ves, Perc Approach Remove Radioact Elem from Prostate/Seminal Ves, Perc Remove Infusion Dev from Prostate/Seminal Ves, Perc Remove of Autol Sub from Prostate/Seminal Ves, Perc Approach Remove of Synth Sub from Prostate/Seminal Ves, Perc Approach Remove Nonaut Sub from Prostate/Seminal Ves, Perc Remove Drain Dev from Prostate/Seminal Ves, Perc Endo Remove Radioact Elem from Prostate/Seminal Ves, Perc Endo Remove Infusion Dev from Prostate/Seminal Ves, Perc Endo Remove Autol Sub from Prostate/Seminal Ves, Perc Endo Remove Synth Sub from Prostate/Seminal Ves, Perc Endo Remove Nonaut Sub from Prostate/Seminal Ves, Perc Endo Removal of Drain Dev from Prostate/Seminal Ves, Via Opening Remove Radioact Elem from Prostate/Seminal Ves, Via Opening Remove Infusion Dev from Prostate/Seminal Ves, Via Opening Removal of Autol Sub from Prostate/Seminal Ves, Via Opening Removal of Synth Sub from Prostate/Seminal Ves, Via Opening Removal of Nonaut Sub from Prostate/Seminal Ves, Via Opening Removal of Drainage Device from Prostate/Seminal Ves, Endo Removal of Radioact Elem from Prostate/Seminal Ves, Endo Removal of Infusion Device from Prostate/Seminal Ves, Endo Removal of Autol Sub from Prostate/Seminal Ves, Endo Removal of Synth Sub from Prostate/Seminal Ves, Endo Removal of Nonaut Sub from Prostate/Seminal Ves, Endo Remove Drain Dev from Prostate/Seminal Ves, Extern Remove Radioact Elem from Prostate/Seminal Ves, Extern Remove Infusion Dev from Prostate/Seminal Ves, Extern Removal of Drain Dev from Scrotum & Tunica, Open Approach Removal of Infusion Dev from Scrotum & Tunica, Open Approach Removal of Autol Sub from Scrotum & Tunica, Open Approach Removal of Synth Sub from Scrotum & Tunica, Open Approach Removal of Nonaut Sub from Scrotum & Tunica, Open Approach Removal of Drain Dev from Scrotum & Tunica, Perc Approach Removal of Infusion Dev from Scrotum & Tunica, Perc Approach Removal of Autol Sub from Scrotum & Tunica, Perc Approach Removal of Synth Sub from Scrotum & Tunica, Perc Approach Removal of Nonaut Sub from Scrotum & Tunica, Perc Approach Remove Drain Dev from Scrotum & Tunica, Perc Endo Remove Infusion Dev from Scrotum & Tunica, Perc Endo Remove Autol Sub from Scrotum & Tunica, Perc Endo Remove Synth Sub from Scrotum & Tunica, Perc Endo Remove Nonaut Sub from Scrotum & Tunica, Perc Endo Removal of Drain Dev from Scrotum & Tunica, Via Opening Removal of Infusion Dev from Scrotum & Tunica, Via Opening Removal of Autol Sub from Scrotum & Tunica, Via Opening Removal of Synth Sub from Scrotum & Tunica, Via Opening Removal of Nonaut Sub from Scrotum & Tunica, Via Opening Removal of Drainage Device from Scrotum & Tunica, Endo Removal of Infusion Device from Scrotum & Tunica, Endo Removal of Autol Sub from Scrotum & Tunica, Endo Removal of Synthetic Substitute from Scrotum & Tunica, Endo Removal of Nonaut Sub from Scrotum & Tunica, Endo Removal of Drain Dev from Scrotum & Tunica, Extern Approach

1.150 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VP8X3Z Remove Infusion Dev from Scrotum & Tunica, Extern 0VPD00Z Removal of Drainage Device from Testis, Open Approach 0VPD03Z Removal of Infusion Device from Testis, Open Approach 0VPD07Z Removal of Autol Sub from Testis, Open Approach 0VPD0JZ Removal of Synthetic Substitute from Testis, Open Approach 0VPD0KZ Removal of Nonaut Sub from Testis, Open Approach 0VPD30Z Removal of Drainage Device from Testis, Perc Approach 0VPD33Z Removal of Infusion Device from Testis, Perc Approach 0VPD37Z Removal of Autol Sub from Testis, Perc Approach 0VPD3JZ Removal of Synthetic Substitute from Testis, Perc Approach 0VPD3KZ Removal of Nonaut Sub from Testis, Perc Approach 0VPD40Z Removal of Drainage Device from Testis, Perc Endo Approach 0VPD43Z Removal of Infusion Device from Testis, Perc Endo Approach 0VPD47Z Removal of Autol Sub from Testis, Perc Endo Approach 0VPD4JZ Removal of Synth Sub from Testis, Perc Endo Approach 0VPD4KZ Removal of Nonaut Sub from Testis, Perc Endo Approach 0VPD70Z Removal of Drainage Device from Testis, Via Opening 0VPD73Z Removal of Infusion Device from Testis, Via Opening 0VPD77Z Removal of Autol Sub from Testis, Via Opening 0VPD7JZ Removal of Synthetic Substitute from Testis, Via Opening 0VPD7KZ Removal of Nonaut Sub from Testis, Via Opening 0VPD80Z Removal of Drainage Device from Testis, Endo 0VPD83Z Removal of Infusion Device from Testis, Endo 0VPD87Z Removal of Autologous Tissue Substitute from Testis, Endo 0VPD8JZ Removal of Synthetic Substitute from Testis, Endo 0VPD8KZ Removal of Nonautologous Tissue Substitute from Testis, Endo 0VPDX0Z Removal of Drainage Device from Testis, External Approach 0VPDX3Z Removal of Infusion Device from Testis, External Approach 0VPM00Z Remove Drain Dev from Epididymis/Sperm Cord, Open 0VPM03Z Remove Infusion Dev from Epididymis/Sperm Cord, Open 0VPM07Z Remove Autol Sub from Epididymis/Sperm Cord, Open 0VPM0CZ Remove Extralum Dev from Epididymis/Sperm Cord, Open 0VPM0JZ Remove Synth Sub from Epididymis/Sperm Cord, Open 0VPM0KZ Remove Nonaut Sub from Epididymis/Sperm Cord, Open 0VPM30Z Remove Drain Dev from Epididymis/Sperm Cord, Perc 0VPM33Z Remove Infusion Dev from Epididymis/Sperm Cord, Perc 0VPM37Z Remove Autol Sub from Epididymis/Sperm Cord, Perc 0VPM3CZ Remove Extralum Dev from Epididymis/Sperm Cord, Perc 0VPM3JZ Remove Synth Sub from Epididymis/Sperm Cord, Perc 0VPM3KZ Remove Nonaut Sub from Epididymis/Sperm Cord, Perc 0VPM40Z Remove Drain Dev from Epididymis/Sperm Cord, Perc Endo 0VPM43Z Remove Infusion Dev from Epididymis/Sperm Cord, Perc Endo 0VPM47Z Remove Autol Sub from Epididymis/Sperm Cord, Perc Endo 0VPM4CZ Remove Extralum Dev from Epididymis/Sperm Cord, Perc Endo 0VPM4JZ Remove Synth Sub from Epididymis/Sperm Cord, Perc Endo 0VPM4KZ Remove Nonaut Sub from Epididymis/Sperm Cord, Perc Endo 0VPM70Z Removal of Drain Dev from Epididymis/Sperm Cord, Via Opening 0VPM73Z Remove Infusion Dev from Epididymis/Sperm Cord, Via Opening 0VPM77Z Removal of Autol Sub from Epididymis/Sperm Cord, Via Opening 0VPM7CZ Remove Extralum Dev from Epididymis/Sperm Cord, Via Opening 0VPM7JZ Removal of Synth Sub from Epididymis/Sperm Cord, Via Opening 0VPM7KZ Remove of Nonaut Sub from Epididymis/Sperm Cord, Via Opening 0VPM80Z Removal of Drainage Device from Epididymis/Sperm Cord, Endo 0VPM83Z Removal of Infusion Device from Epididymis/Sperm Cord, Endo 0VPM87Z Removal of Autol Sub from Epididymis/Sperm Cord, Endo 0VPM8CZ Removal of Extralum Dev from Epididymis/Sperm Cord, Endo 0VPM8JZ Removal of Synth Sub from Epididymis/Sperm Cord, Endo 0VPM8KZ Removal of Nonaut Sub from Epididymis/Sperm Cord, Endo 0VPMX0Z Remove Drain Dev from Epididymis/Sperm Cord, Extern 0VPMX3Z Remove Infusion Dev from Epididymis/Sperm Cord, Extern 0VPR00Z Removal of Drainage Device from Vas Deferens, Open Approach 0VPR03Z Removal of Infusion Device from Vas Deferens, Open Approach 0VPR07Z Removal of Autol Sub from Vas Deferens, Open Approach 0VPR0CZ Removal of Extralum Dev from Vas Deferens, Open Approach 0VPR0DZ Removal of Intralum Dev from Vas Deferens, Open Approach 0VPR0JZ Removal of Synth Sub from Vas Deferens, Open Approach 0VPR0KZ Removal of Nonaut Sub from Vas Deferens, Open Approach 0VPR30Z Removal of Drainage Device from Vas Deferens, Perc Approach

September 2011

Edit code lists 1.151

Procedures allowed for males only

0VPR33Z 0VPR37Z 0VPR3CZ 0VPR3DZ 0VPR3JZ 0VPR3KZ 0VPR40Z 0VPR43Z 0VPR47Z 0VPR4CZ 0VPR4DZ 0VPR4JZ 0VPR4KZ 0VPR70Z 0VPR73Z 0VPR77Z 0VPR7CZ 0VPR7DZ 0VPR7JZ 0VPR7KZ 0VPR80Z 0VPR83Z 0VPR87Z 0VPR8CZ 0VPR8DZ 0VPR8JZ 0VPR8KZ 0VPRX0Z 0VPRX3Z 0VPRXDZ 0VPS00Z 0VPS03Z 0VPS07Z 0VPS0JZ 0VPS0KZ 0VPS30Z 0VPS33Z 0VPS37Z 0VPS3JZ 0VPS3KZ 0VPS40Z 0VPS43Z 0VPS47Z 0VPS4JZ 0VPS4KZ 0VPS70Z 0VPS73Z 0VPS77Z 0VPS7JZ 0VPS7KZ 0VPS80Z 0VPS83Z 0VPS87Z 0VPS8JZ 0VPS8KZ 0VPSX0Z 0VPSX3Z 0VQ00ZZ 0VQ03ZZ 0VQ04ZZ 0VQ07ZZ 0VQ08ZZ 0VQ10ZZ 0VQ13ZZ 0VQ14ZZ 0VQ20ZZ 0VQ23ZZ 0VQ24ZZ

Removal of Infusion Device from Vas Deferens, Perc Approach Removal of Autol Sub from Vas Deferens, Perc Approach Removal of Extralum Dev from Vas Deferens, Perc Approach Removal of Intralum Dev from Vas Deferens, Perc Approach Removal of Synth Sub from Vas Deferens, Perc Approach Removal of Nonaut Sub from Vas Deferens, Perc Approach Removal of Drain Dev from Vas Deferens, Perc Endo Approach Remove of Infusion Dev from Vas Deferens, Perc Endo Approach Removal of Autol Sub from Vas Deferens, Perc Endo Approach Remove of Extralum Dev from Vas Deferens, Perc Endo Approach Remove of Intralum Dev from Vas Deferens, Perc Endo Approach Removal of Synth Sub from Vas Deferens, Perc Endo Approach Removal of Nonaut Sub from Vas Deferens, Perc Endo Approach Removal of Drainage Device from Vas Deferens, Via Opening Removal of Infusion Device from Vas Deferens, Via Opening Removal of Autol Sub from Vas Deferens, Via Opening Removal of Extralum Dev from Vas Deferens, Via Opening Removal of Intralum Dev from Vas Deferens, Via Opening Removal of Synth Sub from Vas Deferens, Via Opening Removal of Nonaut Sub from Vas Deferens, Via Opening Removal of Drainage Device from Vas Deferens, Endo Removal of Infusion Device from Vas Deferens, Endo Removal of Autol Sub from Vas Deferens, Endo Removal of Extraluminal Device from Vas Deferens, Endo Removal of Intraluminal Device from Vas Deferens, Endo Removal of Synthetic Substitute from Vas Deferens, Endo Removal of Nonaut Sub from Vas Deferens, Endo Removal of Drain Dev from Vas Deferens, Extern Approach Removal of Infusion Dev from Vas Deferens, Extern Approach Removal of Intralum Dev from Vas Deferens, Extern Approach Removal of Drainage Device from Penis, Open Approach Removal of Infusion Device from Penis, Open Approach Removal of Autol Sub from Penis, Open Approach Removal of Synthetic Substitute from Penis, Open Approach Removal of Nonaut Sub from Penis, Open Approach Removal of Drainage Device from Penis, Percutaneous Approach Removal of Infusion Device from Penis, Percutaneous Approach Removal of Autol Sub from Penis, Perc Approach Removal of Synthetic Substitute from Penis, Perc Approach Removal of Nonaut Sub from Penis, Perc Approach Removal of Drainage Device from Penis, Perc Endo Approach Removal of Infusion Device from Penis, Perc Endo Approach Removal of Autol Sub from Penis, Perc Endo Approach Removal of Synth Sub from Penis, Perc Endo Approach Removal of Nonaut Sub from Penis, Perc Endo Approach Removal of Drainage Device from Penis, Via Opening Removal of Infusion Device from Penis, Via Opening Removal of Autol Sub from Penis, Via Opening Removal of Synthetic Substitute from Penis, Via Opening Removal of Nonaut Sub from Penis, Via Opening Removal of Drainage Device from Penis, Endo Removal of Infusion Device from Penis, Endo Removal of Autologous Tissue Substitute from Penis, Endo Removal of Synthetic Substitute from Penis, Endo Removal of Nonautologous Tissue Substitute from Penis, Endo Removal of Drainage Device from Penis, External Approach Removal of Infusion Device from Penis, External Approach Repair Prostate, Open Approach Repair Prostate, Percutaneous Approach Repair Prostate, Percutaneous Endoscopic Approach Repair Prostate, Via Natural or Artificial Opening Repair Prostate, Endo Repair Right Seminal Vesicle, Open Approach Repair Right Seminal Vesicle, Percutaneous Approach Repair Right Seminal Vesicle, Perc Endo Approach Repair Left Seminal Vesicle, Open Approach Repair Left Seminal Vesicle, Percutaneous Approach Repair Left Seminal Vesicle, Perc Endo Approach

1.152 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VQ30ZZ 0VQ33ZZ 0VQ34ZZ 0VQ50ZZ 0VQ53ZZ 0VQ54ZZ 0VQ5XZZ 0VQ60ZZ 0VQ63ZZ 0VQ64ZZ 0VQ70ZZ 0VQ73ZZ 0VQ74ZZ 0VQ90ZZ 0VQ93ZZ 0VQ94ZZ 0VQB0ZZ 0VQB3ZZ 0VQB4ZZ 0VQC0ZZ 0VQC3ZZ 0VQC4ZZ 0VQF0ZZ 0VQF3ZZ 0VQF4ZZ 0VQG0ZZ 0VQG3ZZ 0VQG4ZZ 0VQH0ZZ 0VQH3ZZ 0VQH4ZZ 0VQJ0ZZ 0VQJ3ZZ 0VQJ4ZZ 0VQK0ZZ 0VQK3ZZ 0VQK4ZZ 0VQL0ZZ 0VQL3ZZ 0VQL4ZZ 0VQN0ZZ 0VQN3ZZ 0VQN4ZZ 0VQP0ZZ 0VQP3ZZ 0VQP4ZZ 0VQQ0ZZ 0VQQ3ZZ 0VQQ4ZZ 0VQS0ZZ 0VQS3ZZ 0VQS4ZZ 0VQSXZZ 0VQT0ZZ 0VQT3ZZ 0VQT4ZZ 0VQTXZZ 0VR90JZ 0VRB0JZ 0VRC0JZ 0VS90ZZ 0VS93ZZ 0VS94ZZ 0VSB0ZZ 0VSB3ZZ 0VSB4ZZ 0VSC0ZZ 0VSC3ZZ

Repair Bilateral Seminal Vesicles, Open Approach Repair Bilateral Seminal Vesicles, Percutaneous Approach Repair Bilateral Seminal Vesicles, Perc Endo Approach Repair Scrotum, Open Approach Repair Scrotum, Percutaneous Approach Repair Scrotum, Percutaneous Endoscopic Approach Repair Scrotum, External Approach Repair Right Tunica Vaginalis, Open Approach Repair Right Tunica Vaginalis, Percutaneous Approach Repair Right Tunica Vaginalis, Perc Endo Approach Repair Left Tunica Vaginalis, Open Approach Repair Left Tunica Vaginalis, Percutaneous Approach Repair Left Tunica Vaginalis, Perc Endo Approach Repair Right Testis, Open Approach Repair Right Testis, Percutaneous Approach Repair Right Testis, Percutaneous Endoscopic Approach Repair Left Testis, Open Approach Repair Left Testis, Percutaneous Approach Repair Left Testis, Percutaneous Endoscopic Approach Repair Bilateral Testes, Open Approach Repair Bilateral Testes, Percutaneous Approach Repair Bilateral Testes, Percutaneous Endoscopic Approach Repair Right Spermatic Cord, Open Approach Repair Right Spermatic Cord, Percutaneous Approach Repair Right Spermatic Cord, Perc Endo Approach Repair Left Spermatic Cord, Open Approach Repair Left Spermatic Cord, Percutaneous Approach Repair Left Spermatic Cord, Percutaneous Endoscopic Approach Repair Bilateral Spermatic Cords, Open Approach Repair Bilateral Spermatic Cords, Percutaneous Approach Repair Bilateral Spermatic Cords, Perc Endo Approach Repair Right Epididymis, Open Approach Repair Right Epididymis, Percutaneous Approach Repair Right Epididymis, Percutaneous Endoscopic Approach Repair Left Epididymis, Open Approach Repair Left Epididymis, Percutaneous Approach Repair Left Epididymis, Percutaneous Endoscopic Approach Repair Bilateral Epididymis, Open Approach Repair Bilateral Epididymis, Percutaneous Approach Repair Bilateral Epididymis, Perc Endo Approach Repair Right Vas Deferens, Open Approach Repair Right Vas Deferens, Percutaneous Approach Repair Right Vas Deferens, Percutaneous Endoscopic Approach Repair Left Vas Deferens, Open Approach Repair Left Vas Deferens, Percutaneous Approach Repair Left Vas Deferens, Percutaneous Endoscopic Approach Repair Bilateral Vas Deferens, Open Approach Repair Bilateral Vas Deferens, Percutaneous Approach Repair Bilateral Vas Deferens, Perc Endo Approach Repair Penis, Open Approach Repair Penis, Percutaneous Approach Repair Penis, Percutaneous Endoscopic Approach Repair Penis, External Approach Repair Prepuce, Open Approach Repair Prepuce, Percutaneous Approach Repair Prepuce, Percutaneous Endoscopic Approach Repair Prepuce, External Approach Replacement of Right Testis with Synth Sub, Open Approach Replacement of Left Testis with Synth Sub, Open Approach Replacement of Bi Testis with Synth Sub, Open Approach Reposition Right Testis, Open Approach Reposition Right Testis, Percutaneous Approach Reposition Right Testis, Percutaneous Endoscopic Approach Reposition Left Testis, Open Approach Reposition Left Testis, Percutaneous Approach Reposition Left Testis, Percutaneous Endoscopic Approach Reposition Bilateral Testes, Open Approach Reposition Bilateral Testes, Percutaneous Approach

September 2011

Edit code lists 1.153

Procedures allowed for males only

0VSC4ZZ 0VSF0ZZ 0VSF3ZZ 0VSF4ZZ 0VSG0ZZ 0VSG3ZZ 0VSG4ZZ 0VSH0ZZ 0VSH3ZZ 0VSH4ZZ 0VT00ZZ 0VT04ZZ 0VT07ZZ 0VT08ZZ 0VT10ZZ 0VT14ZZ 0VT20ZZ 0VT24ZZ 0VT30ZZ 0VT34ZZ 0VT50ZZ 0VT54ZZ 0VT5XZZ 0VT60ZZ 0VT64ZZ 0VT70ZZ 0VT74ZZ 0VT90ZZ 0VT94ZZ 0VTB0ZZ 0VTB4ZZ 0VTC0ZZ 0VTC4ZZ 0VTF0ZZ 0VTF4ZZ 0VTG0ZZ 0VTG4ZZ 0VTH0ZZ 0VTH4ZZ 0VTJ0ZZ 0VTJ4ZZ 0VTK0ZZ 0VTK4ZZ 0VTL0ZZ 0VTL4ZZ 0VTN0ZZ 0VTN4ZZ 0VTP0ZZ 0VTP4ZZ 0VTQ0ZZ 0VTQ4ZZ 0VTS0ZZ 0VTS4ZZ 0VTSXZZ 0VTT0ZZ 0VTT4ZZ 0VTTXZZ 0VU107Z 0VU10JZ 0VU10KZ 0VU147Z 0VU14JZ 0VU14KZ 0VU207Z 0VU20JZ 0VU20KZ 0VU247Z 0VU24JZ

