Medicare Code Editor Software

Preliminary 06/24/09 

z/OS Batch 

Medicare Code Editor Software 

Object/Source Installation Manual 

PB2009-101191 

Software version 26.0 

PBL–010 October 2009

06/24/09 Preliminary 

Document number 

October 2009 

PBL–010 

ii Medicare Code Editor Software 

October 2009


About this document 

THIS MANUAL CONTAINS the information needed to install 

version 26.0 of the Medicare Code Editor (MCE) software that runs 

under the z/OS batch operating system. The manual assumes that the 

person installing the software has experience working with Basic 

Assembly Language (BAL) and z/OS Job Control Language (JCL). 

The Centers for Medicare and Medicaid Services has approved this 

version of the Medicare Code Editor software and requires its use by 

Medicare fiscal intermediaries. 

October 2009 

iii


iv Medicare Code Editor Software 

October 2009


Contents 

Preface 

About this document iii 

Chapter 1 Introduction 1.3 

Types of edits 1.3 

Purpose of the software 1.4 

Versions and date ranges 1.4 

Chapter 2 Program output 2.3 

Elements in the output report 2.4 

Title line 2.4 

Optional information 2.4 

Provider number 2.4 

Patient information 2.5 

Diagnosis code(s) 2.5 

Procedure code(s) 2.5 

Chapter 3 Installing the software 3.3 

Installation media 3.3 

Downloading the installation media files 3.5 

File 1 - JCL library 3.6 

File 2 - library of object programs 3.7 

File 3 - installation test database 3.8 

File 4 - English description VSAM file 3.9 

Layout of the description file 3.9 

File 5 - library of source programs and tables 3.11 

Files 6 and 7 - MCE v26.0 EBCDIC tables 3.12 

EBCDIC Diagnosis table 3.12 

EBCDIC Procedure table 3.14 

Running the test program 3.17 

October 2009 

Contents v


Chapter 4 Running the program 4.3 

Calling the editor 4.3 

JCL for executing the program 4.4 

Using the alternate interface 4.7 

Chapter 5 The control block 5.3 

DXPTR 5.4 

NDXPTR 5.4 

SGPTR 5.5 

NSGPTR 5.5 

AGEPTR 5.5 

SEXPTR 5.5 

DSTATPTR 5.5 

PROVPTR 5.6 

PPSPTR 5.6 

DATEPTR 5.6 

VPTR 5.7 

ADXFLGPTR 5.7 

DXFLGPTR 5.7 

PRFLGPTR 5.8 

BUFFPTR 5.9 

Flag values 5.11 

DSCPTR 5.11 

OPTPTR 5.11 

Chapter 6 The report programs 6.3 

MCE260PA 6.3 

MCE260PB 6.3 

MCE260PC 6.4 

Uses for the report programs 6.5 

MCE260PA 6.5 

MCE260PB 6.5 

MCE260PC 6.5 

Appendix A MCE software edits A.3 

1. Invalid diagnosis or procedure code A.4 

2. E-code as principal diagnosis A.4 

3. Duplicate of PDX A.4 

4. Age conflict A.4 

5. Sex conflict A.4 

6. Manifestation code as principal diagnosis A.5 

7. Non-specific principal diagnosis A.5 

8. Questionable admission A.5 

9. Unacceptable principal diagnosis A.5 

10. Non-specific O.R. procedure A.5 

11. Non-covered procedure A.5 

12. Open biopsy check A.6 

13. Bilateral procedure A.6 

14. Invalid age A.6 

15. Invalid sex A.6 

16. Invalid discharge status A.6 

17. Limited coverage A.6 

18. Wrong procedure performed A.6 

vi Medicare Code Editor Software 

October 2009


Appendix B Summary of changes B.3 

Software B.3 

Tables B.3 

Documentation B.4 

Index I.1 

October 2009 

Contents vii


viii Medicare Code Editor Software 

October 2009


Figures 

Figure 

Title and page 

2–1 Sample output report 2.4 

3–1 Sample JCL to install the JCL library 3.6 

3–2 Sample JCL to install the program object library (file 2) 3.7 

3–3 Sample JCL to install the test database (file 3) 3.8 

3–4 Sample JCL to install the English description file (file 4) 3.9 

3–5 Sample JCL to install the program source library (file 5) 3.11 

3–6 Sample JCL for downloading the EBCDIC tables 3.16 

3–7 Sample JCL to execute the COBOL test program 3.18 

3–8 COBOL test program output 3.19 

4–1 Sample JCL for edit-only procedure 4.5 

4–2 Sample JCL for edit-print procedure 4.6 

6–1 Example of print JCL using a COBOL interface program 6.7 

October 2009 

Figures ix


x Medicare Code Editor Software 

October 2009


Tables 

Table 

Title and page 

1–1 Program versions with discharge date ranges 1.4 

3–1 Files on the installation media 3.4 

3–2 File characteristics 3.5 

3–3 Files contained in JCL library (file 1) 3.6 

