1

Invalid diagnosis code

2

Diagnosis and age conflict

3

Diagnosis and sex conflict

4

Medicare secondary payer alert

5

E-code as reason for visit

6

Invalid procedure code

7

Procedure and age conflict

8

Procedure and sex conflict

9

Nov-covered service

10

Non-covered service submitted for verification of denial (condition code 21 from header information on claim)

11

Non-covered service submitted for FI review (condition code 20 from header information on claim)

12

Questionable covered service

13

Additional payment for service not provided by Medicare

14

Code indicates a site of service not included in OPPS

15

Service unit out of range for procedure

16

Multiple bilateral procedures without modifier 50 (see Appendix A)

17

Multiple bilateral procedures with modifier 50 (see Appendix A)

18

Inpatient procedure

19

Mutually exclusive procedure that is not allowed even if appropriate modifier present

20

Component of a comprehensive procedure that is not allowed even if appropriate modifier present

21

Medical visit on same day as a type "T" or "S" procedure without modifier 25 (see Appendix B)

22

Invalid modifier

23

Invalid date

24

Date out of OCE range

25

Invalid age

26

Invalid sex

27

Only incidental services reported

28

Code not recognized by Medicare; alternate code for same service available

29

Partial hospitalization service for non-mental health diagnosis

30

Insufficient services on day of partial hospitalization

31

Partial hospitalization on same day as ECT or type "T" procedure

32

Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days

33

Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services

34

Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria

35

Only activity therapy and/or occupational therapy services provided

36

Extensive mental health services provided on day of ECT or significant procedure

37

Terminated bilateral procedure or terminated procedure with units greater than one

38

Inconsistency between implanted device and implantation procedure

39

Mutually exclusive procedure that would be allowed if appropriate modifier were present

40

Component of a comprehensive procedure that would be allowed if appropriate modifier were present

41

Invalid revenue code

42

Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)