Reposition Bilateral Testes, Perc Endo Approach Reposition Right Spermatic Cord, Open Approach Reposition Right Spermatic Cord, Percutaneous Approach Reposition Right Spermatic Cord, Perc Endo Approach Reposition Left Spermatic Cord, Open Approach Reposition Left Spermatic Cord, Percutaneous Approach Reposition Left Spermatic Cord, Perc Endo Approach Reposition Bilateral Spermatic Cords, Open Approach Reposition Bilateral Spermatic Cords, Percutaneous Approach Reposition Bilateral Spermatic Cords, Perc Endo Approach Resection of Prostate, Open Approach Resection of Prostate, Percutaneous Endoscopic Approach Resection of Prostate, Via Natural or Artificial Opening Resection of Prostate, Endo Resection of Right Seminal Vesicle, Open Approach Resection of Right Seminal Vesicle, Perc Endo Approach Resection of Left Seminal Vesicle, Open Approach Resection of Left Seminal Vesicle, Perc Endo Approach Resection of Bilateral Seminal Vesicles, Open Approach Resection of Bilateral Seminal Vesicles, Perc Endo Approach Resection of Scrotum, Open Approach Resection of Scrotum, Percutaneous Endoscopic Approach Resection of Scrotum, External Approach Resection of Right Tunica Vaginalis, Open Approach Resection of Right Tunica Vaginalis, Perc Endo Approach Resection of Left Tunica Vaginalis, Open Approach Resection of Left Tunica Vaginalis, Perc Endo Approach Resection of Right Testis, Open Approach Resection of Right Testis, Percutaneous Endoscopic Approach Resection of Left Testis, Open Approach Resection of Left Testis, Percutaneous Endoscopic Approach Resection of Bilateral Testes, Open Approach Resection of Bilateral Testes, Perc Endo Approach Resection of Right Spermatic Cord, Open Approach Resection of Right Spermatic Cord, Perc Endo Approach Resection of Left Spermatic Cord, Open Approach Resection of Left Spermatic Cord, Perc Endo Approach Resection of Bilateral Spermatic Cords, Open Approach Resection of Bilateral Spermatic Cords, Perc Endo Approach Resection of Right Epididymis, Open Approach Resection of Right Epididymis, Perc Endo Approach Resection of Left Epididymis, Open Approach Resection of Left Epididymis, Perc Endo Approach Resection of Bilateral Epididymis, Open Approach Resection of Bilateral Epididymis, Perc Endo Approach Resection of Right Vas Deferens, Open Approach Resection of Right Vas Deferens, Perc Endo Approach Resection of Left Vas Deferens, Open Approach Resection of Left Vas Deferens, Perc Endo Approach Resection of Bilateral Vas Deferens, Open Approach Resection of Bilateral Vas Deferens, Perc Endo Approach Resection of Penis, Open Approach Resection of Penis, Percutaneous Endoscopic Approach Resection of Penis, External Approach Resection of Prepuce, Open Approach Resection of Prepuce, Percutaneous Endoscopic Approach Resection of Prepuce, External Approach Supplement R Seminal Vesicle with Autol Sub, Open Approach Supplement R Seminal Vesicle with Synth Sub, Open Approach Supplement R Seminal Vesicle with Nonaut Sub, Open Approach Supplement R Seminal Vesicle w Autol Sub, Perc Endo Supplement R Seminal Vesicle w Synth Sub, Perc Endo Supplement R Seminal Vesicle w Nonaut Sub, Perc Endo Supplement L Seminal Vesicle with Autol Sub, Open Approach Supplement L Seminal Vesicle with Synth Sub, Open Approach Supplement L Seminal Vesicle with Nonaut Sub, Open Approach Supplement L Seminal Vesicle w Autol Sub, Perc Endo Supplement L Seminal Vesicle w Synth Sub, Perc Endo

1.154 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VU24KZ 0VU307Z 0VU30JZ 0VU30KZ 0VU347Z 0VU34JZ 0VU34KZ 0VU507Z 0VU50JZ 0VU50KZ 0VU547Z 0VU54JZ 0VU54KZ 0VU5X7Z 0VU5XJZ 0VU5XKZ 0VU607Z 0VU60JZ 0VU60KZ 0VU647Z 0VU64JZ 0VU64KZ 0VU707Z 0VU70JZ 0VU70KZ 0VU747Z 0VU74JZ 0VU74KZ 0VU907Z 0VU90JZ 0VU90KZ 0VUB07Z 0VUB0JZ 0VUB0KZ 0VUC07Z 0VUC0JZ 0VUC0KZ 0VUF07Z 0VUF0JZ 0VUF0KZ 0VUF47Z 0VUF4JZ 0VUF4KZ 0VUG07Z 0VUG0JZ 0VUG0KZ 0VUG47Z 0VUG4JZ 0VUG4KZ 0VUH07Z 0VUH0JZ 0VUH0KZ 0VUH47Z 0VUH4JZ 0VUH4KZ 0VUJ07Z 0VUJ0JZ 0VUJ0KZ 0VUJ47Z 0VUJ4JZ 0VUJ4KZ 0VUK07Z 0VUK0JZ 0VUK0KZ 0VUK47Z 0VUK4JZ 0VUK4KZ 0VUL07Z

Supplement L Seminal Vesicle w Nonaut Sub, Perc Endo Supplement Bi Seminal Vesicle with Autol Sub, Open Approach Supplement Bi Seminal Vesicle with Synth Sub, Open Approach Supplement Bi Seminal Vesicle with Nonaut Sub, Open Approach Supplement Bi Seminal Vesicle w Autol Sub, Perc Endo Supplement Bi Seminal Vesicle w Synth Sub, Perc Endo Supplement Bi Seminal Vesicle w Nonaut Sub, Perc Endo Supplement Scrotum with Autol Sub, Open Approach Supplement Scrotum with Synthetic Substitute, Open Approach Supplement Scrotum with Nonaut Sub, Open Approach Supplement Scrotum with Autol Sub, Perc Endo Approach Supplement Scrotum with Synth Sub, Perc Endo Approach Supplement Scrotum with Nonaut Sub, Perc Endo Approach Supplement Scrotum with Autol Sub, Extern Approach Supplement Scrotum with Synth Sub, Extern Approach Supplement Scrotum with Nonaut Sub, Extern Approach Supplement R Tunica Vaginalis with Autol Sub, Open Approach Supplement R Tunica Vaginalis with Synth Sub, Open Approach Supplement R Tunica Vaginalis with Nonaut Sub, Open Approach Supplement R Tunica Vaginalis w Autol Sub, Perc Endo Supplement R Tunica Vaginalis w Synth Sub, Perc Endo Supplement R Tunica Vaginalis w Nonaut Sub, Perc Endo Supplement L Tunica Vaginalis with Autol Sub, Open Approach Supplement L Tunica Vaginalis with Synth Sub, Open Approach Supplement L Tunica Vaginalis with Nonaut Sub, Open Approach Supplement L Tunica Vaginalis w Autol Sub, Perc Endo Supplement L Tunica Vaginalis w Synth Sub, Perc Endo Supplement L Tunica Vaginalis w Nonaut Sub, Perc Endo Supplement Right Testis with Autol Sub, Open Approach Supplement Right Testis with Synth Sub, Open Approach Supplement Right Testis with Nonaut Sub, Open Approach Supplement Left Testis with Autol Sub, Open Approach Supplement Left Testis with Synth Sub, Open Approach Supplement Left Testis with Nonaut Sub, Open Approach Supplement Bilateral Testes with Autol Sub, Open Approach Supplement Bilateral Testes with Synth Sub, Open Approach Supplement Bilateral Testes with Nonaut Sub, Open Approach Supplement R Sperm Cord with Autol Sub, Open Approach Supplement R Sperm Cord with Synth Sub, Open Approach Supplement R Sperm Cord with Nonaut Sub, Open Approach Supplement R Sperm Cord with Autol Sub, Perc Endo Approach Supplement R Sperm Cord with Synth Sub, Perc Endo Approach Supplement R Sperm Cord with Nonaut Sub, Perc Endo Approach Supplement Left Spermatic Cord with Autol Sub, Open Approach Supplement Left Spermatic Cord with Synth Sub, Open Approach Supplement L Sperm Cord with Nonaut Sub, Open Approach Supplement L Sperm Cord with Autol Sub, Perc Endo Approach Supplement L Sperm Cord with Synth Sub, Perc Endo Approach Supplement L Sperm Cord with Nonaut Sub, Perc Endo Approach Supplement Bi Sperm Cord with Autol Sub, Open Approach Supplement Bi Sperm Cord with Synth Sub, Open Approach Supplement Bi Sperm Cord with Nonaut Sub, Open Approach Supplement Bi Sperm Cord with Autol Sub, Perc Endo Approach Supplement Bi Sperm Cord with Synth Sub, Perc Endo Approach Supplement Bi Sperm Cord with Nonaut Sub, Perc Endo Approach Supplement Right Epididymis with Autol Sub, Open Approach Supplement Right Epididymis with Synth Sub, Open Approach Supplement Right Epididymis with Nonaut Sub, Open Approach Supplement R Epididymis with Autol Sub, Perc Endo Approach Supplement R Epididymis with Synth Sub, Perc Endo Approach Supplement R Epididymis with Nonaut Sub, Perc Endo Approach Supplement Left Epididymis with Autol Sub, Open Approach Supplement Left Epididymis with Synth Sub, Open Approach Supplement Left Epididymis with Nonaut Sub, Open Approach Supplement L Epididymis with Autol Sub, Perc Endo Approach Supplement L Epididymis with Synth Sub, Perc Endo Approach Supplement L Epididymis with Nonaut Sub, Perc Endo Approach Supplement B Epididymis with Autol Sub, Open Approach

September 2011

Edit code lists 1.155

Procedures allowed for males only

0VUL0JZ 0VUL0KZ 0VUL47Z 0VUL4JZ 0VUL4KZ 0VUN07Z 0VUN0JZ 0VUN0KZ 0VUN47Z 0VUN4JZ 0VUN4KZ 0VUP07Z 0VUP0JZ 0VUP0KZ 0VUP47Z 0VUP4JZ 0VUP4KZ 0VUQ07Z 0VUQ0JZ 0VUQ0KZ 0VUQ47Z 0VUQ4JZ 0VUQ4KZ 0VUS07Z 0VUS0JZ 0VUS0KZ 0VUS47Z 0VUS4JZ 0VUS4KZ 0VUSX7Z 0VUSXJZ 0VUSXKZ 0VUT07Z 0VUT0JZ 0VUT0KZ 0VUT47Z 0VUT4JZ 0VUT4KZ 0VUTX7Z 0VUTXJZ 0VUTXKZ 0VW400Z 0VW403Z 0VW407Z 0VW40JZ 0VW40KZ 0VW430Z 0VW433Z 0VW437Z 0VW43JZ 0VW43KZ 0VW440Z 0VW443Z 0VW447Z 0VW44JZ 0VW44KZ 0VW470Z 0VW473Z 0VW477Z 0VW47JZ 0VW47KZ 0VW480Z 0VW483Z 0VW487Z 0VW48JZ 0VW48KZ 0VW4X0Z 0VW4X3Z

Supplement B Epididymis with Synth Sub, Open Approach Supplement B Epididymis with Nonaut Sub, Open Approach Supplement B Epididymis with Autol Sub, Perc Endo Approach Supplement B Epididymis with Synth Sub, Perc Endo Approach Supplement B Epididymis with Nonaut Sub, Perc Endo Approach Supplement Right Vas Deferens with Autol Sub, Open Approach Supplement Right Vas Deferens with Synth Sub, Open Approach Supplement Right Vas Deferens with Nonaut Sub, Open Approach Supplement R Vas Deferens with Autol Sub, Perc Endo Approach Supplement R Vas Deferens with Synth Sub, Perc Endo Approach Supplement R Vas Deferens w Nonaut Sub, Perc Endo Supplement Left Vas Deferens with Autol Sub, Open Approach Supplement Left Vas Deferens with Synth Sub, Open Approach Supplement Left Vas Deferens with Nonaut Sub, Open Approach Supplement L Vas Deferens with Autol Sub, Perc Endo Approach Supplement L Vas Deferens with Synth Sub, Perc Endo Approach Supplement L Vas Deferens w Nonaut Sub, Perc Endo Supplement Bi Vas Deferens with Autol Sub, Open Approach Supplement Bi Vas Deferens with Synth Sub, Open Approach Supplement Bi Vas Deferens with Nonaut Sub, Open Approach Supplement Bi Vas Deferens w Autol Sub, Perc Endo Supplement Bi Vas Deferens w Synth Sub, Perc Endo Supplement Bi Vas Deferens w Nonaut Sub, Perc Endo Supplement Penis with Autol Sub, Open Approach Supplement Penis with Synthetic Substitute, Open Approach Supplement Penis with Nonaut Sub, Open Approach Supplement Penis with Autol Sub, Perc Endo Approach Supplement Penis with Synth Sub, Perc Endo Approach Supplement Penis with Nonaut Sub, Perc Endo Approach Supplement Penis with Autol Sub, Extern Approach Supplement Penis with Synthetic Substitute, Extern Approach Supplement Penis with Nonaut Sub, Extern Approach Supplement Prepuce with Autol Sub, Open Approach Supplement Prepuce with Synthetic Substitute, Open Approach Supplement Prepuce with Nonaut Sub, Open Approach Supplement Prepuce with Autol Sub, Perc Endo Approach Supplement Prepuce with Synth Sub, Perc Endo Approach Supplement Prepuce with Nonaut Sub, Perc Endo Approach Supplement Prepuce with Autol Sub, Extern Approach Supplement Prepuce with Synth Sub, Extern Approach Supplement Prepuce with Nonaut Sub, Extern Approach Revision of Drain Dev in Prostate/Seminal Ves, Open Approach Revise Infusion Dev in Prostate/Seminal Ves, Open Revision of Autol Sub in Prostate/Seminal Ves, Open Approach Revision of Synth Sub in Prostate/Seminal Ves, Open Approach Revise of Nonaut Sub in Prostate/Seminal Ves, Open Approach Revision of Drain Dev in Prostate/Seminal Ves, Perc Approach Revise Infusion Dev in Prostate/Seminal Ves, Perc Revision of Autol Sub in Prostate/Seminal Ves, Perc Approach Revision of Synth Sub in Prostate/Seminal Ves, Perc Approach Revise of Nonaut Sub in Prostate/Seminal Ves, Perc Approach Revise Drain Dev in Prostate/Seminal Ves, Perc Endo Revise Infusion Dev in Prostate/Seminal Ves, Perc Endo Revise Autol Sub in Prostate/Seminal Ves, Perc Endo Revise Synth Sub in Prostate/Seminal Ves, Perc Endo Revise Nonaut Sub in Prostate/Seminal Ves, Perc Endo Revision of Drain Dev in Prostate/Seminal Ves, Via Opening Revise of Infusion Dev in Prostate/Seminal Ves, Via Opening Revision of Autol Sub in Prostate/Seminal Ves, Via Opening Revision of Synth Sub in Prostate/Seminal Ves, Via Opening Revision of Nonaut Sub in Prostate/Seminal Ves, Via Opening Revision of Drainage Device in Prostate/Seminal Ves, Endo Revision of Infusion Device in Prostate/Seminal Ves, Endo Revision of Autol Sub in Prostate/Seminal Ves, Endo Revision of Synth Sub in Prostate/Seminal Ves, Endo Revision of Nonaut Sub in Prostate/Seminal Ves, Endo Revise of Drain Dev in Prostate/Seminal Ves, Extern Approach Revise Infusion Dev in Prostate/Seminal Ves, Extern

1.156 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VW4X7Z 0VW4XJZ 0VW4XKZ 0VW800Z 0VW803Z 0VW807Z 0VW80JZ 0VW80KZ 0VW830Z 0VW833Z 0VW837Z 0VW83JZ 0VW83KZ 0VW840Z 0VW843Z 0VW847Z 0VW84JZ 0VW84KZ 0VW870Z 0VW873Z 0VW877Z 0VW87JZ 0VW87KZ 0VW880Z 0VW883Z 0VW887Z 0VW88JZ 0VW88KZ 0VW8X0Z 0VW8X3Z 0VW8X7Z 0VW8XJZ 0VW8XKZ 0VWD00Z 0VWD03Z 0VWD07Z 0VWD0JZ 0VWD0KZ 0VWD30Z 0VWD33Z 0VWD37Z 0VWD3JZ 0VWD3KZ 0VWD40Z 0VWD43Z 0VWD47Z 0VWD4JZ 0VWD4KZ 0VWD70Z 0VWD73Z 0VWD77Z 0VWD7JZ 0VWD7KZ 0VWD80Z 0VWD83Z 0VWD87Z 0VWD8JZ 0VWD8KZ 0VWDX0Z 0VWDX3Z 0VWDX7Z 0VWDXJZ 0VWDXKZ 0VWM00Z 0VWM03Z 0VWM07Z 0VWM0CZ 0VWM0JZ

Revise of Autol Sub in Prostate/Seminal Ves, Extern Approach Revise of Synth Sub in Prostate/Seminal Ves, Extern Approach Revise Nonaut Sub in Prostate/Seminal Ves, Extern Revision of Drain Dev in Scrotum & Tunica, Open Approach Revision of Infusion Dev in Scrotum & Tunica, Open Approach Revision of Autol Sub in Scrotum & Tunica, Open Approach Revision of Synth Sub in Scrotum & Tunica, Open Approach Revision of Nonaut Sub in Scrotum & Tunica, Open Approach Revision of Drain Dev in Scrotum & Tunica, Perc Approach Revision of Infusion Dev in Scrotum & Tunica, Perc Approach Revision of Autol Sub in Scrotum & Tunica, Perc Approach Revision of Synth Sub in Scrotum & Tunica, Perc Approach Revision of Nonaut Sub in Scrotum & Tunica, Perc Approach Revise of Drain Dev in Scrotum & Tunica, Perc Endo Approach Revise Infusion Dev in Scrotum & Tunica, Perc Endo Revise of Autol Sub in Scrotum & Tunica, Perc Endo Approach Revise of Synth Sub in Scrotum & Tunica, Perc Endo Approach Revise of Nonaut Sub in Scrotum & Tunica, Perc Endo Approach Revision of Drainage Device in Scrotum & Tunica, Via Opening Revision of Infusion Device in Scrotum & Tunica, Via Opening Revision of Autol Sub in Scrotum & Tunica, Via Opening Revision of Synth Sub in Scrotum & Tunica, Via Opening Revision of Nonaut Sub in Scrotum & Tunica, Via Opening Revision of Drainage Device in Scrotum & Tunica, Endo Revision of Infusion Device in Scrotum & Tunica, Endo Revision of Autol Sub in Scrotum & Tunica, Endo Revision of Synthetic Substitute in Scrotum & Tunica, Endo Revision of Nonaut Sub in Scrotum & Tunica, Endo Revision of Drain Dev in Scrotum & Tunica, Extern Approach Revise of Infusion Dev in Scrotum & Tunica, Extern Approach Revision of Autol Sub in Scrotum & Tunica, Extern Approach Revision of Synth Sub in Scrotum & Tunica, Extern Approach Revision of Nonaut Sub in Scrotum & Tunica, Extern Approach Revision of Drainage Device in Testis, Open Approach Revision of Infusion Device in Testis, Open Approach Revision of Autol Sub in Testis, Open Approach Revision of Synthetic Substitute in Testis, Open Approach Revision of Nonaut Sub in Testis, Open Approach Revision of Drainage Device in Testis, Percutaneous Approach Revision of Infusion Device in Testis, Percutaneous Approach Revision of Autol Sub in Testis, Perc Approach Revision of Synthetic Substitute in Testis, Perc Approach Revision of Nonaut Sub in Testis, Perc Approach Revision of Drainage Device in Testis, Perc Endo Approach Revision of Infusion Device in Testis, Perc Endo Approach Revision of Autol Sub in Testis, Perc Endo Approach Revision of Synth Sub in Testis, Perc Endo Approach Revision of Nonaut Sub in Testis, Perc Endo Approach Revision of Drainage Device in Testis, Via Opening Revision of Infusion Device in Testis, Via Opening Revision of Autol Sub in Testis, Via Opening Revision of Synthetic Substitute in Testis, Via Opening Revision of Nonaut Sub in Testis, Via Opening Revision of Drainage Device in Testis, Endo Revision of Infusion Device in Testis, Endo Revision of Autologous Tissue Substitute in Testis, Endo Revision of Synthetic Substitute in Testis, Endo Revision of Nonautologous Tissue Substitute in Testis, Endo Revision of Drainage Device in Testis, External Approach Revision of Infusion Device in Testis, External Approach Revision of Autol Sub in Testis, Extern Approach Revision of Synthetic Substitute in Testis, Extern Approach Revision of Nonaut Sub in Testis, Extern Approach Revise of Drain Dev in Epididymis/Sperm Cord, Open Approach Revise Infusion Dev in Epididymis/Sperm Cord, Open Revise of Autol Sub in Epididymis/Sperm Cord, Open Approach Revise Extralum Dev in Epididymis/Sperm Cord, Open Revise of Synth Sub in Epididymis/Sperm Cord, Open Approach

September 2011

Edit code lists 1.157

Procedures allowed for males only

0VWM0KZ 0VWM30Z 0VWM33Z 0VWM37Z 0VWM3CZ 0VWM3JZ 0VWM3KZ 0VWM40Z 0VWM43Z 0VWM47Z 0VWM4CZ 0VWM4JZ 0VWM4KZ 0VWM70Z 0VWM73Z 0VWM77Z 0VWM7CZ 0VWM7JZ 0VWM7KZ 0VWM80Z 0VWM83Z 0VWM87Z 0VWM8CZ 0VWM8JZ 0VWM8KZ 0VWMX0Z 0VWMX3Z 0VWMX7Z 0VWMXCZ 0VWMXJZ 0VWMXKZ 0VWR00Z 0VWR03Z 0VWR07Z 0VWR0CZ 0VWR0DZ 0VWR0JZ 0VWR0KZ 0VWR30Z 0VWR33Z 0VWR37Z 0VWR3CZ 0VWR3DZ 0VWR3JZ 0VWR3KZ 0VWR40Z 0VWR43Z 0VWR47Z 0VWR4CZ 0VWR4DZ 0VWR4JZ 0VWR4KZ 0VWR70Z 0VWR73Z 0VWR77Z 0VWR7CZ 0VWR7DZ 0VWR7JZ 0VWR7KZ 0VWR80Z 0VWR83Z 0VWR87Z 0VWR8CZ 0VWR8DZ 0VWR8JZ 0VWR8KZ 0VWRX0Z 0VWRX3Z

