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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