Medicare Code Editor Definitions of Medicare Code Edits



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Medicare Code Editor

Definitions of Medicare Code Edits

v31.0 October 2013
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/FY_14_Definition_of-Medicare_Code_Edits_V_31_Manual.pdf

Manifestations not allowed as principal diagnosis

2842 Myelophthisis

28952 Splenic sequestration

28983 Myelofibrosis

29410 Dementia w/o behav dist

29411 Dementia w behavior dist

3207 Mening in oth bact dis

3210 Cryptococcal meningitis

3211 Mening in oth fungal dis

3212 Mening in oth viral dis

3213 Trypanosomiasis meningit

3214 Meningit d/t sarcoidosis

3218 Mening in oth nonbac dis

32301 Enceph/encephmye oth dis

32302 Myelitis-oth viral dis

3231 Rickettsial encephalitis

3232 Protozoal encephalitis

32341 Ot encph/mye ot inf else

32342 Oth myelitis ot inf else

32361 Inf ac dis encephalomyel

32362 Postinf encephalitis NEC

32363 Postinfectious Myelitis

32371 Toxic encph & encephlomy

32372 Toxic myelitis

32701 Insomnia in other dis

32702 Insomnia dt mental disor

32714 Hypersomnia in other dis

32715 Hypersom dt mental disor

32726 Sleep hypovent oth dis

32727 Cntrl sleep apnea ot dis

32737 Circadian rhym oth dis

32744 Parasomnia oth diseases

3302 Cereb degen in lipidosis

3303 Cerb deg chld in oth dis

3317 Cereb degen in oth dis

3344 Cerebel atax in oth dis

3362 Comb deg cord in oth dis

3363 Myelopathy in oth dis

3371 Aut neuropthy in oth dis

34121 Acute myelitis oth cond

34710 Narclpsy w/o cat oth dis

34711 Narcolepsy w cat oth dis

3571 Neurpthy in col vasc dis

3572 Neuropathy in diabetes

3573 Neuropathy in malig dis

3574 Neuropathy in other dis

3581 Myasthenia in oth dis

35839 Lambert-Eaton syn ot dis

3595 Myopathy in endocrin dis

3596 Infl myopathy in oth dis

36201 Diabetic retinopathy NOS

36202 Prolif diab retinopathy

36203 Nonprolf db retnoph NOS

36204 Mild nonprolf db retnoph

36205 Mod nonprolf db retinoph

36206 Sev nonprolf db retinoph

36207 Diabetic macular edema

36271 Ret dystrph in lipidoses

36272 Ret dystrph in syst dis

36411 Chr iridocyl in oth dis

36544 Glaucoma w systemic synd

36641 Diabetic cataract

36642 Tetanic cataract

36643 Myotonic cataract

36644 Cataract w syndrome NEC

37044 Keratitis in exanthema

37105 Phthisical cornea

37215 Parasitic conjunctivitis

37231 Rosacea conjunctivitis

37233 Mucocutan dis conjunctiv

3734 infect derm lid w deform

3735 Infec dermatitis lid NEC

3736 Parasitic infest eyelid

37451 Xanthelasma

37613 Parasite infest, orbit

37621 Thyrotoxic exophthalmos

37622 Exophthalm ophthalmopleg

38013 Ac infect extern ear NEC

38015 Chr mycot otitis externa

38202 Ac supp OM in oth dis

4200 Ac pericardit in oth dis

4211 Ac endocardit in oth dis

4220 Ac myocardit in oth dis

42491 Endocarditis in oth dis

4257 Metabolic cardiomyopathy

4258 Cardiomyopath in oth dis

44381 Angiopathy in other dis

45620 Bleed esoph var oth dis

45621 Esoph varice oth dis NOS

4841 Pneum w cytomeg incl dis

4843 Pneumonia in whoop cough

4845 Pneumonia in anthrax

4846 Pneum in aspergillosis

4847 Pneum in oth sys mycoses

4848 Pneum in infect dis NEC

5161 Idio pulm hemosiderosis

5171 Rheumatic pneumonia

5172 Syst sclerosis lung dis

5173 Acute chest syndrome

5178 Lung involv in oth dis

52510 Acq absence of teeth NOS

52511 Loss of teeth d/t trauma

52512 Loss teeth d/t peri dis

52513 Loss of teeth d/t caries

52519 Loss of teeth NEC

5670 Peritonitis in infec dis

5731 Hepatitis in viral dis

5732 Hepatitis in oth inf dis

58081 Ac nephritis in oth dis

58181 Nephrotic syn in oth dis

58281 Chr nephritis in oth dis

58381 Nephritis NOS in oth dis

59081 Pyelonephrit in oth dis

5954 Cystitis in oth dis

59801 Ureth strict:oth infect

6014 Prostatitis in oth dis

60491 Orchitis in oth disease

60881 Male gen dis in oth dis

61611 Vaginitis in oth disease

61651 Vulvar ulcer in oth dis

6281 Infertil-pituitary orig

71110 Reiter arthritis-unspec

71111 Reiter arthritis-shlder

71112 Reiter arthritis-up/arm

71113 Reiter arthritis-forearm

71114 Reiter arthritis-hand

71115 Reiter arthritis-pelvis

71116 Reiter arthritis-l/leg

71117 Reiter arthritis-ankle

71118 Reiter arthritis NEC

71119 Reiter arthritis-mult

71120 Behcet arthritis-unspec

71121 Behcet arthritis-shlder