Revise of Nonaut Sub in Epididymis/Sperm Cord, Open Approach Revise of Drain Dev in Epididymis/Sperm Cord, Perc Approach Revise Infusion Dev in Epididymis/Sperm Cord, Perc Revise of Autol Sub in Epididymis/Sperm Cord, Perc Approach Revise Extralum Dev in Epididymis/Sperm Cord, Perc Revise of Synth Sub in Epididymis/Sperm Cord, Perc Approach Revise of Nonaut Sub in Epididymis/Sperm Cord, Perc Approach Revise Drain Dev in Epididymis/Sperm Cord, Perc Endo Revise Infusion Dev in Epididymis/Sperm Cord, Perc Endo Revise Autol Sub in Epididymis/Sperm Cord, Perc Endo Revise Extralum Dev in Epididymis/Sperm Cord, Perc Endo Revise Synth Sub in Epididymis/Sperm Cord, Perc Endo Revise Nonaut Sub in Epididymis/Sperm Cord, Perc Endo Revision of Drain Dev in Epididymis/Sperm Cord, Via Opening Revise of Infusion Dev in Epididymis/Sperm Cord, Via Opening Revision of Autol Sub in Epididymis/Sperm Cord, Via Opening Revise of Extralum Dev in Epididymis/Sperm Cord, Via Opening Revision of Synth Sub in Epididymis/Sperm Cord, Via Opening Revision of Nonaut Sub in Epididymis/Sperm Cord, Via Opening Revision of Drainage Device in Epididymis/Sperm Cord, Endo Revision of Infusion Device in Epididymis/Sperm Cord, Endo Revision of Autol Sub in Epididymis/Sperm Cord, Endo Revision of Extralum Dev in Epididymis/Sperm Cord, Endo Revision of Synth Sub in Epididymis/Sperm Cord, Endo Revision of Nonaut Sub in Epididymis/Sperm Cord, Endo Revise Drain Dev in Epididymis/Sperm Cord, Extern Revise Infusion Dev in Epididymis/Sperm Cord, Extern Revise Autol Sub in Epididymis/Sperm Cord, Extern Revise Extralum Dev in Epididymis/Sperm Cord, Extern Revise Synth Sub in Epididymis/Sperm Cord, Extern Revise Nonaut Sub in Epididymis/Sperm Cord, Extern Revision of Drainage Device in Vas Deferens, Open Approach Revision of Infusion Device in Vas Deferens, Open Approach Revision of Autol Sub in Vas Deferens, Open Approach Revision of Extralum Dev in Vas Deferens, Open Approach Revision of Intralum Dev in Vas Deferens, Open Approach Revision of Synth Sub in Vas Deferens, Open Approach Revision of Nonaut Sub in Vas Deferens, Open Approach Revision of Drainage Device in Vas Deferens, Perc Approach Revision of Infusion Device in Vas Deferens, Perc Approach Revision of Autol Sub in Vas Deferens, Perc Approach Revision of Extralum Dev in Vas Deferens, Perc Approach Revision of Intralum Dev in Vas Deferens, Perc Approach Revision of Synth Sub in Vas Deferens, Perc Approach Revision of Nonaut Sub in Vas Deferens, Perc Approach Revision of Drain Dev in Vas Deferens, Perc Endo Approach Revision of Infusion Dev in Vas Deferens, Perc Endo Approach Revision of Autol Sub in Vas Deferens, Perc Endo Approach Revision of Extralum Dev in Vas Deferens, Perc Endo Approach Revision of Intralum Dev in Vas Deferens, Perc Endo Approach Revision of Synth Sub in Vas Deferens, Perc Endo Approach Revision of Nonaut Sub in Vas Deferens, Perc Endo Approach Revision of Drainage Device in Vas Deferens, Via Opening Revision of Infusion Device in Vas Deferens, Via Opening Revision of Autol Sub in Vas Deferens, Via Opening Revision of Extraluminal Device in Vas Deferens, Via Opening Revision of Intraluminal Device in Vas Deferens, Via Opening Revision of Synth Sub in Vas Deferens, Via Opening Revision of Nonaut Sub in Vas Deferens, Via Opening Revision of Drainage Device in Vas Deferens, Endo Revision of Infusion Device in Vas Deferens, Endo Revision of Autol Sub in Vas Deferens, Endo Revision of Extraluminal Device in Vas Deferens, Endo Revision of Intraluminal Device in Vas Deferens, Endo Revision of Synthetic Substitute in Vas Deferens, Endo Revision of Nonaut Sub in Vas Deferens, Endo Revision of Drainage Device in Vas Deferens, Extern Approach Revision of Infusion Device in Vas Deferens, Extern Approach

1.158 Definitions of Medicare Code Edits

September 2011

Procedures allowed for males only

0VWRX7Z 0VWRXCZ 0VWRXDZ 0VWRXJZ 0VWRXKZ 0VWS00Z 0VWS03Z 0VWS07Z 0VWS0JZ 0VWS0KZ 0VWS30Z 0VWS33Z 0VWS37Z 0VWS3JZ 0VWS3KZ 0VWS40Z 0VWS43Z 0VWS47Z 0VWS4JZ 0VWS4KZ 0VWS70Z 0VWS73Z 0VWS77Z 0VWS7JZ 0VWS7KZ 0VWS80Z 0VWS83Z 0VWS87Z 0VWS8JZ 0VWS8KZ 0VWSX0Z 0VWSX3Z 0VWSX7Z 0VWSXJZ 0VWSXKZ 0W4M070 0W4M0J0 0W4M0K0 0W4M0Z0 0WPM07Z 0WPM0KZ 0WPM37Z 0WPM3KZ 0WPM47Z 0WPM4KZ 0WPMX7Z 0WPMXJZ 0WPMXKZ 0WUM07Z 0WUM47Z 0WWM07Z 0WWM0KZ 0WWM37Z 0WWM3KZ 0WWM47Z 0WWM4KZ 3E0N33Z 3E0N36Z 3E0N37Z 3E0N3BZ 3E0N3GC 3E0N3HZ 3E0N3JZ 3E0N3KZ 3E0N3SF 3E0N3TZ 3E1N38X 3E1N38Z

Revision of Autol Sub in Vas Deferens, Extern Approach Revision of Extralum Dev in Vas Deferens, Extern Approach Revision of Intralum Dev in Vas Deferens, Extern Approach Revision of Synth Sub in Vas Deferens, Extern Approach Revision of Nonaut Sub in Vas Deferens, Extern Approach Revision of Drainage Device in Penis, Open Approach Revision of Infusion Device in Penis, Open Approach Revision of Autol Sub in Penis, Open Approach Revision of Synthetic Substitute in Penis, Open Approach Revision of Nonaut Sub in Penis, Open Approach Revision of Drainage Device in Penis, Percutaneous Approach Revision of Infusion Device in Penis, Percutaneous Approach Revision of Autol Sub in Penis, Perc Approach Revision of Synthetic Substitute in Penis, Perc Approach Revision of Nonaut Sub in Penis, Perc Approach Revision of Drainage Device in Penis, Perc Endo Approach Revision of Infusion Device in Penis, Perc Endo Approach Revision of Autol Sub in Penis, Perc Endo Approach Revision of Synth Sub in Penis, Perc Endo Approach Revision of Nonaut Sub in Penis, Perc Endo Approach Revision of Drainage Device in Penis, Via Opening Revision of Infusion Device in Penis, Via Opening Revision of Autol Sub in Penis, Via Opening Revision of Synthetic Substitute in Penis, Via Opening Revision of Nonaut Sub in Penis, Via Opening Revision of Drainage Device in Penis, Endo Revision of Infusion Device in Penis, Endo Revision of Autologous Tissue Substitute in Penis, Endo Revision of Synthetic Substitute in Penis, Endo Revision of Nonautologous Tissue Substitute in Penis, Endo Revision of Drainage Device in Penis, External Approach Revision of Infusion Device in Penis, External Approach Revision of Autol Sub in Penis, Extern Approach Revision of Synthetic Substitute in Penis, External Approach Revision of Nonaut Sub in Penis, Extern Approach Create Vagina in Male Perineum w Autol Sub, Open Create Vagina in Male Perineum w Synth Sub, Open Create Vagina in Male Perineum w Nonaut Sub, Open Creation of Vagina in Male Perineum, Open Approach Removal of Autol Sub from Male Perineum, Open Approach Removal of Nonaut Sub from Male Perineum, Open Approach Removal of Autol Sub from Male Perineum, Perc Approach Removal of Nonaut Sub from Male Perineum, Perc Approach Removal of Autol Sub from Male Perineum, Perc Endo Approach Removal of Nonaut Sub from Male Perineum, Perc Endo Approach Removal of Autol Sub from Male Perineum, Extern Approach Removal of Synth Sub from Male Perineum, Extern Approach Removal of Nonaut Sub from Male Perineum, Extern Approach Supplement Male Perineum with Autol Sub, Open Approach Supplement Male Perineum with Autol Sub, Perc Endo Approach Revision of Autol Sub in Male Perineum, Open Approach Revision of Nonaut Sub in Male Perineum, Open Approach Revision of Autol Sub in Male Perineum, Perc Approach Revision of Nonaut Sub in Male Perineum, Perc Approach Revision of Autol Sub in Male Perineum, Perc Endo Approach Revision of Nonaut Sub in Male Perineum, Perc Endo Approach Introduction of Anti-inflam into Male Reprod, Perc Approach Introduction of Nutritional into Male Reprod, Perc Approach Introduce Electrol/Water Bal in Male Reprod, Perc Introduction of Local Anesth into Male Reprod, Perc Approach Introduce Oth Therap Subst in Male Reprod, Perc Introduce of Radioact Subst into Male Reprod, Perc Approach Introduce of Contrast Agent into Male Reprod, Perc Approach Introduce of Oth Diagn Subst into Male Reprod, Perc Approach Introduction of Other Gas into Male Reprod, Perc Approach Introduction of Destr Agent into Male Reprod, Perc Approach Irrigate of Male Reprod using Irrigat, Perc Approach, Diagn Irrigation of Male Reproductive using Irrigat, Perc Approach

September 2011

Edit code lists 1.159

Procedures allowed for males only

3E1N78X 3E1N78Z 3E1N88X 3E1N88Z 8E0VX1C 8E0VX63 BV000ZZ BV001ZZ BV00YZZ BV010ZZ BV011ZZ BV01YZZ BV020ZZ BV021ZZ BV02YZZ BV030ZZ BV031ZZ BV03YZZ BV050ZZ BV051ZZ BV05YZZ BV060ZZ BV061ZZ BV06YZZ BV080ZZ BV081ZZ BV08YZZ BV100ZZ BV101ZZ BV10YZZ BV10ZZZ BV180ZZ BV181ZZ BV18YZZ BV18ZZZ

Irrigation of Male Reprod using Irrigat, Via Opening, Diagn Irrigation of Male Reproductive using Irrigat, Via Opening Irrigation of Male Reproductive using Irrigat, Endo, Diagn Irrigation of Male Reproductive using Irrigat, Endo Therapeutic Massage of Prostate Sperm Collection Plain Radiography of Corpora Cavernosa using H Osm Contrast Plain Radiography of Corpora Cavernosa using L Osm Contrast Plain Radiography of Corpora Cavernosa using Other Contrast Plain Radiography of Right Epididymis using H Osm Contrast Plain Radiography of Right Epididymis using L Osm Contrast Plain Radiography of Right Epididymis using Other Contrast Plain Radiography of Left Epididymis using H Osm Contrast Plain Radiography of Left Epididymis using L Osm Contrast Plain Radiography of Left Epididymis using Other Contrast Plain Radiography of Prostate using High Osmolar Contrast Plain Radiography of Prostate using Low Osmolar Contrast Plain Radiography of Prostate using Other Contrast Plain Radiography of Right Testicle using H Osm Contrast Plain Radiography of Right Testicle using L Osm Contrast Plain Radiography of Right Testicle using Other Contrast Plain Radiography of Left Testicle using H Osm Contrast Plain Radiography of Left Testicle using L Osm Contrast Plain Radiography of Left Testicle using Other Contrast Plain Radiography of Vasa Vasorum using H Osm Contrast Plain Radiography of Vasa Vasorum using Low Osmolar Contrast Plain Radiography of Vasa Vasorum using Other Contrast Fluoroscopy of Corpora Cavernosa using High Osmolar Contrast Fluoroscopy of Corpora Cavernosa using Low Osmolar Contrast Fluoroscopy of Corpora Cavernosa using Other Contrast Fluoroscopy of Corpora Cavernosa Fluoroscopy of Vasa Vasorum using High Osmolar Contrast Fluoroscopy of Vasa Vasorum using Low Osmolar Contrast Fluoroscopy of Vasa Vasorum using Other Contrast Fluoroscopy of Vasa Vasorum

1.160 Definitions of Medicare Code Edits

September 2011

6. Manifestation code as principal diagnosis

6. Manifestation code as principal diagnosis

Manifestation codes describe the manifestation of an underlying disease, not the disease itself, and therefore should not be used as a principal diagnosis. The following list contains ICD-10-CM diagnoses with corresponding English descriptions identified as manifestation codes.

Manifestations not allowed as principal diagnosis


D77 E35 F0280 F0281 F54 G01 G02 G053 G054 G07 G130 G131 G138 G26 G320 G328 G4727 G4736 G4737 G47421 G47429 G4754 G53 G55 G59 G63 G733 G737 G914 G94 G990 G992 G998 H22 H28 H32 H36 H42 H6240 H6241 H6242 H6243 H628X1 H628X2 H628X3 H628X9 H671 H672 H673 H679 H7500 H7501 H7502 Oth disord of bld/bld-frm organs in diseases classd elswhr Disorders of endocrine glands in diseases classd elswhr Dementia in oth diseases classd elswhr, w/o behavrl disturb Dementia in oth diseases classd elswhr, w behavioral disturb Psych & behavrl factors assoc w disord or dis classd elswhr Meningitis in bacterial diseases classified elsewhere Meningitis in oth infec/parastc diseases classd elswhr Encephalitis and encephalomyelitis in diseases classd elswhr Myelitis in diseases classified elsewhere Intcrn & intraspinal abscs & granuloma in dis classd elswhr Paraneoplastic neuromyopathy and neuropathy Oth systemic atrophy aff cnsl in neoplastic disease Systemic atrophy aff cnsl in oth diseases classd elswhr Extrapyramidal and movement disord in diseases classd elswhr Subac comb degeneration of spinal cord in dis classd elswhr Oth degeneratv disord of nervous sys in dis classd elswhr Circadian rhythm sleep disorder in conditions classd elswhr Sleep related hypoventilation in conditions classd elswhr Central sleep apnea in conditions classified elsewhere Narcolepsy in conditions classified elsewhere with cataplexy Narcolepsy in conditions classified elsewhere w/o cataplexy Parasomnia in conditions classified elsewhere Cranial nerve disorders in diseases classified elsewhere Nerve root and plexus compressions in diseases classd elswhr Mononeuropathy in diseases classified elsewhere Polyneuropathy in diseases classified elsewhere Myasthenic syndromes in other diseases classified elsewhere Myopathy in diseases classified elsewhere Hydrocephalus in diseases classified elsewhere Other disorders of brain in diseases classified elsewhere Autonomic neuropathy in diseases classified elsewhere Myelopathy in diseases classified elsewhere Oth disrd of nervous system in diseases classified elsewhere Disorders of iris and ciliary body in diseases classd elswhr Cataract in diseases classified elsewhere Chorioretinal disorders in diseases classified elsewhere Retinal disorders in diseases classified elsewhere Glaucoma in diseases classified elsewhere Otitis externa in oth diseases classd elswhr, unsp ear Otitis externa in oth diseases classd elswhr, right ear Otitis externa in oth diseases classd elswhr, left ear Otitis externa in oth diseases classd elswhr, bilateral Oth disorders of r ext ear in diseases classd elswhr Oth disorders of left external ear in diseases classd elswhr Oth disorders of ext ear in diseases classd elswhr, bi Oth disorders of ext ear in diseases classd elswhr, unsp ear Otitis media in diseases classified elsewhere, right ear Otitis media in diseases classified elsewhere, left ear Otitis media in diseases classified elsewhere, bilateral Otitis media in diseases classified elsewhere, unsp ear Mastoiditis in infec/parastc dis classd elswhr, unsp ear Mastoiditis in infec/parastc diseases classd elswhr, r ear Mastoiditis in infec/parastc dis classd elswhr, left ear

September 2011

Edit code lists 1.161

Manifestations not allowed as principal diagnosis

H7503 H7580 H7581 H7582 H7583 H821 H822 H823 H829 H9400 H9401 H9402 H9403 H9480 H9481 H9482 H9483 I32 I39 I41 I43 I52 I680 I682 I688 I790 I791 I798 J17 J910 J918 J99 K23 K67 K77 K87 L14 L45 L54 L62 L86 L99 M01X0 M01X11 M01X12 M01X19 M01X21 M01X22 M01X29 M01X31 M01X32 M01X39 M01X41 M01X42 M01X49 M01X51 M01X52 M01X59 M01X61 M01X62 M01X69 M01X71 M01X72 M01X79 M01X8 M01X9 M0288 M0289

Mastoiditis in infec/parastc diseases classd elswhr, bi Oth disrd of mid ear and mast in dis classd elswhr, unsp ear Oth disrd of r mid ear and mastoid in diseases classd elswhr Oth disrd of l mid ear and mastoid in diseases classd elswhr Oth disrd of mid ear and mastoid in dis classd elswhr, bi Vertiginous syndromes in diseases classd elswhr, right ear Vertiginous syndromes in diseases classd elswhr, left ear Vertiginous syndromes in diseases classd elswhr, bilateral Vertiginous syndromes in diseases classd elswhr, unsp ear Acustc neuritis in infec/parastc dis classd elswhr, unsp ear Acustc neuritis in infec/parastc dis classd elswhr, r ear Acustc neuritis in infec/parastc dis classd elswhr, left ear Acustc neuritis in infec/parastc diseases classd elswhr, bi Oth disrd of ear in diseases classified elsewhere, unsp ear Oth disrd of right ear in diseases classified elsewhere Oth disrd of left ear in diseases classified elsewhere Oth disrd of ear in diseases classified elsewhere, bilateral Pericarditis in diseases classified elsewhere Endocarditis and heart valve disord in dis classd elswhr Myocarditis in diseases classified elsewhere Cardiomyopathy in diseases classified elsewhere Other heart disorders in diseases classified elsewhere Cerebral amyloid angiopathy Cerebral arteritis in other diseases classified elsewhere Oth cerebrovascular disorders in diseases classd elswhr Aneurysm of aorta in diseases classified elsewhere Aortitis in diseases classified elsewhere Oth disord of art,arterioles & capilare in dis classd elswhr Pneumonia in diseases classified elsewhere Malignant pleural effusion Pleural effusion in other conditions classified elsewhere Respiratory disorders in diseases classified elsewhere Disorders of esophagus in diseases classified elsewhere Disorders of peritoneum in infectious diseases classd elswhr Liver disorders in diseases classified elsewhere Disord of GB, biliary trac and pancreas in dis classd elswhr Bullous disorders in diseases classified elsewhere Papulosquamous disorders in diseases classified elsewhere Erythema in diseases classified elsewhere Nail disorders in diseases classified elsewhere Keratoderma in diseases classified elsewhere Oth disorders of skin, subcu in diseases classd elswhr Dir infct of unsp joint in infec/parastc dis classd elswhr Direct infct of r shldr in infec/parastc dis classd elswhr Direct infct of l shldr in infec/parastc dis classd elswhr Dir infct of unsp shldr in infec/parastc dis classd elswhr Direct infct of r elbow in infec/parastc dis classd elswhr Direct infct of l elbow in infec/parastc dis classd elswhr Dir infct of unsp elbow in infec/parastc dis classd elswhr Direct infct of r wrist in infec/parastc dis classd elswhr Direct infct of l wrist in infec/parastc dis classd elswhr Dir infct of unsp wrist in infec/parastc dis classd elswhr Direct infct of r hand in infec/parastc dis classd elswhr Direct infct of l hand in infec/parastc dis classd elswhr Direct infct of unsp hand in infec/parastc dis classd elswhr Direct infct of r hip in infec/parastc dis classd elswhr Direct infct of left hip in infec/parastc dis classd elswhr Direct infct of unsp hip in infec/parastc dis classd elswhr Direct infct of r knee in infec/parastc dis classd elswhr Direct infct of l knee in infec/parastc dis classd elswhr Direct infct of unsp knee in infec/parastc dis classd elswhr Dir infct of right ank/ft in infec/parastc dis classd elswhr Dir infct of left ank/ft in infec/parastc dis classd elswhr Dir infct of unsp ank/ft in infec/parastc dis classd elswhr Direct infct of verteb in infec/parastc dis classd elswhr Dir infct of mult joints in infec/parastc dis classd elswhr Other reactive arthropathies, vertebrae Other reactive arthropathies, multiple sites

1.162 Definitions of Medicare Code Edits

September 2011

Manifestations not allowed as principal diagnosis

M029 M1480 M14811 M14812 M14819 M14821 M14822 M14829 M14831 M14832 M14839 M14841 M14842 M14849 M14851 M14852 M14859 M14861 M14862 M14869 M14871 M14872 M14879 M1488 M1489 M360 M361 M362 M363 M364 M368 M4980 M4981 M4982 M4983 M4984 M4985 M4986 M4987 M4988 M4989 M6380 M63811 M63812 M63819 M63821 M63822 M63829 M63831 M63832 M63839 M63841 M63842 M63849 M63851 M63852 M63859 M63861 M63862 M63869 M63871 M63872 M63879 M6388 M6389 M9050 M90511 M90512