3–4 Object library members 3.7 

3–5 Test database format 3.8 

3–6 Source library members (file 5) 3.11 

3–7 Diagnosis table 3.12 

3–8 Procedure table 3.14 

4–1 Work area parameters 4.7 

5–1 Control block and elements of MCE system 5.3 

5–2 UB-04 discharge status codes 5.5 

5–3 PPS values 5.6 

5–4 Versions 5.7 

5–5 MCE diagnosis code edits 5.8 

5–6 MCE procedure code edits 5.8 

5–7 Buffer description 5.9 

5–8 Edit flag values 5.11 

6–1 Carriage control character values 6.3 

6–2 MCE260PC tagline format 6.4 

6–3 MCE260PC tagline example 6.4 

October 2009 

Tables xi


xii Medicare Code Editor Software 

October 2009


Chapter 1 

1Introduction


Contents Introduction 1.3 

Types of edits 1.3 

Purpose of the software 1.4 

Versions and date ranges 1.4 

1.2 Medicare Code Editor Software 

October 2009


Chapter 1 

Introduction 

ON APRIL 20, 1983, CONGRESS ENACTED “Prospective Payment 

for Medicare Inpatient Hospital Services” as Title VI of the 

Social Security Amendment. Under Title VI, hospitals are paid a 

fixed price by Diagnosis Related Group (DRG) for treating Medicare 

patients. 

In order to determine the appropriate DRG for a Medicare patient, 

the age, sex, discharge status, principal diagnosis, secondary diagnoses, 

and procedures performed must be reported by hospitals to 

their Medicare fiscal intermediaries. The logic of the DRG Definitions 

assumes that the patient information provided is accurate, and 

no attempt is made by the DRG Definitions to edit the data for accuracy. 

Only for extreme inconsistencies in the medical information 

will a DRG not be assigned to a patient record. 

Types of edits 

Three types of edits can be performed before assigning a DRG: 

◆ Code edits examine a record for the correct use of the 

ICD-9-CM codes that describe a patient’s diagnoses and procedures. 

Code edits include basic consistency checks on the 

interrelationships of a patient’s age, sex, and diagnoses and 

procedures. 

◆ Coverage edits examine patient type and performed procedures 

to determine if the services rendered are covered by Medicare 

and to what extent they are covered. 

October 2009 

Introduction 1.3


◆ 

Clinical edits examine the clinical consistency of the diagnostic 

and procedural information on the medical claim to determine if 

they are clinically reasonable and therefore if they should be 

paid. 

In a first phase of edits, the Centers for Medicare and Medicaid Services 

(CMS) provides all fiscal intermediaries with a code editing 

package, referred to as the Medicare Code Editor (MCE). MCE software 

contains edits that deal primarily with coding and coverage 

related issues. 

Purpose of the software 

MCE detects and reports errors in the coding of claims data. While 

the program identifies and indicates the nature of the error, it does not 

correct the error. A particular error condition is associated with each 

type of coding error that is identified. 

Versions and date ranges 

Table 1–1 lists the versions contained in this release of MCE software. 

The patient’s discharge date determines the version used for 

processing. 

Table 1–1. Program versions with discharge date ranges 

MCE version DRG version Discharge date range 

MCE 26.0 DRG 27.0 10/01/2009 - 09/30/2010 

MCE 25.0 DRG 26.0 10/01/2008 - 09/30/2009 

MCE 24.1 DRG 25.1 04/01/2008 - 09/30/2008 

MCE 24.0 DRG 25.0 10/01/2007 - 03/31/2008 

MCE 23.0 DRG 24.0 10/01/2006 - 09/30/2007 

MCE 22.0 DRG 23.0 10/01/2005 - 09/30/2006 

MCE 21.0 DRG 22.0 10/01/2004 - 09/30/2005 

MCE 20.0 DRG 21.0 10/01/2003 - 09/30/2004 

MCE 19.0 DRG 20.0 10/01/2002 - 09/30/2003 

MCE 18.0 DRG 19.0 10/01/2001 - 09/30/2002 

MCE 17.0 DRG 18.0 10/01/2000 - 09/30/2001 

MCE 16.0 DRG 17.0 10/01/1999 - 09/30/2000 

MCE 15.1 DRG 16.0 07/01/1999 - 09/30/1999 

MCE 15.0 DRG 16.0 10/01/1998 - 06/30/1999 

MCE 14.0 DRG 15.0 10/01/1997 - 09/30/1998 

MCE 13.0 DRG 14.0 10/01/1996 - 09/30/1997 

MCE 12.0 DRG 13.0 10/01/1995 - 09/30/1996 

MCE 11.0 DRG 12.0 10/01/1994 - 09/30/1995 

MCE 10.0 DRG 11.0 10/01/1993 - 09/30/1994 

1.4 Medicare Code Editor Software October 2009


Table 1–1. Program versions with discharge date ranges (continued) 

