Medicare Code Edits

This option is available to Advanced subscribers only.

Watch a brief YouTube movie and see how easy it is to edit a code with MCE using ICD10Doc.

Medicare imposes restrictions on ICD codes reported - Diagnosis and Procedures - in both ICD-9 and ICD-10.
When reviewing an ICD code - be it Diagnosis or Procedure / ICD-9 or ICD-10 - the ICD10Doc application will display the relevant code edits.



The Medicare Code Edits may be classified as:

1. Invalid diagnosis or procedure code
2. E-code as principal diagnosis
3. Duplicate of PDX
4. Age conflict
5. Sex conflict
6. Manifestation code as principal diagnosis
7. Non-specific principal diagnosis (Discontinued as of 10/01/07) *
8. Questionable admission
9. Unacceptable principal diagnosis
10. Non-specific O.R. procedure (Discontinued as of 10/01/07) *
11. Non-covered procedure
12. Open biopsy check (Discontinued as of 10/01/10) *
13. Bilateral procedure *
14. Invalid age
15. Invalid sex
16. Invalid discharge status *
17. Limited coverage
18. Wrong procedure, wrong patient, wrong side *
19. Procedure inconsistent with length of stay *

NOTE: the categories marked with * are NOT considered by ICD10Doc.

For more information on Medicare Code Edits visit CMS web sites on ICD-9 code edits or ICD-10 code edits
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