Reactive arthropathy, unspecified Arthropathies in oth diseases classd elswhr, unsp site Arthropathies in oth diseases classd elswhr, right shoulder Arthropathies in oth diseases classd elswhr, left shoulder Arthropathies in oth diseases classd elswhr, unsp shoulder Arthropathies in oth diseases classd elswhr, right elbow Arthropathies in oth diseases classd elswhr, left elbow Arthropathies in oth diseases classd elswhr, unsp elbow Arthropathies in oth diseases classd elswhr, right wrist Arthropathies in oth diseases classd elswhr, left wrist Arthropathies in oth diseases classd elswhr, unsp wrist Arthropathies in oth diseases classd elswhr, right hand Arthropathies in oth diseases classd elswhr, left hand Arthropathies in oth diseases classd elswhr, unsp hand Arthropathies in oth diseases classd elswhr, right hip Arthropathies in oth diseases classified elsewhere, left hip Arthropathies in oth diseases classified elsewhere, unsp hip Arthropathies in oth diseases classd elswhr, right knee Arthropathies in oth diseases classd elswhr, left knee Arthropathies in oth diseases classd elswhr, unsp knee Arthropathies in oth diseases classd elswhr, right ank/ft Arthropathies in oth diseases classd elswhr, left ank/ft Arthropathies in oth diseases classd elswhr, unsp ank/ft Arthropathies in oth diseases classd elswhr, vertebrae Arthropathies in oth diseases classd elswhr, multiple sites Dermato(poly)myositis in neoplastic disease Arthropathy in neoplastic disease Hemophilic arthropathy Arthropathy in other blood disorders Arthropathy in hypersensitivity reactions classd elswhr Systemic disord of conn tiss in oth diseases classd elswhr Spondylopathy in diseases classified elsewhere, site unsp Spond in diseases classd elswhr, occipt-atlan-ax region Spondylopathy in diseases classd elswhr, cervical region Spondylopathy in diseases classd elswhr, cervicothor region Spondylopathy in diseases classd elswhr, thoracic region Spond in diseases classd elswhr, thoracolumbar region Spondylopathy in diseases classd elswhr, lumbar region Spondylopathy in diseases classd elswhr, lumbosacral region Spond in diseases classd elswhr, sacr/sacrocygl region Spond in diseases classd elswhr, multiple sites in spine Disorders of muscle in diseases classd elswhr, unsp site Disorders of muscle in diseases classd elswhr, r shoulder Disorders of muscle in diseases classd elswhr, left shoulder Disorders of muscle in diseases classd elswhr, unsp shoulder Disorders of muscle in diseases classd elswhr, r up arm Disorders of muscle in diseases classd elswhr, l up arm Disord of muscle in diseases classd elswhr, unsp upper arm Disorders of muscle in diseases classd elswhr, right forearm Disorders of muscle in diseases classd elswhr, left forearm Disorders of muscle in diseases classd elswhr, unsp forearm Disorders of muscle in diseases classd elswhr, right hand Disorders of muscle in diseases classd elswhr, left hand Disorders of muscle in diseases classd elswhr, unsp hand Disorders of muscle in diseases classd elswhr, right thigh Disorders of muscle in diseases classd elswhr, left thigh Disorders of muscle in diseases classd elswhr, unsp thigh Disorders of muscle in diseases classd elswhr, r low leg Disorders of muscle in diseases classd elswhr, l low leg Disord of muscle in diseases classd elswhr, unsp lower leg Disorders of muscle in diseases classd elswhr, right ank/ft Disorders of muscle in diseases classd elswhr, left ank/ft Disorders of muscle in diseases classd elswhr, unsp ank/ft Disorders of muscle in diseases classd elswhr, oth site Disord of muscle in diseases classd elswhr, multiple sites Osteonecrosis in diseases classified elsewhere, unsp site Osteonecrosis in diseases classd elswhr, right shoulder Osteonecrosis in diseases classd elswhr, left shoulder

September 2011

Edit code lists 1.163

Manifestations not allowed as principal diagnosis

M90519 M90521 M90522 M90529 M90531 M90532 M90539 M90541 M90542 M90549 M90551 M90552 M90559 M90561 M90562 M90569 M90571 M90572 M90579 M9058 M9059 M9060 M90611 M90612 M90619 M90621 M90622 M90629 M90631 M90632 M90639 M90641 M90642 M90649 M90651 M90652 M90659 M90661 M90662 M90669 M90671 M90672 M90679 M9068 M9069 M9080 M90811 M90812 M90819 M90821 M90822 M90829 M90831 M90832 M90839 M90841 M90842 M90849 M90851 M90852 M90859 M90861 M90862 M90869 M90871 M90872 M90879 M9088

Osteonecrosis in diseases classd elswhr, unsp shoulder Osteonecrosis in diseases classd elswhr, right upper arm Osteonecrosis in diseases classd elswhr, left upper arm Osteonecrosis in diseases classd elswhr, unsp upper arm Osteonecrosis in diseases classd elswhr, right forearm Osteonecrosis in diseases classified elsewhere, left forearm Osteonecrosis in diseases classified elsewhere, unsp forearm Osteonecrosis in diseases classified elsewhere, right hand Osteonecrosis in diseases classified elsewhere, left hand Osteonecrosis in diseases classified elsewhere, unsp hand Osteonecrosis in diseases classified elsewhere, right thigh Osteonecrosis in diseases classified elsewhere, left thigh Osteonecrosis in diseases classified elsewhere, unsp thigh Osteonecrosis in diseases classd elswhr, right lower leg Osteonecrosis in diseases classd elswhr, left lower leg Osteonecrosis in diseases classd elswhr, unsp lower leg Osteonecrosis in diseases classd elswhr, right ank/ft Osteonecrosis in diseases classd elswhr, left ankle and foot Osteonecrosis in diseases classd elswhr, unsp ankle and foot Osteonecrosis in diseases classified elsewhere, other site Osteonecrosis in diseases classd elswhr, multiple sites Osteitis deformans in neoplastic diseases, unspecified site Osteitis deformans in neoplastic diseases, right shoulder Osteitis deformans in neoplastic diseases, left shoulder Osteitis deformans in neoplastic diseases, unsp shoulder Osteitis deformans in neoplastic diseases, right upper arm Osteitis deformans in neoplastic diseases, left upper arm Osteitis deformans in neoplastic diseases, unsp upper arm Osteitis deformans in neoplastic diseases, right forearm Osteitis deformans in neoplastic diseases, left forearm Osteitis deformans in neoplastic diseases, unsp forearm Osteitis deformans in neoplastic diseases, right hand Osteitis deformans in neoplastic diseases, left hand Osteitis deformans in neoplastic diseases, unspecified hand Osteitis deformans in neoplastic diseases, right thigh Osteitis deformans in neoplastic diseases, left thigh Osteitis deformans in neoplastic diseases, unspecified thigh Osteitis deformans in neoplastic diseases, right lower leg Osteitis deformans in neoplastic diseases, left lower leg Osteitis deformans in neoplastic diseases, unsp lower leg Osteitis deformans in neoplastic diseases, right ank/ft Osteitis deformans in neoplastic diseases, left ank/ft Osteitis deformans in neoplastic diseases, unsp ank/ft Osteitis deformans in neoplastic diseases, other site Osteitis deformans in neoplastic diseases, multiple sites Osteopathy in diseases classified elsewhere, unsp site Osteopathy in diseases classified elsewhere, right shoulder Osteopathy in diseases classified elsewhere, left shoulder Osteopathy in diseases classified elsewhere, unsp shoulder Osteopathy in diseases classified elsewhere, right upper arm Osteopathy in diseases classified elsewhere, left upper arm Osteopathy in diseases classified elsewhere, unsp upper arm Osteopathy in diseases classified elsewhere, right forearm Osteopathy in diseases classified elsewhere, left forearm Osteopathy in diseases classified elsewhere, unsp forearm Osteopathy in diseases classified elsewhere, right hand Osteopathy in diseases classified elsewhere, left hand Osteopathy in diseases classified elsewhere, unsp hand Osteopathy in diseases classified elsewhere, right thigh Osteopathy in diseases classified elsewhere, left thigh Osteopathy in diseases classified elsewhere, unsp thigh Osteopathy in diseases classified elsewhere, right lower leg Osteopathy in diseases classified elsewhere, left lower leg Osteopathy in diseases classified elsewhere, unsp lower leg Osteopathy in diseases classd elswhr, right ankle and foot Osteopathy in diseases classd elswhr, left ankle and foot Osteopathy in diseases classd elswhr, unsp ankle and foot Osteopathy in diseases classified elsewhere, other site

1.164 Definitions of Medicare Code Edits

September 2011

Manifestations not allowed as principal diagnosis

M9089 N08 N16 N22 N29 N33 N37 N4832 N51 N521 N74 N770 N771 R4782 R5081

Osteopathy in diseases classified elsewhere, multiple sites Glomerular disorders in diseases classified elsewhere Renal tubulo-interstitial disord in diseases classd elswhr Calculus of urinary tract in diseases classified elsewhere Oth disorders of kidney and ureter in diseases classd elswhr Bladder disorders in diseases classified elsewhere Urethral disorders in diseases classified elsewhere Priapism due to disease classified elsewhere Disorders of male genital organs in diseases classd elswhr Erectile dysfunction due to diseases classified elsewhere Female pelvic inflam disorders in diseases classd elswhr Ulceration of vulva in diseases classified elsewhere Vaginitis, vulvitis and vulvovaginitis in dis classd elswhr Fluency disorder in conditions classified elsewhere Fever presenting with conditions classified elsewhere

September 2011

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7. Non-specific principal 7. Non-specific principal diagnosis diagnosis

Effective 10/01/07, the non-specific principal diagnosis edit was discontinued and will appear for claims processed using MCE version 2.0-23.0 only. Some diagnoses are not usually sufficient justification for admission to an acute care hospital. For example, if a patient is given code R030 for elevated blood pressure reading, without diagnosis of hypertension, then the patient would have a questionable admission, since elevated blood pressure reading is not normally sufficient justification for admission to a hospital. The following list contains diagnosis codes with corresponding English descriptions identified as questionable admission when used as a principal diagnosis.

8. Questionable admission

Questionable admissions - principal diagnosis only


E119 E139 E6609 E661 E668 E669 H6120 H6121 H6122 H6123 I10 I444 I445 I4460 I4469 I447 I450 I4510 I4519 R030 R972 T887XXA T888XXA T889XXA Z21 Z45010 Z45018 Z4502 Z4509 Type 2 diabetes mellitus without complications Other specified diabetes mellitus without complications Other obesity due to excess calories Drug-induced obesity Other obesity Obesity, unspecified Impacted cerumen, unspecified ear Impacted cerumen, right ear Impacted cerumen, left ear Impacted cerumen, bilateral Essential (primary) hypertension Left anterior fascicular block Left posterior fascicular block Unspecified fascicular block Other fascicular block Left bundle-branch block, unspecified Right fascicular block Unspecified right bundle-branch block Other right bundle-branch block Elevated blood-pressure reading, w/o diagnosis of htn Elevated prostate specific antigen [PSA] Unsp adverse effect of drug or medicament, init encntr Oth complications of surgical and medical care, NEC, init Complication of surgical and medical care, unsp, init encntr Asymptomatic human immunodeficiency virus infection status Encntr for checking and test of card pacemaker pulse gnrtr Encounter for adjust and mgmt oth prt cardiac pacemaker Encntr for adjust and mgmt of automatic implntbl card defib Encounter for adjustment and management of cardiac device

1.166 Definitions of Medicare Code Edits

September 2011

9.Unacceptable Unacceptable principal 9. principal diagnosis diagnosis

There are selected codes that describe a circumstance which influences an individuals health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis. One of the unacceptable principal diagnosis codes is considered acceptable when a secondary diagnosis is also coded on the record. If no secondary diagnosis is present for this code, the message REQUIRES SECONDARY DX will appear. The following pages contain a list of codes with corresponding English descriptions identified as unacceptable when entered as principal diagnosis.

Note: Codes that require a secondary diagnosis are indicated with an asterisk (*).

Unacceptable principal diagnoses


B6013 C802 D47Z1 D89810 D89811 D89812 D89813 F17200 F17201 F17210 F17211 F17220 F17221 F17290 F17291 F529 F819 G543 H168 H547 H579 H9390 H9391 H9392 H9393 I2582 I2583 I2601 I2690 I314 I7092 I76 L490 L491 L492 L493 L494 L495 L496 L497 Keratoconjunctivitis due to Acanthamoeba Malignant neoplasm associated with transplanted organ Post-transplant lymphoproliferative disorder (PTLD) Acute graft-versus-host disease Chronic graft-versus-host disease Acute on chronic graft-versus-host disease Graft-versus-host disease, unspecified Nicotine dependence, unspecified, uncomplicated Nicotine dependence, unspecified, in remission Nicotine dependence, cigarettes, uncomplicated Nicotine dependence, cigarettes, in remission Nicotine dependence, chewing tobacco, uncomplicated Nicotine dependence, chewing tobacco, in remission Nicotine dependence, other tobacco product, uncomplicated Nicotine dependence, other tobacco product, in remission Unsp sexual dysfnct not due to a sub or known physiol cond Developmental disorder of scholastic skills, unspecified Thoracic root disorders, not elsewhere classified Other keratitis Unspecified visual loss Unspecified disorder of eye and adnexa Unspecified disorder of ear, unspecified ear Unspecified disorder of right ear Unspecified disorder of left ear Unspecified disorder of ear, bilateral Chronic total occlusion of coronary artery Coronary atherosclerosis due to lipid rich plaque Septic pulmonary embolism with acute cor pulmonale Septic pulmonary embolism without acute cor pulmonale Cardiac tamponade Chronic total occlusion of artery of the extremities Septic arterial embolism Exfoliatn due to erythemat cond w < 10 pct of body surface Exfoliatn due to erythemat cond w 10-19 pct of body surface Exfoliatn due to erythemat cond w 20-29 pct of body surface Exfoliatn due to erythemat cond w 30-39 pct of body surface Exfoliatn due to erythemat cond w 40-49 pct of body surface Exfoliatn due to erythemat cond w 50-59 pct of body surface Exfoliatn due to erythemat cond w 60-69 pct of body surface Exfoliatn due to erythemat cond w 70-79 pct of body surface

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Unacceptable principal diagnoses

L498 L499 M960 N641 O0900 O0901 O0902 O0903 O0910 O0911 O0912 O0913 O09211 O09212 O09213 O09219 O09291 O09292 O09293 O09299 O0930 O0931 O0932 O0933 O0940 O0941 O0942 O0943 O09511 O09512 O09513 O09519 O09521 O09522 O09523 O09529 O09611 O09612 O09613 O09619 O09621 O09622 O09623 O09629 O0970 O0971 O0972 O0973 O09811 O09812 O09813 O09819 O09821 O09822 O09823 O09829 O09891 O09892 O09893 O09899 O0990 O0991 O0992 O0993 O30001 O30002 O30003 O30009

Exfoliatn due to erythemat cond w 80-89 pct of body surface Exfoliatn d/t erythemat cond w 90 or more pct of body surfc Pseudarthrosis after fusion or arthrodesis Fat necrosis of breast Suprvsn of preg w history of infertility, unsp trimester Suprvsn of preg w history of infertility, first trimester Suprvsn of preg w history of infertility, second trimester Suprvsn of preg w history of infertility, third trimester Suprvsn of preg w history of ectopic or molar preg, unsp tri Suprvsn of preg w history of ect or molar preg, first tri Suprvsn of preg w history of ect or molar preg, second tri Suprvsn of preg w history of ect or molar preg, third tri Suprvsn of preg w history of pre-term labor, first trimester Suprvsn of preg w history of pre-term labor, second tri Suprvsn of preg w history of pre-term labor, third trimester Suprvsn of preg w history of pre-term labor, unsp trimester Suprvsn of preg w poor reprodctv or obstet hx, first tri Suprvsn of preg w poor reprodctv or obstet hx, second tri Suprvsn of preg w poor reprodctv or obstet hx, third tri Suprvsn of preg w poor reprodctv or obstet history, unsp tri Suprvsn of preg w insufficient antenat care, unsp trimester Suprvsn of preg w insufficient antenat care, first trimester Suprvsn of preg w insufficient antenat care, second tri Suprvsn of preg w insufficient antenat care, third trimester Supervision of pregnancy w grand multiparity, unsp trimester Suprvsn of pregnancy w grand multiparity, first trimester Suprvsn of pregnancy w grand multiparity, second trimester Suprvsn of pregnancy w grand multiparity, third trimester Supervision of elderly primigravida, first trimester Supervision of elderly primigravida, second trimester Supervision of elderly primigravida, third trimester Supervision of elderly primigravida, unspecified trimester Supervision of elderly multigravida, first trimester Supervision of elderly multigravida, second trimester Supervision of elderly multigravida, third trimester Supervision of elderly multigravida, unspecified trimester Supervision of young primigravida, first trimester Supervision of young primigravida, second trimester Supervision of young primigravida, third trimester Supervision of young primigravida, unspecified trimester Supervision of young multigravida, first trimester Supervision of young multigravida, second trimester Supervision of young multigravida, third trimester Supervision of young multigravida, unspecified trimester Suprvsn of high risk preg due to social problems, unsp tri Suprvsn of high risk preg due to social problems, first tri Suprvsn of high risk preg due to social problems, second tri Suprvsn of high risk preg due to social problems, third tri Suprvsn of preg rslt from assisted reprodctv tech, first tri Suprvsn of preg rslt from assist reprodctv tech, second tri Suprvsn of preg rslt from assisted reprodctv tech, third tri Suprvsn of preg rslt from assisted reprodctv tech, unsp tri Suprvsn of preg w hx of in utero proc dur prev preg, 1st tri Suprvsn of preg w hx of in utero proc dur prev preg, 2nd tri Suprvsn of preg w hx of in utero proc dur prev preg, 3rd tri Suprvsn of preg w hx of in utero proc dur prev preg,unsp tri Supervision of other high risk pregnancies, first trimester Supervision of other high risk pregnancies, second trimester Supervision of other high risk pregnancies, third trimester Supervision of other high risk pregnancies, unsp trimester Supervision of high risk pregnancy, unsp, unsp trimester Supervision of high risk pregnancy, unsp, first trimester Supervision of high risk pregnancy, unsp, second trimester Supervision of high risk pregnancy, unsp, third trimester Twin preg, unsp num plcnta & amnio sacs, first trimester Twin preg, unsp num plcnta & amnio sacs, second trimester Twin preg, unsp num plcnta & amnio sacs, third trimester Twin pregnancy, unsp num plcnta & amnio sacs, unsp trimester

1.168 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

O30011 O30012 O30013 O30019 O30031 O30032 O30033 O30039 O30041 O30042 O30043 O30049 O30091 O30092 O30093 O30099 O30101 O30102 O30103 O30109 O30111 O30112 O30113 O30119 O30121 O30122 O30123 O30129 O30191 O30192 O30193 O30199 O30201 O30202 O30203 O30209 O30211 O30212 O30213 O30219 O30221 O30222 O30223 O30229 O30291 O30292 O30293 O30299 O30801 O30802 O30803 O30809 O30811 O30812 O30813 O30819 O30821 O30822 O30823 O30829 O30891 O30892 O30893 O30899 O99820 O99825 R180 R4183

Twin pregnancy, monochorionic/monoamniotic, first trimester Twin pregnancy, monochorionic/monoamniotic, second trimester Twin pregnancy, monochorionic/monoamniotic, third trimester Twin pregnancy, monochorionic/monoamniotic, unsp trimester Twin pregnancy, monochorionic/diamniotic, first trimester Twin pregnancy, monochorionic/diamniotic, second trimester Twin pregnancy, monochorionic/diamniotic, third trimester Twin pregnancy, monochorionic/diamniotic, unsp trimester Twin pregnancy, dichorionic/diamniotic, first trimester Twin pregnancy, dichorionic/diamniotic, second trimester Twin pregnancy, dichorionic/diamniotic, third trimester Twin pregnancy, dichorionic/diamniotic, unsp trimester Twin preg, unable to dtrm num plcnta & amnio sacs, first tri Twin preg, unable to dtrm num plcnta & amnio sacs, 2nd tri Twin preg, unable to dtrm num plcnta & amnio sacs, third tri Twin preg, unable to dtrm num plcnta & amnio sacs, unsp tri Triplet preg, unsp num plcnta & amnio sacs, first trimester Triplet preg, unsp num plcnta & amnio sacs, second trimester Triplet preg, unsp num plcnta & amnio sacs, third trimester Triplet preg, unsp num plcnta & amnio sacs, unsp trimester Triplet preg w two or more monochorionic fetuses, first tri Triplet preg w two or more monochorionic fetuses, second tri Triplet preg w two or more monochorionic fetuses, third tri Triplet preg w two or more monochorionic fetuses, unsp tri Triplet preg w two or more monoamnio fetuses, first tri Triplet preg w two or more monoamnio fetuses, second tri Triplet preg w two or more monoamnio fetuses, third tri Triplet preg w two or more monoamnio fetuses, unsp trimester Trp preg, unable to dtrm num plcnta & amnio sacs, first tri Trp preg, unable to dtrm num plcnta & amnio sacs, second tri Trp preg, unable to dtrm num plcnta & amnio sacs, third tri Trp preg, unable to dtrm num plcnta & amnio sacs, unsp tri Quad preg, unsp num plcnta & amnio sacs, first trimester Quad preg, unsp num plcnta & amnio sacs, second trimester Quad preg, unsp num plcnta & amnio sacs, third trimester Quad pregnancy, unsp num plcnta & amnio sacs, unsp trimester Quad preg w two or more monochorionic fetuses, first tri Quad preg w two or more monochorionic fetuses, second tri Quad preg w two or more monochorionic fetuses, third tri Quad preg w two or more monochorionic fetuses, unsp tri Quad preg w two or more monoamnio fetuses, first trimester Quad preg w two or more monoamnio fetuses, second trimester Quad preg w two or more monoamnio fetuses, third trimester Quad preg w two or more monoamnio fetuses, unsp trimester Quad preg, unable to dtrm num plcnta & amnio sacs, first tri Quad preg, unable to dtrm num plcnta & amnio sacs, 2nd tri Quad preg, unable to dtrm num plcnta & amnio sacs, third tri Quad preg, unable to dtrm num plcnta & amnio sacs, unsp tri Oth multiple gest, unsp num plcnta & amnio sacs, first tri Oth multiple gest, unsp num plcnta & amnio sacs, second tri Oth multiple gest, unsp num plcnta & amnio sacs, third tri Oth multiple gest, unsp num plcnta & amnio sacs, unsp tri Oth mult gest w two or more monochorionic fetuses, first tri Oth mult gest w two or more monochorionic fetuses, 2nd tri Oth mult gest w two or more monochorionic fetuses, third tri Oth mult gest w two or more monochorionic fetuses, unsp tri Oth multiple gest w two or more monoamnio fetuses, first tri Oth mult gest w two or more monoamnio fetuses, second tri Oth multiple gest w two or more monoamnio fetuses, third tri Oth multiple gest w two or more monoamnio fetuses, unsp tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 1st tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 2nd tri Oth mult gest, unab to dtrm num plcnta & amnio sacs, 3rd tri Oth mult gest,unab to dtrm num plcnta & amnio sacs, unsp tri Streptococcus B carrier state complicating pregnancy Streptococcus B carrier state complicating the puerperium Malignant ascites Borderline intellectual functioning