MCE version DRG version Discharge date range 

MCE 9.0 DRG 10.0 10/01/1992 - 09/30/1993 

MCE 8.0 DRG 9.0 10/01/1991 - 09/30/1992 

MCE 7.0 DRG 8.0 10/01/1990 - 09/30/1991 

MCE 6.0 DRG 7.0 10/01/1989 - 09/30/1990 

MCE 5.0 DRG 6.0 10/01/1988 - 09/30/1989 

MCE 4.0 DRG 5.0 10/01/1987 - 09/30/1988 

MCE 3.0 DRG 4.0 10/01/1986 - 09/30/1987 

MCE 2.0 DRG 3.0 03/01/1984 - 09/30/1986 

October 2009 

Introduction 1.5




Chapter 2 

2Program output


Contents Program output 2.3 

Elements in the output report 2.4 

Title line 2.4 

Optional information 2.4 

Provider number 2.4 

Patient information 2.5 

Diagnosis code(s) 2.5 

Procedure code(s) 2.5 


October 2009


Chapter 2 

Program output 

THIS CHAPTER DESCRIBES the output from the Medicare Code 

Editor (MCE) software program. When conflicting or incorrect information 

on a medical claim has been identified, the Medicare Code 

Editor prints a summary of the medical claim information, including 

the edit message that identifies the potential problem. 

Figure 2–1, shown on the next page, illustrates the MCE summary 

format and content of the printed claim. The illustration is intended 

to be an example of a claims summary that is generated. No error 

messages appear in the example. 

When error messages occur, they appear to the right of the code in 

question or at the bottom of the report. The Definitions of Medicare 

Code Edits guide contains more information on the edits that appear 

in MCE software. 

October 2009 

Program output 2.3


Title line 

Optional 

information 

Provider 

number 

Patient 

information 

MEDICARE CODE EDITOR -Vxx.x mm/dd/yyyy PAGE 1 

DATA EDITED: COMMUNITY HOSPITAL 

PATIENT ID: 058655 

LOS: 3 

PROVIDER NUMBER: 123456789123456 (PPS) 

AGE: 66 

SEX: 01 MALE 

DISCHARGE STATUS: 01 HOME 

DATE: 20041202 

ADMITTING DIAGNOSIS 

36617 MATURE CATARACT 

Diagnosis 

code(s) 

PRINCIPAL DIAGNOSIS 

36617 MATURE CATARACT 

SECONDARY DIAGNOSIS 

4019 HYPERTENSION NOS 

Procedure 

code(s) 

PROCEDURE 

1319 INTRACAPSUL LENS EXT NEC 

Figure 2–1. Sample output report 

Elements in the output report 

Title line 

Optional information 

Data elements in the MCE output report are described below. 

The title line includes the name of the software, the date the report 

was produced (mm/dd/yyyy format), the program version that processed 

the claim, and the report’s page number. Each record is 

printed on a separate page. 

This section contains optional patient information from the claims 

record. The user may enter up to 11 lines, each 40 characters long, of 

optional information. For example, a hospital name and claim identifier 

can be reported as optional fields. The claim identifier can be a 

medical record number, social security number, patient’s name, or 

any other identifier chosen by the user. 

Figure 2–1 shows the hospital name, patient ID, and length of stay 

reported in the optional fields section. Additional information (e.g., 

physician number) can also be reported in this section at the user’s 

option. Information on the description of the print program pointer 

OPTPTR is given in chapter 5. 

Provider number 

The 15 character Medicare provider number is reported. The type of 

hospital (i.e., PPS or non-PPS) is also reported in parentheses next to 

the provider number. 



Patient information 

This section contains the required patient information from the 

claims record (i.e., age, sex, discharge status, and discharge date). 

Discharge status must be coded according to the UB-04 conventions. 

See table 5–2 on page 5.5 for a list of valid discharge status codes. 

Discharge date is displayed in the same format as the date was 

entered (i.e., yyyymmdd). There are no separators in the 8-character 

field. 