71122 Behcet arthritis-up/arm

71123 Behcet arthritis-forearm

71124 Behcet arthritis-hand

71125 Behcet arthritis-pelvis

71126 Behcet arthritis-l/leg

71127 Behcet arthritis-ankle

71128 Behcet arthritis NEC

71129 Behcet arthritis-mult

71130 Dysenter arthrit-unspec

71131 Dysenter arthrit-shlder

71132 Dysenter arthrit-up/arm

71133 Dysenter arthrit-forearm

71134 Dysenter arthrit-hand

71135 Dysenter arthrit-pelvis

71136 Dysenter arthrit-l/leg

71137 Dysenter arthrit-ankle

71138 Dysenter arthrit NEC

71139 Dysenter arthrit-mult

71140 Bact arthritis-unspec

71141 Bact arthritis-shlder

71142 Bact arthritis-up/arm

71143 Bact arthritis-forearm

71144 Bact arthritis-hand

71145 Bact arthritis-pelvis

71146 Bact arthritis-l/leg

71147 Bact arthritis-ankle

71148 Bact arthritis NEC

71149 Bact arthritis-mult

71150 Viral arthritis-unspec

71151 Viral arthritis-shlder

71152 Viral arthritis-up/arm

71153 Viral arthritis-forearm

71154 Viral arthritis-hand

71155 Viral arthritis-pelvis

71156 Viral arthritis-l/leg

71157 Viral arthritis-ankle

71158 Viral arthritis NEC

71159 Viral arthritis-mult

71160 Mycotic arthritis-unspec

71161 Mycotic arthritis-shlder

71162 Mycotic arthritis-up/arm

71163 Mycotic arthrit-forearm

71164 Mycotic arthritis-hand

71165 Mycotic arthritis-pelvis

71166 Mycotic arthritis-l/leg

71167 Mycotic arthritis-ankle

71168 Mycotic arthritis NEC

71169 Mycotic arthritis-mult

71170 Helminth arthrit-unspec

71171 Helminth arthrit-shlder

71172 Helminth arthrit-up/arm

71173 Helminth arthrit-forearm

71174 Helminth arthrit-hand

71175 Helminth arthrit-pelvis

71176 Helminth arthrit-l/leg

71177 Helminth arthrit-ankle

71178 Helminth arthrit NEC

71179 Helminth arthrit-mult

71180 Inf arthritis NEC-unspec

71181 Inf arthritis NEC-shlder

71182 Inf arthritis NEC-up/arm

71183 Inf arthrit NEC-forearm

71184 Inf arthritis NEC-hand

71185 Inf arthritis NEC-pelvis

71186 Inf arthritis NEC-l/leg

71187 Inf arthritis NEC-ankle

71188 Inf arthrit NEC-oth site

71189 Inf arthritis NEC-mult

71210 Dicalc phos cryst-unspec

71211 Dicalc phos cryst-shlder

71212 Dicalc phos cryst-up/arm

71213 Dicalc phos crys-forearm

71214 Dicalc phos cryst-hand

71215 Dicalc phos cryst-pelvis

71216 Dicalc phos cryst-l/leg

71217 Dicalc phos cryst-ankle

71218 Dicalc phos cry-site NEC

71219 Dicalc phos cryst-mult

71220 Pyrophosph cryst-unspec

71221 Pyrophosph cryst-shlder

71222 Pyrophosph cryst-up/arm

71223 Pyrophosph cryst-forearm

71224 Pyrophosph cryst-hand

71225 Pyrophosph cryst-pelvis

71226 Pyrophosph cryst-l/leg

71227 Pyrophosph cryst-ankl

71228 Pyrophos cryst-site NEC

71229 Pyrophos cryst-mult

71230 Chondrocalcin NOS-unspec

71231 Chondrocalcin NOS-shlder

71232 Chondrocalcin NOS-up/arm

71233 Chondrocalc NOS-forearm

71234 Chondrocalcin NOS-hand

71235 Chondrocalcin NOS-pelvis

71236 Chondrocalcin NOS-l/leg

71237 Chondrocalcin NOS-ankle

71238 Chondrocalc NOS-oth site

71239 Chondrocalcin NOS-mult

7130 Arthrop w endocr/met dis

7131 Arthrop w noninf GI dis

7132 Arthropath w hematol dis

7133 Arthropathy w skin dis

7134 Arthropathy w resp dis

7135 Arthropathy w nerve dis

7136 Arthrop w hypersen react

7137 Arthrop w system dis NEC

7138 Arthrop w oth dis NEC

72081 Spondylopathy in oth dis

72701 Synovitis in oth dis

73070 Polio osteopathy-unspec

73071 Polio osteopathy-shlder

73072 Polio osteopathy-up/arm

73073 Polio osteopathy-forearm

73074 Polio osteopathy-hand

73075 Polio osteopathy-pelvis

73076 Polio osteopathy-l/leg

73077 Polio osteopathy-ankle

73078 Polio osteopathy NEC

73079 Polio osteopathy-mult

73080 Bone infect NEC-unspec

73081 Bone infect NEC-shlder

73082 Bone infect NEC-up/arm

73083 Bone infect NEC-forearm

73084 Bone infect NEC-hand

73085 Bone infect NEC-pelvis

73086 Bone infect NEC-l/leg

73087 Bone infect NEC-ankle

73088 Bone infect NEC-oth site

73089 Bone infect NEC-mult

7311 Osteitis def in oth dis

7318 Bone involv in oth dis

73740 Spin curv NOS in oth dis

73741 Kyphosis in oth dis

73742 Lordosis in oth dis

73743 Scoliosis in oth dis

7740 Perinat jaund-hered anem

77431 Neonat jaund in oth dis

7745 Perinatal jaundice NEC

78061 Fever in other diseases

78452 Flncy dsord cond elsewhr



78552 Septic shock

V4031 Wandering-dis elsewher
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