September 2011

Edit code lists 1.169

Unacceptable principal diagnoses

R45850 R4681 R4689 Z0000 Z0001 Z00110 Z00111 Z00121 Z00129 Z002 Z003 Z005 Z0070 Z0071 Z008 Z0110 Z01110 Z01118 Z0112 Z0120 Z0121 Z0130 Z0131 Z01812 Z01818 Z0182 Z0183 Z0184 Z0189 Z020 Z022 Z024 Z025 Z026 Z0271 Z0279 Z0282 Z0289 Z029 Z0371 Z0372 Z0373 Z0374 Z0375 Z0379 Z048 Z049 Z08 Z09 Z110 Z111 Z112 Z113 Z114 Z1151 Z1159 Z116 Z118 Z119 Z120 Z1210 Z1211 Z1212 Z1213 Z122 Z1231 Z1239 Z124

Homicidal ideations Obsessive-compulsive behavior Other symptoms and signs involving appearance and behavior Encntr for general adult medical exam w/o abnormal findings Encounter for general adult medical exam w abnormal findings Health examination for newborn under 8 days old Health examination for newborn 8 to 28 days old Encounter for routine child health exam w abnormal findings Encntr for routine child health exam w/o abnormal findings Encounter for exam for period of rapid growth in childhood Encounter for examination for adolescent development state Encounter for exam of potential donor of organ and tissue Encntr for exam for delay growth in chldhd w/o abn findings Encntr for exam for delay growth in chldhd w abn findings Encounter for other general examination Encounter for exam of ears and hearing w/o abnormal findings Encounter for hearing exam following failed hear screening Encntr for exam of ears and hearing w oth abnormal findings Encounter for hearing conservation and treatment Encounter for dental exam and cleaning w/o abnormal findings Encounter for dental exam and cleaning w abnormal findings Encounter for exam of blood pressure w/o abnormal findings Encounter for exam of blood pressure w abnormal findings Encounter for preprocedural laboratory examination Encounter for other preprocedural examination Encounter for allergy testing Encounter for blood typing Encounter for antibody response examination Encounter for other specified special examinations Encounter for exam for admission to educational institution Encounter for exam for admission to residential institution Encounter for examination for driving license Encounter for examination for participation in sport Encounter for examination for insurance purposes Encounter for disability determination Encounter for issue of other medical certificate Encounter for adoption services Encounter for other administrative examinations Encounter for administrative examinations, unspecified Encntr for susp prob w amnio cavity and membrane ruled out Encounter for suspected placental problem ruled out Encounter for suspected fetal anomaly ruled out Encounter for suspected problem with fetal growth ruled out Encounter for suspected cervical shortening ruled out Encntr for oth suspected maternal and fetal cond ruled out Encounter for examination and observation for oth reasons Encounter for examination and observation for unsp reason Encntr for follow-up exam after trtmt for malignant neoplasm Encntr for f/u exam aft trtmt for cond oth than malig neoplm Encounter for screening for intestinal infectious diseases Encounter for screening for respiratory tuberculosis Encounter for screening for other bacterial diseases Encntr screen for infections w sexl mode of transmiss Encounter for screening for human immunodeficiency virus Encounter for screening for human papillomavirus (HPV) Encounter for screening for other viral diseases Encntr screen for oth protozoal diseases and helminthiases Encounter for screening for oth infec/parastc diseases Encounter for screening for infec/parastc diseases, unsp Encounter for screening for malignant neoplasm of stomach Encntr screen for malignant neoplasm of intest tract, unsp Encounter for screening for malignant neoplasm of colon Encounter for screening for malignant neoplasm of rectum Encntr screen for malignant neoplasm of small intestine Encntr screen for malignant neoplasm of respiratory organs Encntr screen mammogram for malignant neoplasm of breast Encounter for oth screening for malignant neoplasm of breast Encounter for screening for malignant neoplasm of cervix

1.170 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z126 Z1271 Z1272 Z1273 Z1279 Z1281 Z1282 Z1283 Z1289 Z129 Z130 Z131 Z1321 Z13220 Z13228 Z1329 Z134 Z135 Z136 Z1371 Z1379 Z13810 Z13811 Z13818 Z13820 Z13828 Z1383 Z1384 Z13850 Z13858 Z1388 Z1389 Z139 Z1401 Z1402 Z141 Z148 Z1501 Z1502 Z1503 Z1504 Z1509 Z1581 Z1589 Z16 Z170 Z171 Z1801 Z1809 Z1810 Z1811 Z1812 Z182 Z1831 Z1832 Z1833 Z1839 Z1881 Z1883 Z1889 Z189 Z2009 Z201 Z202 Z203 Z204 Z207 Z20810

Encounter for screening for malignant neoplasm of bladder Encounter for screening for malignant neoplasm of testis Encounter for screening for malignant neoplasm of vagina Encounter for screening for malignant neoplasm of ovary Encntr screen for malignant neoplasm of genitourinary organs Encntr screen for malignant neoplasm of oral cavity Encntr screen for malignant neoplasm of nervous system Encounter for screening for malignant neoplasm of skin Encounter for screening for malignant neoplasm of oth sites Encounter for screening for malignant neoplasm, site unsp Encntr screen for dis of the bld/bld-form org/immun mechnsm Encounter for screening for diabetes mellitus Encounter for screening for nutritional disorder Encounter for screening for lipoid disorders Encounter for screening for other metabolic disorders Encounter for screening for oth suspected endocrine disorder Encntr screen for certain developmental disorders in chldhd Encounter for screening for eye and ear disorders Encounter for screening for cardiovascular disorders Encntr for nonprocreat screen for genetic dis carrier status Encntr for oth screening for genetic and chromsoml anomalies Encounter for screening for upper gastrointestinal disorder Encounter for screening for lower gastrointestinal disorder Encounter for screening for other digestive system disorders Encounter for screening for osteoporosis Encounter for screening for other musculoskeletal disorder Encounter for screening for respiratory disorder NEC Encounter for screening for dental disorders Encounter for screening for traumatic brain injury Encounter for screening for other nervous system disorders Encntr screen for disorder due to exposure to contaminants Encounter for screening for other disorder Encounter for screening, unspecified Asymptomatic hemophilia A carrier Symptomatic hemophilia A carrier Cystic fibrosis carrier Genetic carrier of other disease Genetic susceptibility to malignant neoplasm of breast Genetic susceptibility to malignant neoplasm of ovary Genetic susceptibility to malignant neoplasm of prostate Genetic susceptibility to malignant neoplasm of endometrium Genetic susceptibility to other malignant neoplasm Genetic susceptibility to multiple endocrine neoplasia [MEN] Genetic susceptibility to other disease Infection with drug resistant microorganisms Estrogen receptor positive status [ER+] Estrogen receptor negative status [ER-] Retained depleted uranium fragments Other retained radioactive fragments Retained metal fragments, unspecified Retained magnetic metal fragments Retained nonmagnetic metal fragments Retained plastic fragments Retained animal quills or spines Retained tooth Retained wood fragments Other retained organic fragments Retained glass fragments Retained stone or crystalline fragments Other specified retained foreign body fragments Retained foreign body fragments, unspecified material Contact w and exposure to oth intestinal infectious diseases Contact with and (suspected) exposure to tuberculosis Contact w and exposure to infect w a sexl mode of transmiss Contact with and (suspected) exposure to rabies Contact with and (suspected) exposure to rubella Cntct w & expsr to pediculosis, acariasis & oth infestations Contact with and (suspected) exposure to anthrax

September 2011

Edit code lists 1.171

Unacceptable principal diagnoses

Z20818 Z2089 Z209 Z220 Z221 Z222 Z2231 Z2232 Z22330 Z22338 Z2239 Z224 Z2250 Z2251 Z2252 Z2259 Z226 Z228 Z229 Z23 Z2801 Z2802 Z2803 Z2804 Z2809 Z281 Z2820 Z2821 Z2829 Z283 Z2881 Z2882 Z2889 Z289 Z30011 Z30012 Z30013 Z30014 Z30018 Z30019 Z3002 Z3009 Z3040 Z3041 Z3042 Z30430 Z30431 Z30432 Z30433 Z3049 Z308 Z309 Z3141 Z3142 Z31430 Z31438 Z31440 Z31441 Z31448 Z3149 Z315 Z3161 Z3162 Z3169 Z3181 Z3182 Z3183 Z3184

Contact w and exposure to oth bact communicable diseases Contact w and exposure to oth communicable diseases Contact w and exposure to unsp communicable disease Carrier of typhoid Carrier of other intestinal infectious diseases Carrier of diphtheria Carrier of bacterial disease due to meningococci Carrier of bacterial disease due to staphylococci Carrier of Group B streptococcus Carrier of other streptococcus Carrier of other specified bacterial diseases Carrier of infections w sexl mode of transmiss Carrier of unspecified viral hepatitis Carrier of viral hepatitis B Carrier of viral hepatitis C Carrier of other viral hepatitis Carrier of human T-lymphotropic virus type-1 infection Carrier of other infectious diseases Carrier of infectious disease, unspecified Encounter for immunization Immunization not crd out because of acute illness of patient Immuniz not crd out bec chronic illness or cond of patient Immuniz not crd out bec immune compromised state of patient Immuniz not crd out bec patient allergy to vaccine or cmpnt Immunization not carried out because of oth contraindication Immuniz not crd out because of patient belief/grp pressr Immuniz not crd out bec patient decision for unsp reason Immunization not carried out because of patient refusal Immuniz not crd out bec patient decision for oth reason Underimmunization status Immuniz not crd out due to patient having had the disease Immunization not carried out because of caregiver refusal Immunization not carried out for other reason Immunization not carried out for unspecified reason Encounter for initial prescription of contraceptive pills Encounter for prescription of emergency contraception Encounter for initial prescription of injectable contracep Encounter for initial prescription of uterin contracep dev Encounter for initial prescription of other contraceptives Encounter for initial prescription of contraceptives, unsp Cnsl and instruction in natrl family planning to avoid preg Encounter for oth general cnsl and advice on contraception Encounter for surveillance of contraceptives, unspecified Encounter for surveillance of contraceptive pills Encounter for surveillance of injectable contraceptive Encounter for insertion of intrauterine contraceptive device Encounter for routine checking of intrauterine contracep dev Encounter for removal of intrauterine contraceptive device Encntr for removal and reinsertion of uterin contracep dev Encounter for surveillance of other contraceptives Encounter for other contraceptive management Encounter for contraceptive management, unspecified Encounter for fertility testing Aftercare following sterilization reversal Encntr fem for test for genetc dis carrier stat for pro mgmt Encounter for oth genetic testing of female for pro mgmt Encntr male test for genetic dis carrier status for pro mgmt Encntr for testing of male prtnr of pt w recur preg loss Encounter for oth genetic testing of male for pro mgmt Encounter for other procreative investigation and testing Encounter for genetic counseling Procreat counseling and advice using natural family planning Encounter for fertility preservation counseling Encounter for oth general cnsl and advice on procreation Encounter for male factor infertility in female patient Encounter for Rh incompatibility status Encounter for assisted reprodctv fertility procedure cycle Encounter for fertility preservation procedure

1.172 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z3189 Z319 Z322 Z323 Z331 Z3400 Z3401 Z3402 Z3403 Z3480 Z3481 Z3482 Z3483 Z3490 Z3491 Z3492 Z3493 Z36 Z370 Z371 Z372 Z373 Z374 Z3750 Z3751 Z3752 Z3753 Z3754 Z3759 Z3760 Z3761 Z3762 Z3763 Z3764 Z3769 Z377 Z379 Z381 Z384 Z387 Z391 Z392 Z408 Z409 Z413 Z418 Z419 Z439 Z449 Z4582 Z4589 Z459 Z460 Z461 Z464 Z4651 Z4659 Z466 Z4681 Z4689 Z469 Z4800 Z4801 Z4802 Z4821 Z4822 Z4823 Z4824

Encounter for other procreative management Encounter for procreative management, unspecified Encounter for childbirth instruction Encounter for childcare instruction Pregnant state, incidental Encntr for suprvsn of normal first pregnancy, unsp trimester Encntr for suprvsn of normal first preg, first trimester Encntr for suprvsn of normal first preg, second trimester Encntr for suprvsn of normal first preg, third trimester Encounter for suprvsn of normal pregnancy, unsp trimester Encounter for suprvsn of normal pregnancy, first trimester Encounter for suprvsn of normal pregnancy, second trimester Encounter for suprvsn of normal pregnancy, third trimester Encntr for suprvsn of normal pregnancy, unsp, unsp trimester Encntr for suprvsn of normal preg, unsp, first trimester Encntr for suprvsn of normal preg, unsp, second trimester Encntr for suprvsn of normal preg, unsp, third trimester Encounter for antenatal screening of mother Single live birth Single stillbirth Twins, both liveborn Twins, one liveborn and one stillborn Twins, both stillborn Multiple births, unspecified, all liveborn Triplets, all liveborn Quadruplets, all liveborn Quintuplets, all liveborn Sextuplets, all liveborn Other multiple births, all liveborn Multiple births, unspecified, some liveborn Triplets, some liveborn Quadruplets, some liveborn Quintuplets, some liveborn Sextuplets, some liveborn Other multiple births, some liveborn Other multiple births, all stillborn Outcome of delivery, unspecified Single liveborn infant, born outside hospital Twin liveborn infant, born outside hospital Other multiple liveborn infant, born outside hospital Encounter for care and examination of lactating mother Encounter for routine postpartum follow-up Encounter for other prophylactic surgery Encounter for prophylactic surgery, unspecified Encounter for ear piercing Encntr for oth proc for purpose oth than remedy health state Encntr for proc for purpose oth than remedy hlth state, unsp Encounter for attention to unspecified artificial opening Encounter for fit/adjst of unsp external prosthetic device Encntr for adjust or removal of myringotomy device (tube) Encounter for adjustment and management of implanted devices Encounter for adjust and management of unsp implanted device Encounter for fit/adjst of spectacles and contact lenses Encounter for fitting and adjustment of hearing aid Encounter for fitting and adjustment of orthodontic device Encounter for fitting and adjustment of gastric lap band Encounter for fit/adjst of GI appliance and device Encounter for fitting and adjustment of urinary device Encounter for fitting and adjustment of insulin pump Encounter for fitting and adjustment of oth devices Encounter for fitting and adjustment of unspecified device Encounter for change or removal of nonsurg wound dressing Encounter for change or removal of surgical wound dressing Encounter for removal of sutures Encounter for aftercare following heart transplant Encounter for aftercare following kidney transplant Encounter for aftercare following liver transplant Encounter for aftercare following lung transplant

September 2011

Edit code lists 1.173

Unacceptable principal diagnoses

Z48280 Z48288 Z48290 Z48298 Z4902 Z4931 Z4932 Z515 *Z5189 Z52000 Z52001 Z52008 Z52010 Z52011 Z52018 Z52090 Z52091 Z52098 Z52810 Z52811 Z52812 Z52813 Z52819 Z5301 Z5309 Z531 Z5320 Z5321 Z5329 Z538 Z539 Z550 Z551 Z552 Z553 Z554 Z558 Z559 Z560 Z561 Z562 Z563 Z564 Z565 Z566 Z5681 Z5682 Z5689 Z569 Z570 Z571 Z572 Z5731 Z5739 Z574 Z575 Z576 Z577 Z578 Z579 Z590 Z591 Z592 Z593 Z594 Z595 Z596 Z597

Encounter for aftercare following heart-lung transplant Encounter for aftercare following multiple organ transplant Encounter for aftercare following bone marrow transplant Encounter for aftercare following other organ transplant Encounter for fit/adjst of peritoneal dialysis catheter Encounter for adequacy testing for hemodialysis Encounter for adequacy testing for peritoneal dialysis Encounter for palliative care Encounter for other specified aftercare Unspecified donor, whole blood Unspecified donor, stem cells Unspecified donor, other blood Autologous donor, whole blood Autologous donor, stem cells Autologous donor, other blood Other blood donor, whole blood Other blood donor, stem cells Other blood donor, other blood Egg (Oocyte) donor under age 35, anonymous recipient Egg (Oocyte) donor under age 35, designated recipient Egg (Oocyte) donor age 35 and over, anonymous recipient Egg (Oocyte) donor age 35 and over, designated recipient Egg (Oocyte) donor, unspecified Proc/trtmt not carried out due to patient smoking Proc/trtmt not carried out because of contraindication Proc/trtmt not crd out bec pt belief and group pressure Proc/trtmt not crd out bec pt decision for unsp reasons Proc/trtmt not crd out d/t pt lv bef seen by hlth care prov Proc/trtmt not crd out bec pt decision for oth reasons Procedure and treatment not carried out for other reasons Procedure and treatment not carried out, unspecified reason Illiteracy and low-level literacy Schooling unavailable and unattainable Failed school examinations Underachievement in school Educational maladjustment & discord w teachers & classmates Other problems related to education and literacy Problems related to education and literacy, unspecified Unemployment, unspecified Change of job Threat of job loss Stressful work schedule Discord with boss and workmates Uncongenial work environment Other physical and mental strain related to work Sexual harassment on the job Military deployment status Other problems related to employment Unspecified problems related to employment Occupational exposure to noise Occupational exposure to radiation Occupational exposure to dust Occupational exposure to environmental tobacco smoke Occupational exposure to other air contaminants Occupational exposure to toxic agents in agriculture Occupational exposure to toxic agents in other industries Occupational exposure to extreme temperature Occupational exposure to vibration Occupational exposure to other risk factors Occupational exposure to unspecified risk factor Homelessness Inadequate housing Discord with neighbors, lodgers and landlord Problems related to living in residential institution Lack of adequate food and safe drinking water Extreme poverty Low income Insufficient social insurance and welfare support

1.174 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z598 Z599 Z600 Z602 Z603 Z604 Z605 Z608 Z609 Z620 Z621 Z6221 Z6222 Z6229 Z623 Z626 Z62810 Z62811 Z62812 Z62819 Z62820 Z62821 Z62822 Z62890 Z62891 Z62898 Z629 Z630 Z631 Z6331 Z6332 Z634 Z635 Z636 Z6371 Z6372 Z6379 Z638 Z639 Z640 Z641 Z644 Z650 Z651 Z652 Z653 Z654 Z655 Z658 Z659 Z66 Z6710 Z6711 Z6720 Z6721 Z6730 Z6731 Z6740 Z6741 Z6790 Z6791 Z681 Z6820 Z6821 Z6822 Z6823 Z6824 Z6825

Other problems related to housing and economic circumstances Problem related to housing and economic circumstances, unsp Problems of adjustment to life-cycle transitions Problems related to living alone Acculturation difficulty Social exclusion and rejection Target of (perceived) adverse discrimination and persecution Other problems related to social environment Problem related to social environment, unspecified Inadequate parental supervision and control Parental overprotection Child in welfare custody Institutional upbringing Other upbringing away from parents Hostility towards and scapegoating of child Inappropriate (excessive) parental pressure Personal history of physical and sexual abuse in childhood Personal history of psychological abuse in childhood Personal history of neglect in childhood Personal history of unspecified abuse in childhood Parent-biological child conflict Parent-adopted child conflict Parent-foster child conflict Parent-child estrangement NEC Sibling rivalry Other specified problems related to upbringing Problem related to upbringing, unspecified Problems in relationship with spouse or partner Problems in relationship with in-laws Absence of family member due to military deployment Other absence of family member Disappearance and death of family member Disruption of family by separation and divorce Dependent relative needing care at home Stress on fam d/t return of family member from miltry deploy Alcoholism and drug addiction in family Other stressful life events affecting family and household Other specified problems related to primary support group Problem related to primary support group, unspecified Problems related to unwanted pregnancy Problems related to multiparity Discord with counselors Conviction in civil & criminal proceedings w/o imprisonment Imprisonment and other incarceration Problems related to release from prison Problems related to other legal circumstances Victim of crime and terrorism Exposure to disaster, war and other hostilities Oth problems related to psychosocial circumstances Problem related to unspecified psychosocial circumstances Do not resuscitate Type A blood, Rh positive Type A blood, Rh negative Type B blood, Rh positive Type B blood, Rh negative Type AB blood, Rh positive Type AB blood, Rh negative Type O blood, Rh positive Type O blood, Rh negative Unspecified blood type, Rh positive Unspecified blood type, Rh negative Body mass index (BMI) 19 or less, adult Body mass index (BMI) 20.0-20.9, adult Body mass index (BMI) 21.0-21.9, adult Body mass index (BMI) 22.0-22.9, adult Body mass index (BMI) 23.0-23.9, adult Body mass index (BMI) 24.0-24.9, adult Body mass index (BMI) 25.0-25.9, adult

September 2011

Edit code lists 1.175

Unacceptable principal diagnoses

Z6826 Z6827 Z6828 Z6829 Z6830 Z6831 Z6832 Z6833 Z6834 Z6835 Z6836 Z6837 Z6838 Z6839 Z6841 Z6842 Z6843 Z6844 Z6845 Z6851 Z6852 Z6853 Z6854 Z69011 Z69021 Z6911 Z6912 Z6981 Z6982 Z700 Z701 Z702 Z703 Z708 Z709 Z710 Z711 Z712 Z713 Z7141 Z7142 Z7151 Z7152 Z716 Z717 Z7181 Z7189 Z719 Z720 Z723 Z724 Z7251 Z7252 Z7253 Z726 Z72821 Z7289 Z729 Z730 Z731 Z732 Z733 Z734 Z735 Z736 Z73810 Z73811 Z73812

Body mass index (BMI) 26.0-26.9, adult Body mass index (BMI) 27.0-27.9, adult Body mass index (BMI) 28.0-28.9, adult Body mass index (BMI) 29.0-29.9, adult Body mass index (BMI) 30.0-30.9, adult Body mass index (BMI) 31.0-31.9, adult Body mass index (BMI) 32.0-32.9, adult Body mass index (BMI) 33.0-33.9, adult Body mass index (BMI) 34.0-34.9, adult Body mass index (BMI) 35.0-35.9, adult Body mass index (BMI) 36.0-36.9, adult Body mass index (BMI) 37.0-37.9, adult Body mass index (BMI) 38.0-38.9, adult Body mass index (BMI) 39.0-39.9, adult Body mass index (BMI) 40.0-44.9, adult Body mass index (BMI) 45.0-49.9, adult Body mass index (BMI) 50-59.9 , adult Body mass index (BMI) 60.0-69.9, adult Body mass index (BMI) 70 or greater, adult BMI pediatric, less than 5th percentile for age BMI pediatric, 5th percentile to less than 85% for age BMI pediatric, 85% to less than 95th percentile for age BMI pediatric, greater than or equal to 95% for age Encntr for mental health serv for perp of prntl child abuse Encntr for mntl hlth serv for perp of non-prntl child abuse Encntr for mntl hlth serv for victim of spous or prtnr abuse Encntr for mental hlth serv for perp of spous or prtnr abuse Encounter for mental health services for victim of oth abuse Encounter for mental health services for perp of abuse Counseling related to sexual attitude Counseling related to patient's sexual behavior and orientn Cnsl related to sexual behavior and orientn of third party Cnsl rel to comb concrn rgrd sex attitude, behav and orientn Other sex counseling Sex counseling, unspecified Prsn encntr hlth serv to consult on behalf of another person Person w feared hlth complaint in whom no diagnosis is made Person consulting for explanation of exam or test findings Dietary counseling and surveillance Alcohol abuse counseling and surveillance of alcoholic Counseling for family member of alcoholic Drug abuse counseling and surveillance of drug abuser Counseling for family member of drug abuser Tobacco abuse counseling Human immunodeficiency virus [HIV] counseling Spiritual or religious counseling Other specified counseling Counseling, unspecified Tobacco use Lack of physical exercise Inappropriate diet and eating habits High risk heterosexual behavior High risk homosexual behavior High risk bisexual behavior Gambling and betting Inadequate sleep hygiene Other problems related to lifestyle Problem related to lifestyle, unspecified Burn-out Type A behavior pattern Lack of relaxation and leisure Stress, not elsewhere classified Inadequate social skills, not elsewhere classified Social role conflict, not elsewhere classified Limitation of activities due to disability Behavioral insomnia of childhood, sleep-onset assoc type Behavioral insomnia of childhood, limit setting type Behavioral insomnia of childhood, combined type

1.176 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z73819 Z7382 Z7389 Z739 Z7401 Z7409 Z741 Z742 Z743 Z748 Z749 Z750 Z751 Z752 Z753 Z754 Z755 Z758 Z759 Z760 Z762 Z7681 Z7682 Z7689 Z77010 Z77011 Z77018 Z77020 Z77021 Z77028 Z77090 Z77098 Z77110 Z77111 Z77112 Z77118 Z77120 Z77121 Z77122 Z77123 Z77128 Z7721 Z7722 Z7729 Z779 Z780 Z781 Z789 Z7902 Z791 Z792 Z7951 Z7952 Z79810 Z79811 Z79818 Z79890 Z800 Z801 Z802 Z803 Z8041 Z8042 Z8043 Z8049 Z8051 Z8052 Z8059

Behavioral insomnia of childhood, unspecified type Dual sensory impairment Other problems related to life management difficulty Problem related to life management difficulty, unspecified Bed confinement status Other reduced mobility Need for assistance with personal care Need for assist at home & no house memb able to render care Need for continuous supervision Other problems related to care provider dependency Problem related to care provider dependency, unspecified Medical services not available in home Person awaiting admission to adequate facility elsewhere Other waiting period for investigation and treatment Unavailability and inaccessibility of health-care facilities Unavailability and inaccessibility of other helping agencies Holiday relief care Oth prob related to medical facilities and oth health care Unsp problem related to med facilities and oth health care Encounter for issue of repeat prescription Encntr for hlth suprvsn and care of healthy infant and child Expectant parent(s) prebirth pediatrician visit Awaiting organ transplant status Persons encountering health services in oth circumstances Contact with and (suspected) exposure to arsenic Contact with and (suspected) exposure to lead Contact w and (suspected) exposure to oth hazardous metals Contact with and (suspected) exposure to aromatic amines Contact with and (suspected) exposure to benzene Contact w and exposure to oth hazardous aromatic compounds Contact with and (suspected) exposure to asbestos Contact w and expsr to oth hazard, chiefly nonmed, chemicals Contact with and (suspected) exposure to air pollution Contact with and (suspected) exposure to water pollution Contact with and (suspected) exposure to soil pollution Contact w and (suspected) exposure to oth environ pollution Contact with and (suspected) exposure to mold (toxic) Contact w and exposure to harmful algae and algae toxins Contact with and (suspected) exposure to noise Cntct w & expsr to radon & oth naturally occuring radiation Contact w and expsr to oth hazards in the physcl environment Contact w and exposure to potentially hazardous body fluids Cntct w and expsr to environ tobacco smoke (acute) (chronic) Contact w and (suspected ) exposure to oth hazardous substnc Oth contact w and (suspected) exposures hazardous to health Asymptomatic menopausal state Physical restraint status Other specified health status Long term (current) use of antithrombotics/antiplatelets Long term (current) use of non-steroidal non-inflam (NSAID) Long term (current) use of antibiotics Long term (current) use of inhaled steroids Long term (current) use of systemic steroids Lng trm (crnt) use of slctv estrog receptor modulators Long term (current) use of aromatase inhibitors Lng trm (crnt) use of agnt aff estrog recpt & estrog levels Hormone replacement therapy (postmenopausal) Family history of malignant neoplasm of digestive organs Family history of malig neoplasm of trachea, bronc and lung Family hx of malig neoplm of resp and intrathorac organs Family history of malignant neoplasm of breast Family history of malignant neoplasm of ovary Family history of malignant neoplasm of prostate Family history of malignant neoplasm of testis Family history of malignant neoplasm of other genital organs Family history of malignant neoplasm of kidney Family history of malignant neoplasm of bladder Family history of malignant neoplasm of urinary tract organ

September 2011

Edit code lists 1.177

Unacceptable principal diagnoses

Z806 Z807 Z808 Z809 Z810 Z811 Z812 Z813 Z814 Z818 Z820 Z821 Z822 Z823 Z8241 Z8249 Z825 Z8261 Z8262 Z8269 Z8271 Z8279 Z828 Z830 Z831 Z832 Z833 Z8341 Z8349 Z835 Z836 Z8371 Z8379 Z840 Z841 Z842 Z843 Z8481 Z8489 Z8500 Z8501 Z85020 Z85028 Z85030 Z85038 Z85040 Z85048 Z8505 Z85060 Z85068 Z8507 Z8509 Z85110 Z85118 Z8512 Z8520 Z8521 Z8522 Z85230 Z85238 Z8529 Z853 Z8540 Z8541 Z8542 Z8543 Z8544 Z8545

Family history of leukemia Fam hx of malig neoplm of lymphoid, hematpoetc and rel tiss Family history of malignant neoplasm of organs or systems Family history of malignant neoplasm, unspecified Family history of mental retardation Family history of alcohol abuse and dependence Family history of tobacco abuse and dependence Family history of psychoactv substance abuse and dependence Family history of other substance abuse and dependence Family history of other mental and behavioral disorders Family history of epilepsy and oth dis of the nervous sys Family history of blindness and visual loss Family history of deafness and hearing loss Family history of stroke Family history of sudden cardiac death Family hx of ischem heart dis and oth dis of the circ sys Family history of asthma and oth chronic lower resp diseases Family history of arthritis Family history of osteoporosis Family history of diseases of the ms sys and connective tiss Family history of polycystic kidney Fam hx of congen malform, deformations and chromsoml abnlt Family hx of disabil and chr dis leading to disablement, NEC Family history of human immunodeficiency virus [HIV] disease Family history of other infectious and parasitic diseases Family history of dis of the bld/bld-form org/immun mechnsm Family history of diabetes mellitus Family history of multiple endocrine neoplasia syndrome Family history of endo, nutritional and metabolic diseases Family history of eye and ear disorders Family history of other diseases of the respiratory system Family history of colonic polyps Family history of other diseases of the digestive system Family history of diseases of the skin, subcu Family history of disorders of kidney and ureter Family history of other diseases of the genitourinary system Family history of consanguinity Family history of carrier of genetic disease Family history of other specified conditions Personal history of malignant neoplasm of unsp dgstv org Personal history of malignant neoplasm of esophagus Personal history of malignant carcinoid tumor of stomach Personal history of other malignant neoplasm of stomach Personal history of malignant carcinoid tumor of lg int Personal history of malignant neoplasm of large intestine Personal history of malignant carcinoid tumor of rectum Prsnl hx of malig neoplm of rectum, rectosig junct, and anus Personal history of malignant neoplasm of liver Personal history of malignant carcinoid tumor of sm int Personal history of malignant neoplasm of small intestine Personal history of malignant neoplasm of pancreas Personal history of malignant neoplasm of digestive organs Personal history of malig carcinoid tumor of bronc and lung Personal history of malignant neoplasm of bronchus and lung Personal history of malignant neoplasm of trachea Personal history of malignant neoplasm of unsp resp organ Personal history of malignant neoplasm of larynx Prsnl hx of malig neoplm of nasl cav, mid ear, & acces sinus Personal history of malignant carcinoid tumor of thymus Personal history of other malignant neoplasm of thymus Prsnl history of malig neoplm of resp and intrathorac organs Personal history of malignant neoplasm of breast Prsnl history of malig neoplm of unsp female genital organ Personal history of malignant neoplasm of cervix uteri Personal history of malignant neoplasm of oth prt uterus Personal history of malignant neoplasm of ovary Personal history of malig neoplasm of female genital organs Personal history of malig neoplm of unsp male genital organ

1.178 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z8546 Z8547 Z8548 Z8549 Z8550 Z8551 Z85520 Z85528 Z8553 Z8559 Z856 Z8571 Z8572 Z8579 Z85810 Z85818 Z85819 Z85820 Z85821 Z85828 Z85830 Z85831 Z85840 Z85841 Z85848 Z85850 Z85858 Z8589 Z859 Z86000 Z86001 Z86008 Z86010 Z86011 Z86012 Z86018 Z8603 Z8611 Z8612 Z8613 Z8619 Z862 Z8631 Z8639 Z8651 Z8659 Z8661 Z8669 Z8671 Z8672 Z8673 Z8674 Z8679 Z8701 Z8709 Z8711 Z8719 Z872 Z87310 Z87311 Z87312 Z8739 Z87410 Z87411 Z87412 Z8742 Z87430 Z87438

Personal history of malignant neoplasm of prostate Personal history of malignant neoplasm of testis Personal history of malignant neoplasm of epididymis Personal history of malig neoplasm of male genital organs Personal history of malig neoplm of unsp urinary tract organ Personal history of malignant neoplasm of bladder Personal history of malignant carcinoid tumor of kidney Personal history of other malignant neoplasm of kidney Personal history of malignant neoplasm of renal pelvis Personal history of malig neoplasm of urinary tract organ Personal history of leukemia Personal history of Hodgkin lymphoma Personal history of non-Hodgkin lymphomas Prsnl hx of malig neoplm of lymphoid, hematpoetc & rel tiss Personal history of malignant neoplasm of tongue Prsnl hx of malig neoplm of site of lip, oral cav, & pharynx Prsnl hx of malig neoplm of unsp site lip,oral cav,& pharynx Personal history of malignant melanoma of skin Personal history of Merkel cell carcinoma Personal history of other malignant neoplasm of skin Personal history of malignant neoplasm of bone Personal history of malignant neoplasm of soft tissue Personal history of malignant neoplasm of eye Personal history of malignant neoplasm of brain Personal history of malignant neoplasm of prt nervous tissue Personal history of malignant neoplasm of thyroid Personal history of malignant neoplasm of endocrine glands Personal history of malignant neoplasm of organs and systems Personal history of malignant neoplasm, unspecified Personal history of in-situ neoplasm of breast Personal history of in-situ neoplasm of cervix uteri Personal history of in-situ neoplasm of other site Personal history of colonic polyps Personal history of benign neoplasm of the brain Personal history of benign carcinoid tumor Personal history of other benign neoplasm Personal history of neoplasm of uncertain behavior Personal history of tuberculosis Personal history of poliomyelitis Personal history of malaria Personal history of other infectious and parasitic diseases Prsnl history of dis of the bld/bld-form org/immun mechnsm Personal history of diabetic foot ulcer Personal history of endo, nutritional and metabolic disease Personal history of combat and operational stress reaction Personal history of other mental and behavioral disorders Personal history of infections of the central nervous system Personal history of dis of the nervous sys and sense organs Personal history of venous thrombosis and embolism Personal history of thrombophlebitis Prsnl hx of TIA (TIA), and cereb infrc w/o resid deficits Personal history of sudden cardiac arrest Personal history of other diseases of the circulatory system Personal history of pneumonia (recurrent) Personal history of other diseases of the respiratory system Personal history of peptic ulcer disease Personal history of other diseases of the digestive system Personal history of diseases of the skin, subcu Personal history of (healed) osteoporosis fracture Personal history of (healed) other pathological fracture Personal history of (healed) stress fracture Personal history of diseases of the ms sys and conn tiss Personal history of cervical dysplasia Personal history of vaginal dysplasia Personal history of vulvar dysplasia Personal history of oth diseases of the female genital tract Personal history of prostatic dysplasia Personal history of other diseases of male genital organs

September 2011

Edit code lists 1.179

Unacceptable principal diagnoses

Z87440 Z87441 Z87442 Z87448 Z8751 Z8759 Z87710 Z87718 Z87720 Z87721 Z87728 Z87730 Z87738 Z8774 Z8775 Z8776 Z87790 Z87798 Z8781 Z87820 Z87821 Z87828 Z87891 Z87898 Z880 Z881 Z882 Z883 Z884 Z885 Z886 Z887 Z888 Z889 Z89011 Z89012 Z89019 Z89021 Z89022 Z89029 Z89111 Z89112 Z89119 Z89121 Z89122 Z89129 Z89201 Z89202 Z89209 Z89211 Z89212 Z89219 Z89221 Z89222 Z89229 Z89231 Z89232 Z89239 Z89411 Z89412 Z89419 Z89421 Z89422 Z89429 Z89431 Z89432 Z89439 Z89441

Personal history of urinary (tract) infections Personal history of nephrotic syndrome Personal history of urinary calculi Personal history of other diseases of urinary system Personal history of pre-term labor Personal history of comp of preg, chldbrth and the puerp Personal history of (corrected) hypospadias Personal history of (corrected) congenital malform of GU sys Personal history of (corrected) congenital malform of eye Personal history of (corrected) congenital malform of ear Prsnl hx of congen malform of nervous sys and sense organs Personal history of (corrected) cleft lip and palate Personal history of congenital malform of dgstv sys Personal history of congenital malform of heart and circ sys Personal history of congenital malform of resp sys Prsnl hx of congen malform of integument, limbs and ms sys Personal history of congenital malform of face and neck Personal history of oth (corrected) congenital malformations Personal history of (healed) traumatic fracture Personal history of traumatic brain injury Personal history of retained foreign body fully removed Personal history of oth (healed) physical injury and trauma Personal history of nicotine dependence Personal history of other specified conditions Allergy status to penicillin Allergy status to other antibiotic agents status Allergy status to sulfonamides status Allergy status to other anti-infective agents status Allergy status to anesthetic agent status Allergy status to narcotic agent status Allergy status to analgesic agent status Allergy status to serum and vaccine status Allergy status to oth drug/meds/biol subst status Allergy status to unsp drug/meds/biol subst status Acquired absence of right thumb Acquired absence of left thumb Acquired absence of unspecified thumb Acquired absence of right finger(s) Acquired absence of left finger(s) Acquired absence of unspecified finger(s) Acquired absence of right hand Acquired absence of left hand Acquired absence of unspecified hand Acquired absence of right wrist Acquired absence of left wrist Acquired absence of unspecified wrist Acquired absence of right upper limb, unspecified level Acquired absence of left upper limb, unspecified level Acquired absence of unsp upper limb, unspecified level Acquired absence of right upper limb below elbow Acquired absence of left upper limb below elbow Acquired absence of unspecified upper limb below elbow Acquired absence of right upper limb above elbow Acquired absence of left upper limb above elbow Acquired absence of unspecified upper limb above elbow Acquired absence of right shoulder Acquired absence of left shoulder Acquired absence of unspecified shoulder Acquired absence of right great toe Acquired absence of left great toe Acquired absence of unspecified great toe Acquired absence of other right toe(s) Acquired absence of other left toe(s) Acquired absence of other toe(s), unspecified side Acquired absence of right foot Acquired absence of left foot Acquired absence of unspecified foot Acquired absence of right ankle

1.180 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z89442 Z89449 Z8950 Z8951 Z8952 Z89611 Z89612 Z89619 Z89621 Z89622 Z89629 Z899 Z9001 Z9002 Z9009 Z902 Z903 Z90410 Z90411 Z9049 Z905 Z906 Z90710 Z90711 Z90712 Z90721 Z90722 Z9079 Z9081 Z9089 Z91010 Z91011 Z91012 Z91013 Z91018 Z9102 Z91030 Z91038 Z91040 Z91041 Z91048 Z9109 Z9111 Z91120 Z91128 Z91130 Z91138 Z9114 Z9115 Z9119 Z91410 Z91411 Z91412 Z91419 Z9149 Z915 Z9181 Z9182 Z9189 Z920 Z9221 Z9222 Z9223 Z92240 Z92241 Z9225 Z9229 Z923

Acquired absence of left ankle Acquired absence of unspecified ankle Acquired absence of unspecified leg below knee Acquired absence of right leg below knee Acquired absence of left leg below knee Acquired absence of right leg above knee Acquired absence of left leg above knee Acquired absence of unspecified leg above knee Acquired absence of right hip Acquired absence of left hip Acquired absence of unspecified hip Acquired absence of limb, unspecified Acquired absence of eye Acquired absence of larynx Acquired absence of other part of head and neck Acquired absence of lung [part of] Acquired absence of stomach [part of] Acquired total absence of pancreas Acquired partial absence of pancreas Acquired absence of other specified parts of digestive tract Acquired absence of kidney Acquired absence of other parts of urinary tract Acquired absence of both cervix and uterus Acquired absence of uterus with remaining cervical stump Acquired absence of cervix with remaining uterus Acquired absence of ovaries, unilateral Acquired absence of ovaries, bilateral Acquired absence of other genital organ(s) Acquired absence of spleen Acquired absence of other organs Allergy to peanuts Allergy to milk products Allergy to eggs Allergy to seafood Allergy to other foods Food additives allergy status Bee allergy status Other insect allergy status Latex allergy status Radiographic dye allergy status Other nonmedicinal substance allergy status Oth allergy status, oth than to drugs and biolg substances Patient's noncompliance with dietary regimen Pt intentl undrdose of meds regimen due to financl hardship Patient's intentl undrdose of meds regimen for oth reason Pt unintent undrdose of meds regimen due to age-rel debility Patient's unintent undrdose of meds regimen for oth reason Patient's other noncompliance with medication regimen Patient's noncompliance with renal dialysis Patient's noncompliance w oth medical treatment and regimen Personal history of adult physical and sexual abuse Personal history of adult psychological abuse Personal history of adult neglect Personal history of unspecified adult abuse Oth personal history of psychological trauma, NEC Personal history of self-harm History of falling Personal history of military deployment Oth personal risk factors, not elsewhere classified Personal history of contraception Personal history of antineoplastic chemotherapy Personal history of monoclonal drug therapy Personal history of estrogen therapy Personal history of inhaled steroid therapy Personal history of systemic steroid therapy Personal history of immunosupression therapy Personal history of other drug therapy Personal history of irradiation

September 2011

Edit code lists 1.181

Unacceptable principal diagnoses

Z9281 Z9282 Z9283 Z9289 Z930 Z931 Z932 Z933 Z934 Z9350 Z9351 Z9352 Z9359 Z936 Z938 Z939 Z940 Z941 Z942 Z943 Z944 Z945 Z946 Z947 Z9481 Z9482 Z9483 Z9484 Z9489 Z949 Z950 Z951 Z952 Z953 Z954 Z955 Z95810 Z95811 Z95812 Z95818 Z95820 Z95828 Z959 Z960 Z961 Z9620 Z9621 Z9622 Z9629 Z963 Z9641 Z9649 Z965 Z9660 Z96611 Z96612 Z96619 Z96621 Z96622 Z96629 Z96631 Z96632 Z96639 Z96641 Z96642 Z96643 Z96649 Z96651

Prsnl history of extracorporeal membrane oxygenation (ECMO) S/p admn tPA in diff fac w/n last 24 hr bef adm to crnt fac Personal history of failed moderate sedation Personal history of other medical treatment Tracheostomy status Gastrostomy status Ileostomy status Colostomy status Other artificial openings of gastrointestinal tract status Unspecified cystostomy status Cutaneous-vesicostomy status Appendico-vesicostomy status Other cystostomy status Other artificial openings of urinary tract status Other artificial opening status Artificial opening status, unspecified Kidney transplant status Heart transplant status Lung transplant status Heart and lungs transplant status Liver transplant status Skin transplant status Bone transplant status Corneal transplant status Bone marrow transplant status Intestine transplant status Pancreas transplant status Stem cells transplant status Other transplanted organ and tissue status Transplanted organ and tissue status, unspecified Presence of cardiac pacemaker Presence of aortocoronary bypass graft Presence of prosthetic heart valve Presence of xenogenic heart valve Presence of other heart-valve replacement Presence of coronary angioplasty implant and graft Presence of automatic (implantable) cardiac defibrillator Presence of heart assist device Presence of fully implantable artificial heart Presence of other cardiac implants and grafts Peripheral vascular angioplasty status w implants and grafts Presence of other vascular implants and grafts Presence of cardiac and vascular implant and graft, unsp Presence of urogenital implants Presence of intraocular lens Presence of otological and audiological implant, unspecified Cochlear implant status Myringotomy tube(s) status Presence of other otological and audiological implants Presence of artificial larynx Presence of insulin pump (external) (internal) Presence of other endocrine implants Presence of tooth-root and mandibular implants Presence of unspecified orthopedic joint implant Presence of right artificial shoulder joint Presence of left artificial shoulder joint Presence of unspecified artificial shoulder joint Presence of right artificial elbow joint Presence of left artificial elbow joint Presence of unspecified artificial elbow joint Presence of right artificial wrist joint Presence of left artificial wrist joint Presence of unspecified artificial wrist joint Presence of right artificial hip joint Presence of left artificial hip joint Presence of artificial hip joint, bilateral Presence of unspecified artificial hip joint Presence of right artificial knee joint

1.182 Definitions of Medicare Code Edits

September 2011

Unacceptable principal diagnoses

Z96652 Z96653 Z96659 Z96661 Z96662 Z96669 Z96691 Z96692 Z96693 Z96698 Z967 Z9681 Z9689 Z969 Z970 Z9710 Z9711 Z9712 Z9713 Z9714 Z9715 Z9716 Z972 Z973 Z974 Z975 Z978 Z980 Z981 Z982 Z983 Z9841 Z9842 Z9849 Z9851 Z9852 Z9861 Z9862 Z98810 Z98811 Z98818 Z9882 Z9883 Z9884 Z9885 Z9886 Z98870 Z98871 Z9889 Z990 Z992 Z993 Z9981 Z9989

Presence of left artificial knee joint Presence of artificial knee joint, bilateral Presence of unspecified artificial knee joint Presence of right artificial ankle joint Presence of left artificial ankle joint Presence of unspecified artificial ankle joint Finger-joint replacement of right hand Finger-joint replacement of left hand Finger-joint replacement, bilateral Presence of other orthopedic joint implants Presence of other bone and tendon implants Presence of artificial skin Presence of other specified functional implants Presence of functional implant, unspecified Presence of artificial eye Presence of artificial limb (complete) (partial), unsp Presence of artificial right arm (complete) (partial) Presence of artificial left arm (complete) (partial) Presence of artificial right leg (complete) (partial) Presence of artificial left leg (complete) (partial) Presence of artificial arms, bilateral (complete) (partial) Presence of artificial legs, bilateral (complete) (partial) Presence of dental prosthetic device (complete) (partial) Presence of spectacles and contact lenses Presence of external hearing-aid Presence of (intrauterine) contraceptive device Presence of other specified devices Intestinal bypass and anastomosis status Arthrodesis status Presence of cerebrospinal fluid drainage device Post therapeutic collapse of lung status Cataract extraction status, right eye Cataract extraction status, left eye Cataract extraction status, unspecified eye Tubal ligation status Vasectomy status Coronary angioplasty status Peripheral vascular angioplasty status Dental sealant status Dental restoration status Other dental procedure status Breast implant status Filtering (vitreous) bleb after glaucoma surgery status Bariatric surgery status Transplanted organ removal status Personal history of breast implant removal Personal history of in utero procedure during pregnancy Personal history of in utero procedure while a fetus Other specified postprocedural states Dependence on aspirator Dependence on renal dialysis Dependence on wheelchair Dependence on supplemental oxygen Dependence on other enabling machines and devices

September 2011

Edit code lists 1.183

10. Non-specific O.R. 10. Non-specific O.R. procedure procedure

Effective 10/01/07, the non-specific O.R. procedure edit was discontinued and will appear for claims processed using MCE version 2.0-23.0 only. There are some procedures for which Medicare does not provide reimbursement. There are also procedures that would normally not be reimbursed by Medicare but due to the presence of certain diagnoses are reimbursed. The following page contains lists of non-covered procedure codes with corresponding English descriptions, and explains the circumstances in which the edit is applied.

11. Non-covered procedure

Non-covered procedures 1. Percutaneous angioplasty without stent placement. The procedures shown below are identified as always non-covered procedures.
Procedure
037G3ZZ 037G4ZZ 03CG3ZZ 03CG4ZZ 057L3ZZ 057L4ZZ 05CL3ZZ 05CL4ZZ Dilation of Intracranial Artery, Percutaneous Approach Dilation of Intracranial Artery, Percutaneous Endoscopic Approach Extirpation of Matter from Intracranial Artery, Percutaneous Approach Extirpation of Matter from Intracranial Artery, Percutaneous Endoscopic Approach Dilation of Intracranial Vein, Percutaneous Approach Dilation of Intracranial Vein, Percutaneous Endoscopic Approach Extirpation of Matter from Intracranial Vein, Percutaneous Approach Extirpation of Matter from Intracranial Vein, Percutaneous Endoscopic Approach

2. ICD-10-PCS procedure codes for pancreas transplants (0FYG0Z0, 0FYG0Z1) alone [without kidney transplant codes (0TY00Z0, 0TY00Z1, 0TY00Z2, 0TY10Z0, 0TY10Z1, 0TY10Z2)] are considered Non-covered procedures except for the following condition: When either 0FYG0Z0 (Transplantation of Pancreas, Allogeneic, Open Approach) or 0FYG0Z1(Transplantation of Pancreas, Syngeneic, Open Approach) is combined with at least one principal or secondary diagnosis code from the following diagnoses list:
Diagnoses list
E1010 E1011 E1021 E1022 E1029 E10311 E10319 E10321 E10329 E10331 E10339 Type 1 diabetes mellitus with ketoacidosis without coma Type 1 diabetes mellitus with ketoacidosis with coma Type 1 diabetes mellitus with diabetic nephropathy Type 1 diabetes mellitus w diabetic chronic kidney disease Type 1 diabetes mellitus w oth diabetic kidney complication Type 1 diabetes w unsp diabetic retinopathy w macular edema Type 1 diabetes w unsp diabetic rtnop w/o macular edema Type 1 diab w mild nonprlf diabetic rtnop w macular edema Type 1 diab w mild nonprlf diabetic rtnop w/o macular edema Type 1 diab w moderate nonprlf diab rtnop w macular edema Type 1 diab w moderate nonprlf diab rtnop w/o macular edema

1.184 Definitions of Medicare Code Edits

September 2011

Non-covered procedures

E10341 E10349 E10351 E10359 E1036 E1039 E1040 E1041 E1042 E1043 E1044 E1049 E1051 E1052 E1059 E10610 E10618 E10620 E10621 E10622 E10628 E10630 E10638 E10641 E10649 E1065 E1069 E108 E109 E891

Type 1 diab w severe nonprlf diabetic rtnop w macular edema Type 1 diab w severe nonprlf diab rtnop w/o macular edema Type 1 diabetes w prolif diabetic rtnop w macular edema Type 1 diabetes w prolif diabetic rtnop w/o macular edema Type 1 diabetes mellitus with diabetic cataract Type 1 diabetes w oth diabetic ophthalmic complication Type 1 diabetes mellitus with diabetic neuropathy, unsp Type 1 diabetes mellitus with diabetic mononeuropathy Type 1 diabetes mellitus with diabetic polyneuropathy Type 1 diabetes w diabetic autonomic (poly)neuropathy Type 1 diabetes mellitus with diabetic amyotrophy Type 1 diabetes w oth diabetic neurological complication Type 1 diabetes w diabetic peripheral angiopath w/o gangrene Type 1 diabetes w diabetic peripheral angiopathy w gangrene Type 1 diabetes mellitus with oth circulatory complications Type 1 diabetes mellitus w diabetic neuropathic arthropathy Type 1 diabetes mellitus with other diabetic arthropathy Type 1 diabetes mellitus with diabetic dermatitis Type 1 diabetes mellitus with foot ulcer Type 1 diabetes mellitus with other skin ulcer Type 1 diabetes mellitus with other skin complications Type 1 diabetes mellitus with periodontal disease Type 1 diabetes mellitus with other oral complications Type 1 diabetes mellitus with hypoglycemia with coma Type 1 diabetes mellitus with hypoglycemia without coma Type 1 diabetes mellitus with hyperglycemia Type 1 diabetes mellitus with other specified complication Type 1 diabetes mellitus with unspecified complications Type 1 diabetes mellitus without complications Postprocedural hypoinsulinemia

3. The procedures shown below are identified as non-covered procedures except when combined with diagnosis code Z006 (Encntr for exam for nrml cmprsn and ctrl in clncl rsrch prog).
Procedure
02RK0JZ with 02RL0JZ Replacement of Left Ventricle with Synthetic Substitute, Open Approach Replacement of Right Ventricle with Synthetic Substitute, Open Approach

The procedures shown below are always identified as non-covered procedures.


00F3XZZ 00F4XZZ 00F5XZZ 00F6XZZ 02BK0ZZ 02BK3ZZ 02BK4ZZ 02BL0ZZ 02BL3ZZ 02BL4ZZ 02FNXZZ 02WA0JZ 02WA0QZ 02WA3QZ 02WA4QZ 031H09J 031H0AJ 031H0JJ 031H0KJ 031H0ZJ 031J09K Fragmentation in Epidural Space, External Approach Fragmentation in Subdural Space, External Approach Fragmentation in Subarachnoid Space, External Approach Fragmentation in Cerebral Ventricle, External Approach Excision of Right Ventricle, Open Approach Excision of Right Ventricle, Percutaneous Approach Excision of Right Ventricle, Perc Endo Approach Excision of Left Ventricle, Open Approach Excision of Left Ventricle, Percutaneous Approach Excision of Left Ventricle, Percutaneous Endoscopic Approach Fragmentation in Pericardium, External Approach Revision of Synthetic Substitute in Heart, Open Approach Revision of Implant Heart Assist in Heart, Open Approach Revision of Implant Heart Assist in Heart, Perc Approach Revise of Implant Heart Assist in Heart, Perc Endo Approach Bypass R Com Carotid to R Extracran Art w Autol Vn, Open Bypass R Com Carotid to R Extracran Art w Autol Art, Open Bypass R Com Carotid to R Extracran Art w Synth Sub, Open Bypass R Com Carotid to R Extracran Art w Nonaut Sub, Open Bypass R Com Carotid to R Extracran Art, Open Approach Bypass L Com Carotid to L Extracran Art w Autol Vn, Open

September 2011

Edit code lists 1.185

Non-covered procedures

031J0AK 031J0JK 031J0KK 031J0ZK 031K09J 031K0AJ 031K0JJ 031K0KJ 031K0ZJ 031L09K 031L0AK 031L0JK 031L0KK 031L0ZK 031M09J 031M0AJ 031M0JJ 031M0KJ 031M0ZJ 031N09K 031N0AK 031N0JK 031N0KK 031N0ZK 031S09G 031S0AG 031S0JG 031S0KG 031S0ZG 031T09G 031T0AG 031T0JG 031T0KG 031T0ZG 037G3ZZ 037G4ZZ 03CG3ZZ 03CG4ZZ 057L3ZZ 057L4ZZ 05CL3ZZ 05CL4ZZ 08F4XZZ 08F5XZZ 08Q8XZZ 08Q9XZZ 08U80KZ 08U83KZ 08U8XKZ 08U90KZ 08U93KZ 08U9XKZ 0BF1XZZ 0BF2XZZ 0BF3XZZ 0BF4XZZ 0BF5XZZ 0BF6XZZ 0BF7XZZ 0BF8XZZ 0BF9XZZ 0BFBXZZ 0CFBXZZ 0CFCXZZ 0DF5XZZ 0DF6XZZ 0DF8XZZ 0DF9XZZ

Bypass L Com Carotid to L Extracran Art w Autol Art, Open Bypass L Com Carotid to L Extracran Art w Synth Sub, Open Bypass L Com Carotid to L Extracran Art w Nonaut Sub, Open Bypass L Com Carotid to L Extracran Art, Open Approach Bypass R Int Carotid to R Extracran Art w Autol Vn, Open Bypass R Int Carotid to R Extracran Art w Autol Art, Open Bypass R Int Carotid to R Extracran Art w Synth Sub, Open Bypass R Int Carotid to R Extracran Art w Nonaut Sub, Open Bypass R Int Carotid to R Extracran Art, Open Approach Bypass L Int Carotid to L Extracran Art w Autol Vn, Open Bypass L Int Carotid to L Extracran Art w Autol Art, Open Bypass L Int Carotid to L Extracran Art w Synth Sub, Open Bypass L Int Carotid to L Extracran Art w Nonaut Sub, Open Bypass L Int Carotid to L Extracran Art, Open Approach Bypass R Ext Carotid to R Extracran Art w Autol Vn, Open Bypass R Ext Carotid to R Extracran Art w Autol Art, Open Bypass R Ext Carotid to R Extracran Art w Synth Sub, Open Bypass R Ext Carotid to R Extracran Art w Nonaut Sub, Open Bypass R Ext Carotid to R Extracran Art, Open Approach Bypass L Ext Carotid to L Extracran Art w Autol Vn, Open Bypass L Ext Carotid to L Extracran Art w Autol Art, Open Bypass L Ext Carotid to L Extracran Art w Synth Sub, Open Bypass L Ext Carotid to L Extracran Art w Nonaut Sub, Open Bypass L Ext Carotid to L Extracran Art, Open Approach Bypass R Temporal Art to Intracran Art w Autol Vn, Open Bypass R Temporal Art to Intracran Art w Autol Art, Open Bypass R Temporal Art to Intracran Art w Synth Sub, Open Bypass R Temporal Art to Intracran Art w Nonaut Sub, Open Bypass Right Temporal Artery to Intracran Art, Open Approach Bypass L Temporal Art to Intracran Art w Autol Vn, Open Bypass L Temporal Art to Intracran Art w Autol Art, Open Bypass L Temporal Art to Intracran Art w Synth Sub, Open Bypass L Temporal Art to Intracran Art w Nonaut Sub, Open Bypass Left Temporal Artery to Intracran Art, Open Approach Dilation of Intracranial Artery, Percutaneous Approach Dilation of Intracranial Artery, Perc Endo Approach Extirpation of Matter from Intracran Art, Perc Approach Extirpation of Matter from Intracran Art, Perc Endo Approach Dilation of Intracranial Vein, Percutaneous Approach Dilation of Intracranial Vein, Perc Endo Approach Extirpation of Matter from Intracranial Vein, Perc Approach Extirpate of Matter from Intracran Vein, Perc Endo Approach Fragmentation in Right Vitreous, External Approach Fragmentation in Left Vitreous, External Approach Repair Right Cornea, External Approach Repair Left Cornea, External Approach Supplement Right Cornea with Nonaut Sub, Open Approach Supplement Right Cornea with Nonaut Sub, Perc Approach Supplement Right Cornea with Nonaut Sub, Extern Approach Supplement Left Cornea with Nonaut Sub, Open Approach Supplement Left Cornea with Nonaut Sub, Perc Approach Supplement Left Cornea with Nonaut Sub, Extern Approach Fragmentation in Trachea, External Approach Fragmentation in Carina, External Approach Fragmentation in Right Main Bronchus, External Approach Fragmentation in Right Upper Lobe Bronchus, Extern Approach Fragmentation in Right Middle Lobe Bronchus, Extern Approach Fragmentation in Right Lower Lobe Bronchus, Extern Approach Fragmentation in Left Main Bronchus, External Approach Fragmentation in Left Upper Lobe Bronchus, External Approach Fragmentation in Lingula Bronchus, External Approach Fragmentation in Left Lower Lobe Bronchus, External Approach Fragmentation in Right Parotid Duct, External Approach Fragmentation in Left Parotid Duct, External Approach Fragmentation in Esophagus, External Approach Fragmentation in Stomach, External Approach Fragmentation in Small Intestine, External Approach Fragmentation in Duodenum, External Approach

1.186 Definitions of Medicare Code Edits

September 2011

Non-covered procedures

0DFAXZZ 0DFBXZZ 0DFEXZZ 0DFFXZZ 0DFGXZZ 0DFHXZZ 0DFJXZZ 0DFKXZZ 0DFLXZZ 0DFMXZZ 0DFNXZZ 0DFPXZZ 0DFQXZZ 0DV67DZ 0DV68DZ 0FF4XZZ 0FF5XZZ 0FF6XZZ 0FF8XZZ 0FF9XZZ 0FFCXZZ 0FFDXZZ 0FFFXZZ 0FYG0Z2 0JH70MZ 0JH73MZ 0JH80MZ 0JH83MZ 0TFDXZZ 0THB0MZ 0THB3MZ 0THB4MZ 0THB7MZ 0THB8MZ 0TPB0MZ 0TPB3MZ 0TPB4MZ 0TPB7MZ 0TPB8MZ 0U570ZZ 0U573ZZ 0U574ZZ 0U577ZZ 0U578ZZ 0UF5XZZ 0UF6XZZ 0UF7XZZ 0UF9XZZ 0UL70CZ 0UL70DZ 0UL70ZZ 0UL73CZ 0UL73DZ 0UL73ZZ 0UL74CZ 0UL74DZ 0UL74ZZ 0UL77DZ 0UL77ZZ 0UL78DZ 0UL78ZZ 0V5N0ZZ 0V5N3ZZ 0V5N4ZZ 0V5P0ZZ 0V5P3ZZ 0V5P4ZZ 0V5Q0ZZ

Fragmentation in Jejunum, External Approach Fragmentation in Ileum, External Approach Fragmentation in Large Intestine, External Approach Fragmentation in Right Large Intestine, External Approach Fragmentation in Left Large Intestine, External Approach Fragmentation in Cecum, External Approach Fragmentation in Appendix, External Approach Fragmentation in Ascending Colon, External Approach Fragmentation in Transverse Colon, External Approach Fragmentation in Descending Colon, External Approach Fragmentation in Sigmoid Colon, External Approach Fragmentation in Rectum, External Approach Fragmentation in Anus, External Approach Restriction of Stomach with Intraluminal Device, Via Opening Restriction of Stomach with Intraluminal Device, Endo Fragmentation in Gallbladder, External Approach Fragmentation in Right Hepatic Duct, External Approach Fragmentation in Left Hepatic Duct, External Approach Fragmentation in Cystic Duct, External Approach Fragmentation in Common Bile Duct, External Approach Fragmentation in Ampulla of Vater, External Approach Fragmentation in Pancreatic Duct, External Approach Fragmentation in Accessory Pancreatic Duct, Extern Approach Transplantation of Pancreas, Zooplastic, Open Approach Insertion of Stim Gen into Back Subcu/Fascia, Open Approach Insertion of Stim Gen into Back Subcu/Fascia, Perc Approach Insertion of Stim Gen into Abd Subcu/Fascia, Open Approach Insertion of Stim Gen into Abd Subcu/Fascia, Perc Approach Fragmentation in Urethra, External Approach Insertion of Stimulator Lead into Bladder, Open Approach Insertion of Stimulator Lead into Bladder, Perc Approach Insertion of Stim Lead into Bladder, Perc Endo Approach Insertion of Stimulator Lead into Bladder, Via Opening Insertion of Stimulator Lead into Bladder, Endo Removal of Stimulator Lead from Bladder, Open Approach Removal of Stimulator Lead from Bladder, Perc Approach Removal of Stimulator Lead from Bladder, Perc Endo Approach Removal of Stimulator Lead from Bladder, Via Opening Removal of Stimulator Lead from Bladder, Endo Destruction of Bilateral Fallopian Tubes, Open Approach Destruction of Bilateral Fallopian Tubes, Perc Approach Destruction of Bilateral Fallopian Tubes, Perc Endo Approach Destruction of Bilateral Fallopian Tubes, Via Opening Destruction of Bilateral Fallopian Tubes, Endo Fragmentation in Right Fallopian Tube, External Approach Fragmentation in Left Fallopian Tube, External Approach Fragmentation in Bilateral Fallopian Tubes, Extern Approach Fragmentation in Uterus, External Approach Occlusion Bi Fallopian Tube w Extralum Dev, Open Occlusion Bi Fallopian Tube w Intralum Dev, Open Occlusion of Bilateral Fallopian Tubes, Open Approach Occlusion Bi Fallopian Tube w Extralum Dev, Perc Occlusion Bi Fallopian Tube w Intralum Dev, Perc Occlusion of Bilateral Fallopian Tubes, Perc Approach Occlusion Bi Fallopian Tube w Extralum Dev, Perc Endo Occlusion Bi Fallopian Tube w Intralum Dev, Perc Endo Occlusion of Bilateral Fallopian Tubes, Perc Endo Approach Occlusion Bi Fallopian Tube w Intralum Dev, Via Opening Occlusion of Bilateral Fallopian Tubes, Via Opening Occlusion of Bi Fallopian Tube with Intralum Dev, Endo Occlusion of Bilateral Fallopian Tubes, Endo Destruction of Right Vas Deferens, Open Approach Destruction of Right Vas Deferens, Percutaneous Approach Destruction of Right Vas Deferens, Perc Endo Approach Destruction of Left Vas Deferens, Open Approach Destruction of Left Vas Deferens, Percutaneous Approach Destruction of Left Vas Deferens, Perc Endo Approach Destruction of Bilateral Vas Deferens, Open Approach

September 2011

Edit code lists 1.187

Non-covered procedures

0V5Q3ZZ 0V5Q4ZZ 0VBN0ZZ 0VBN3ZZ 0VBN4ZZ 0VBP0ZZ 0VBP3ZZ 0VBP4ZZ 0VBQ0ZZ 0VBQ3ZZ 0VBQ4ZZ 0VLF0CZ 0VLF0DZ 0VLF0ZZ 0VLF3CZ 0VLF3DZ 0VLF3ZZ 0VLF4CZ 0VLF4DZ 0VLF4ZZ 0VLG0CZ 0VLG0DZ 0VLG0ZZ 0VLG3CZ 0VLG3DZ 0VLG3ZZ 0VLG4CZ 0VLG4DZ 0VLG4ZZ 0VLH0CZ 0VLH0DZ 0VLH0ZZ 0VLH3CZ 0VLH3DZ 0VLH3ZZ 0VLH4CZ 0VLH4DZ 0VLH4ZZ 0VLN0CZ 0VLN0ZZ 0VLN3CZ 0VLN3ZZ 0VLN4CZ 0VLN4ZZ 0VLP0CZ 0VLP0ZZ 0VLP3CZ 0VLP3ZZ 0VLP4CZ 0VLP4ZZ 0VLQ0CZ 0VLQ0ZZ 0VLQ3CZ 0VLQ3ZZ 0VLQ4CZ 0VLQ4ZZ 0VTN0ZZ 0VTN4ZZ 0VTP0ZZ 0VTP4ZZ 0VTQ0ZZ 0VTQ4ZZ 0W4M070 0W4M0J0 0W4M0K0 0W4M0Z0 0W4N071 0W4N0J1

Destruction of Bilateral Vas Deferens, Percutaneous Approach Destruction of Bilateral Vas Deferens, Perc Endo Approach Excision of Right Vas Deferens, Open Approach Excision of Right Vas Deferens, Percutaneous Approach Excision of Right Vas Deferens, Perc Endo Approach Excision of Left Vas Deferens, Open Approach Excision of Left Vas Deferens, Percutaneous Approach Excision of Left Vas Deferens, Perc Endo Approach Excision of Bilateral Vas Deferens, Open Approach Excision of Bilateral Vas Deferens, Percutaneous Approach Excision of Bilateral Vas Deferens, Perc Endo Approach Occlusion of R Sperm Cord with Extralum Dev, Open Approach Occlusion of R Sperm Cord with Intralum Dev, Open Approach Occlusion of Right Spermatic Cord, Open Approach Occlusion of R Sperm Cord with Extralum Dev, Perc Approach Occlusion of R Sperm Cord with Intralum Dev, Perc Approach Occlusion of Right Spermatic Cord, Percutaneous Approach Occlusion R Sperm Cord w Extralum Dev, Perc Endo Occlusion R Sperm Cord w Intralum Dev, Perc Endo Occlusion of Right Spermatic Cord, Perc Endo Approach Occlusion of L Sperm Cord with Extralum Dev, Open Approach Occlusion of L Sperm Cord with Intralum Dev, Open Approach Occlusion of Left Spermatic Cord, Open Approach Occlusion of L Sperm Cord with Extralum Dev, Perc Approach Occlusion of L Sperm Cord with Intralum Dev, Perc Approach Occlusion of Left Spermatic Cord, Percutaneous Approach Occlusion L Sperm Cord w Extralum Dev, Perc Endo Occlusion L Sperm Cord w Intralum Dev, Perc Endo Occlusion of Left Spermatic Cord, Perc Endo Approach Occlusion of Bi Sperm Cord with Extralum Dev, Open Approach Occlusion of Bi Sperm Cord with Intralum Dev, Open Approach Occlusion of Bilateral Spermatic Cords, Open Approach Occlusion of Bi Sperm Cord with Extralum Dev, Perc Approach Occlusion of Bi Sperm Cord with Intralum Dev, Perc Approach Occlusion of Bilateral Spermatic Cords, Perc Approach Occlusion Bi Sperm Cord w Extralum Dev, Perc Endo Occlusion Bi Sperm Cord w Intralum Dev, Perc Endo Occlusion of Bilateral Spermatic Cords, Perc Endo Approach Occlusion of R Vas Deferens with Extralum Dev, Open Approach Occlusion of Right Vas Deferens, Open Approach Occlusion of R Vas Deferens with Extralum Dev, Perc Approach Occlusion of Right Vas Deferens, Percutaneous Approach Occlusion R Vas Deferens w Extralum Dev, Perc Endo Occlusion of Right Vas Deferens, Perc Endo Approach Occlusion of L Vas Deferens with Extralum Dev, Open Approach Occlusion of Left Vas Deferens, Open Approach Occlusion of L Vas Deferens with Extralum Dev, Perc Approach Occlusion of Left Vas Deferens, Percutaneous Approach Occlusion L Vas Deferens w Extralum Dev, Perc Endo Occlusion of Left Vas Deferens, Perc Endo Approach Occlusion Bi Vas Deferens w Extralum Dev, Open Occlusion of Bilateral Vas Deferens, Open Approach Occlusion Bi Vas Deferens w Extralum Dev, Perc Occlusion of Bilateral Vas Deferens, Percutaneous Approach Occlusion Bi Vas Deferens w Extralum Dev, Perc Endo Occlusion of Bilateral Vas Deferens, Perc Endo Approach Resection of Right Vas Deferens, Open Approach Resection of Right Vas Deferens, Perc Endo Approach Resection of Left Vas Deferens, Open Approach Resection of Left Vas Deferens, Perc Endo Approach Resection of Bilateral Vas Deferens, Open Approach Resection of Bilateral Vas Deferens, Perc Endo Approach Create Vagina in Male Perineum w Autol Sub, Open Create Vagina in Male Perineum w Synth Sub, Open Create Vagina in Male Perineum w Nonaut Sub, Open Creation of Vagina in Male Perineum, Open Approach Create Penis in Fem Perineum w Autol Sub, Open Create Penis in Fem Perineum w Synth Sub, Open

1.188 Definitions of Medicare Code Edits

September 2011

Non-covered procedures

0W4N0K1 0W4N0Z1 0WF1XZZ 0WF3XZZ 0WF9XZZ 0WFBXZZ 0WFCXZZ 0WFGXZZ 0WFJXZZ 0WFPXZZ 0WFQXZZ

Create Penis in Fem Perineum w Nonaut Sub, Open Creation of Penis in Female Perineum, Open Approach Fragmentation in Cranial Cavity, External Approach Fragmentation in Oral Cavity and Throat, External Approach Fragmentation in Right Pleural Cavity, External Approach Fragmentation in Left Pleural Cavity, External Approach Fragmentation in Mediastinum, External Approach Fragmentation in Peritoneal Cavity, External Approach Fragmentation in Pelvic Cavity, External Approach Fragmentation in Gastrointestinal Tract, External Approach Fragmentation in Respiratory Tract, External Approach

The procedures shown below are identified as non-covered procedures only when any of the diagnoses in the right hand list are present as either a principal or secondary diagnosis.
Procedures
30230AZ 30230G0 30230Y0 30233AZ 30233G0 30233Y0 30240AZ 30240G0 30240Y0 30243AZ 30243G0 30243Y0 30250G0 30250Y0 30253G0 30253Y0 30260G0 30260Y0 30263G0 30263Y0 Transfuse of Embr Stem Cell into Periph Vein, Open Approach Transfuse Autol Bone Marrow in Periph Vein, Open Transfuse Autol Hemat Stem Cell in Periph Vein, Open Transfuse of Embr Stem Cell into Periph Vein, Perc Approach Transfuse Autol Bone Marrow in Periph Vein, Perc Transfuse Autol Hemat Stem Cell in Periph Vein, Perc Transfuse of Embr Stem Cell into Central Vein, Open Approach Transfuse Autol Bone Marrow in Central Vein, Open Transfuse Autol Hemat Stem Cell in Central Vein, Open Transfuse of Embr Stem Cell into Central Vein, Perc Approach Transfuse Autol Bone Marrow in Central Vein, Perc Transfuse Autol Hemat Stem Cell in Central Vein, Perc Transfuse Autol Bone Marrow in Periph Art, Open Transfuse Autol Hemat Stem Cell in Periph Art, Open Transfuse Autol Bone Marrow in Periph Art, Perc Transfuse Autol Hemat Stem Cell in Periph Art, Perc Transfuse Autol Bone Marrow in Central Art, Open Transfuse Autol Hemat Stem Cell in Central Art, Open Transfuse Autol Bone Marrow in Central Art, Perc Transfuse Autol Hemat Stem Cell in Central Art, Perc

Diagnoses
C9100 C9200 C9210 C9211 C9240 C9250 C9260 C92A0 C9300 C9400 C9500 Acute lymphoblastic leukemia not having achieved remission Acute myeloblastic leukemia, not having achieved remission Chronic myeloid leuk, BCR/ABL-positive, not achieve remis Chronic myeloid leukemia, BCR/ABL-positive, in remission Acute promyelocytic leukemia, not having achieved remission Acute myelomonocytic leukemia, not having achieved remission Acute myeloid leukemia w 11q23-abnormality not achieve remis Acute myeloid leuk w multilin dysplasia, not achieve remis Acute monoblastic/monocytic leukemia, not achieve remission Acute erythroid leukemia, not having achieved remission Acute leukemia of unsp cell type not achieve remission

September 2011

Edit code lists 1.189

Non-covered procedures

The procedures shown below are identified as non-covered procedures only when any of the diagnoses in the right hand list are present as either a principal or secondary diagnosis.
Procedures
30230G1 30230Y1 30233G1 30233Y1 30240G1 30240Y1 30243G1 30243Y1 30250G1 30250Y1 30253G1 30253Y1 30260G1 30260Y1 30263G1 30263Y1 Transfuse Nonaut Bone Marrow in Periph Vein, Open Transfuse Nonaut Hemat Stem Cell in Periph Vein, Open Transfuse Nonaut Bone Marrow in Periph Vein, Perc Transfuse Nonaut Hemat Stem Cell in Periph Vein, Perc Transfuse Nonaut Bone Marrow in Central Vein, Open Transfuse Nonaut Hemat Stem Cell in Central Vein, Open Transfuse Nonaut Bone Marrow in Central Vein, Perc Transfuse Nonaut Hemat Stem Cell in Central Vein, Perc Transfuse Nonaut Bone Marrow in Periph Art, Open Transfuse Nonaut Hemat Stem Cell in Periph Art, Open Transfuse Nonaut Bone Marrow in Periph Art, Perc Transfuse Nonaut Hemat Stem Cell in Periph Art, Perc Transfuse Nonaut Bone Marrow in Central Art, Open Transfuse Nonaut Hemat Stem Cell in Central Art, Open Transfuse Nonaut Bone Marrow in Central Art, Perc Transfuse Nonaut Hemat Stem Cell in Central Art, Perc

Diagnoses
C9000 C9001 Multiple myeloma not having achieved remission Multiple myeloma in remission

The procedure shown below is identified as a Non-covered procedure when the beneficiary is over age 60.
Procedure
0SR20JZ 0SR40JZ Replacement of Lum Disc with Synth Sub, Open Approach Replacement of Lumbosacr Disc with Synth Sub, Open Approach

1.190 Definitions of Medicare Code Edits

September 2011

Non-covered procedures

12. Open biopsy check

Effective 10/01/10, the open biopsy check edit was discontinued and will appear for claims processed using MCE version 2.0-26.0 only. Effective 10/01/13, the bilateral procedure edit will be discontinued and will appear for claims processed using MCE version 2.0-29.0 only. A patients age may be necessary for appropriate DRG determination. If the age reported is not between 0 years and 124 years, the Medicare Code Editor will assume the age is in error. A patients sex (gender) may be necessary for appropriate DRG determination. The sex code reported must be either 1 (male) or 2 (female). A patients discharge status may be necessary for appropriate DRG determination. Discharge status must be coded according to the UB-04 conventions. Valid values are:
01 = Home or self-care 02 = Disch/trans to another short term hospital 03 = Disch/trans to SNF 04 = Disch/trans to ICF (valid until 9/30/09) 04 = Cust/supp care (added 10/01/09) 05 = Disch/trans to another type of facility (valid until 03/31/08) 05 = Disch/trans to a designated cancer center or childrens hospital (added 04/01/08) 06 = Care of home health service 07 = Left against medical advice 08 = Home IV service (deleted 10/01/05) 20 = Died 21 = Court/law enfrc (added 10/1/09) 30 = Still a patient 43 = Fed hospital (added 10/01/03) 50 = Hospice-home 51 = Hospice-medical facility 61 = Swing Bed (added 10/01/2001) 62 = Rehab facility/rehab unit (added 10/01/2001) 63 = Long term care hospital (added 10/01/2001) 64 = Nursing facilityMedicaid certified (added 10/01/02) 65 = Psych hosp/unit (added 10/01/03) 66 = Critical access hospital (added 10/01/05) 70 = Discharge/transfer to another type of health care institution not defined elsewhere in the code list (added 04/01/08) 71 = Outpatient services-other facility (10/01/0109/30/03 only) 72 = Outpatient services-this facility (10/01/0109/30/03 only)

13. Bilateral procedure

14. Invalid age

15. Invalid sex

16. Invalid discharge status

September 2011

Edit code lists 1.191

Non-covered procedures

17. Limited coverage

For certain procedures whose medical complexity and serious nature incur extraordinary associated costs, Medicare limits coverage to a portion of the cost. The limited coverage edit indicates the type of limited coverage. (e.g., Heart transplant-Limited coverage, Lung transplant-Limited coverage, etc.) The following is a list of limited coverage procedure codes with corresponding English descriptions.

02HA0QZ 02HA3QZ 02HA4QZ 02YA0Z0 02YA0Z1 02YA0Z2 0BYC0Z0 0BYC0Z1 0BYC0Z2 0BYD0Z0 0BYD0Z1 0BYD0Z2 0BYF0Z0 0BYF0Z1 0BYF0Z2 0BYG0Z0 0BYG0Z1 0BYG0Z2 0BYH0Z0 0BYH0Z1 0BYH0Z2 0BYJ0Z0 0BYJ0Z1 0BYJ0Z2 0BYK0Z0 0BYK0Z1 0BYK0Z2 0BYL0Z0 0BYL0Z1 0BYL0Z2 0BYM0Z0 0BYM0Z1 0BYM0Z2 0DY80Z0 0DY80Z1 0DY80Z2 0DYE0Z0 0DYE0Z1 0DYE0Z2 0FY00Z0 0FY00Z1 0FY00Z2 0FYG0Z0 0FYG0Z1 0TY00Z0 0TY00Z1 0TY00Z2 0TY10Z0 0TY10Z1 0TY10Z2

Insertion of Implant Heart Assist into Heart, Open Approach Insertion of Implant Heart Assist into Heart, Perc Approach Insert Implant Heart Assist in Heart, Perc Endo Transplantation of Heart, Allogeneic, Open Approach Transplantation of Heart, Syngeneic, Open Approach Transplantation of Heart, Zooplastic, Open Approach Transplantation of R Up Lung Lobe, Allogen, Open Approach Transplantation of R Up Lung Lobe, Syngen, Open Approach Transplantation of R Up Lung Lobe, Zooplast, Open Approach Transplantation of R Mid Lung Lobe, Allogen, Open Approach Transplantation of R Mid Lung Lobe, Syngen, Open Approach Transplantation of R Mid Lung Lobe, Zooplast, Open Approach Transplantation of R Low Lung Lobe, Allogen, Open Approach Transplantation of R Low Lung Lobe, Syngen, Open Approach Transplantation of R Low Lung Lobe, Zooplast, Open Approach Transplantation of L Up Lung Lobe, Allogen, Open Approach Transplantation of L Up Lung Lobe, Syngen, Open Approach Transplantation of L Up Lung Lobe, Zooplast, Open Approach Transplantation of Lung Lingula, Allogeneic, Open Approach Transplantation of Lung Lingula, Syngeneic, Open Approach Transplantation of Lung Lingula, Zooplastic, Open Approach Transplantation of L Low Lung Lobe, Allogen, Open Approach Transplantation of L Low Lung Lobe, Syngen, Open Approach Transplantation of L Low Lung Lobe, Zooplast, Open Approach Transplantation of Right Lung, Allogeneic, Open Approach Transplantation of Right Lung, Syngeneic, Open Approach Transplantation of Right Lung, Zooplastic, Open Approach Transplantation of Left Lung, Allogeneic, Open Approach Transplantation of Left Lung, Syngeneic, Open Approach Transplantation of Left Lung, Zooplastic, Open Approach Transplantation of Bilateral Lungs, Allogen, Open Approach Transplantation of Bilateral Lungs, Syngeneic, Open Approach Transplantation of Bilateral Lungs, Zooplast, Open Approach Transplantation of Small Intestine, Allogen, Open Approach Transplantation of Small Intestine, Syngeneic, Open Approach Transplantation of Small Intestine, Zooplast, Open Approach Transplantation of Large Intestine, Allogen, Open Approach Transplantation of Large Intestine, Syngeneic, Open Approach Transplantation of Large Intestine, Zooplast, Open Approach Transplantation of Liver, Allogeneic, Open Approach Transplantation of Liver, Syngeneic, Open Approach Transplantation of Liver, Zooplastic, Open Approach Transplantation of Pancreas, Allogeneic, Open Approach Transplantation of Pancreas, Syngeneic, Open Approach Transplantation of Right Kidney, Allogeneic, Open Approach Transplantation of Right Kidney, Syngeneic, Open Approach Transplantation of Right Kidney, Zooplastic, Open Approach Transplantation of Left Kidney, Allogeneic, Open Approach Transplantation of Left Kidney, Syngeneic, Open Approach Transplantation of Left Kidney, Zooplastic, Open Approach

1.192 Definitions of Medicare Code Edits

September 2011

The procedures shown below are identified as limited coverage procedures when combined with diagnosis code Z006 (Encntr for exam for nrml cmprsn and ctrl in clncl rsrch prog).
Procedure
02RK0JZ with 02RL0JZ Replacement of Left Ventricle with Synth Sub, Open Approach Replacement of Right Ventricle with Synth Sub, Open Approach

18. Wrong procedure performed 18. Wrong procedure

performed

Certain external causes of morbidity codes indicate that the wrong procedure was performed. The following list contains the codes, with corresponding English descriptions, that indicate the wrong procedure was performed.

Wrong procedure performed


Y6551 Y6552 Y6553 Performance of wrong procedure (op) on correct patient Perform of proc (op) on patient not scheduled for surgery Perform of correct procedure (op) on wrong side or body part

September 2011

Edit code lists 1.193

1.194 Definitions of Medicare Code Edits

September 2011

Chapter 2
2

Code list changes

Contents

Code list changes

2.3

2.2 Definitions of Medicare Code Edits

September 2011

Chapter 2

Code list changes

HIS CHAPTER SUMMARIZES the changes in the edit code lists from the last release of the Medicare Code Editor (MCE) software to the current one. The code lists are part of chapter 1 in this manual. No changes.

September 2011

Code list changes 2.3

2.4 Definitions of Medicare Code Edits

September 2011

Index

A
Adult age categories, 1.4 diagnosis codes, 1.47 Age categories, 1.4 adult, 1.4 maternity, 1.4 newborn, 1.4 pediatric, 1.4 Age conflict, 1.4 adult diagnosis codes, 1.47 maternity diagnosis codes, 1.14 newborn diagnosis codes, 1.5 pediatric diagnosis codes, 1.12

newborn diagnoses, 1.5 non-covered procedure, 1.184 pediatric diagnoses, 1.12 procedures allowed for females only, 1.102 procedures allowed for males only, 1.139 questionable admission, 1.166 unacceptable principal diagnosis, 1.167 valid discharge status, 1.191

D
Diagnoses allowed for females only codes, 1.58 Diagnoses allowed for males only codes, 1.131 Duplicate of PDX, 1.4 example, 1.4

B
Bilateral procedure, 1.191

E
E-code as principal diagnosis, 1.4 E-codes, 1.4 Edit list, 1.3 Edits age conflict, 1.4 bilateral procedure, 1.191 duplicate of PDX, 1.4 E-code as principal diagnosis, 1.4 invalid age, 1.191 invalid discharge status, 1.191 invalid sex, 1.191 limited coverage, 1.192

C
Code lists, 1.1 Codes adult diagnoses, 1.47 age conflict, 1.5, 1.12, 1.14, 1.47 diagnoses allowed for females only, 1.58 diagnoses allowed for males only, 1.131 manifestations not allowed as principal dx, 1.161 maternity diagnoses, 1.14

September 2011

Index I.1

03/14/12

Preliminary

manifestation code as principal diagnosis, 1.161 non-covered procedure, 1.184 open biopsy check, 1.191 questionable admission, 1.166 requires secondary diagnosis, 1.167 sex conflict, 1.58 unacceptable principal diagnosis, 1.167 wrong procedure performed, 1.193 Example duplicate of PDX, 1.4

Procedures, wrong procedure performed, 1.193

Q
Questionable admission, 1.166 codes, 1.166

R
Requires secondary diagnosis, 1.167

I
Invalid age, 1.191 Invalid discharge status, 1.191 Invalid sex, 1.191

S
Sex conflict, 1.58 diagnoses allowed for females only codes, 1.58 diagnoses allowed for males only codes, 1.131 procedures allowed for females only codes, 1.102 procedures allowed for males only codes, 1.139

L
Limited coverage, 1.192 List of edits, 1.3

U M
Manifestation code as principal diagnosis, 1.161 Manifestations not allowed as principal dx codes, 1.161 Maternity age categories, 1.4 diagnosis codes, 1.14 UB-04 discharge status code list, 1.191 Unacceptable principal diagnosis, 1.167 codes, 1.167

V
Valid discharge status codes, 1.191

N
Newborn age categories, 1.4 diagnosis codes, 1.5 Non-covered procedure, 1.184 codes, 1.184

W
Wrong procedure performed, 1.193

O
Open biopsy check, 1.191

P
Pediatric age categories, 1.4 diagnosis codes, 1.12 Procedures allowed for females only codes, 1.102 Procedures allowed for males only codes, 1.139

I.2 Definitions of Medicare Code Edits

September 2011

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