The program uses the discharge date to determine which version of 

the software will be used to process the claim. When 

the discharge date is absent or invalid, an error message is 

displayed and the claim stops processing. 

For more information on software version date ranges, see page 1.4. 

Diagnosis code(s) 

Procedure code(s) 

The following diagnosis information is reported: 

◆ 

◆ 

◆ 

ICD-9-CM admitting diagnosis code and English description 

ICD-9-CM principal diagnosis code and English description 

ICD-9-CM secondary diagnosis code(s) and English descriptions 

The ICD-9-CM codes and English descriptions of the procedure(s) 

performed are reported. 

October 2009 

Program output 2.5




Chapter 3 

3Installing the software


Contents Installing the software 3.3 

Installation media 3.3 

Downloading the installation media files 3.5 

File 1 - JCL library 3.6 

File 2 - library of object programs 3.7 

File 3 - installation test database 3.8 

File 4 - English description VSAM file 3.9 

Layout of the description file 3.9 

File 5 - library of source programs and tables 3.11 

Files 6 and 7 - MCE v26.0 EBCDIC tables 3.12 

EBCDIC Diagnosis table 3.12 

EBCDIC Procedure table 3.14 

Running the test program 3.17 


October 2009


Chapter 3 

Installing the software 

THIS CHAPTER DESCRIBES installation of the Medicare Code 

Editor (MCE) software that evaluates patient data to help identify 

possible errors in coding. Appendix A lists the edits contained in the 

program. The Definitions of Medicare Code Edits guide (PBL–011) 

contains more information on coding edits. 

Following description of the installation media, you will be 

instructed how to download the files shown in table 3–1, and test that 

the installation was successful. 

Installation media 

The MCE installation media contains the compiled object code for 

the MCE and print programs, written in the IBM OS Assembler language. 

The media also contains MCE tables and English description 

files that are an integral part of the MCE system, and the source for 

all the executor programs. Table 3–1 lists the files contained on the 

media. 

October 2009 

Installing the software 3.3


Table 3–1. Files on the installation media 

File Name Description 

1 MCE.JCL JCL library of sample JCL to download files 2-7 

2 MCE.OBJ Library of MCE object programs 

3 TESTDB Installation test database 

4 I9DSCRP Combined ICD-9-CM English description file 

5 MCE.ASM Library of source programs and tables 

6 DX.EBC Diagnosis EBCDIC table 

7 SG.EBC Procedure EBCDIC table 



Downloading the installation media files 

This section gives specific information on the installation files and 

downloading them. 

◆ Files 1 (MCE.JCL), 2 (MCE.OBJ), and 5 (MCE.ASM) must be 

copied to disk as partitioned data sets, using the IBM utility 

IEBUPDTE. The input data contains the “./ ADD” cards required 

by the IEBUPDTE utility. 

◆ Files 3 (TESTDB), 6 (DX.EBC), and 7 (SG.EBC) must be copied 

to sequential files, using IEBGENER or any similar utility. 

◆ File 4 (I9DSCRP) must be copied to a VSAM file. 

Table 3–2 lists the physical characteristics of the installation files, 

their comparable disk representations, and their space allocations on 

3390 disk packs. 

Table 3–2. File characteristics 

File LRECL BLKSIZE DSORG tape DSORG disk Space 

1 80 3120 PS PO 2 trks 

2 80 3120 PS PO 3 cyls 

3 1305 27405 PS PS 14 trks 

4 50 27950 PS VSAM 1 cyl 

5 80 3120 PS PO 5 cyls 

6 69 27945 PS PS 2 cyls 

7 69 27945 PS PS 6 trks 

In the JCL examples that follow, the VVVVVV notation for volume 

serial numbers should be replaced with the volume serial number of 

the cartridge you are installing. The number is marked on the cartridge’s 

external label. The JCL examples shown can be run in any 

order. 

October 2009 




File 1 - JCL library 

File 1 contains sample JCL to download the various files on the 

remainder of the cartridge. There also is JCL to run sample COBOL 

interface programs. Table 3–3 lists the files contained in the JCL 

library. 

Table 3–3. Files contained in JCL library (file 1) 

Member 

ALTSTJCL 

CBTSTJCL 

DBLOAD 

EBCLOAD 

OBJLOAD 

SRCLOAD 

VSAMLOAD 

Function 

Run sample COBOL program (ALTTEST) 

Run sample COBOL program (COBTEST) 

Load test database 

Load EBCDIC tables 

Load object library 

Load source library 

Load ICD-9-CM description file 

Figure 3–1 shows sample JCL to copy the partitioned data set of sample 

JCL to disk. 

//JOB CARD FOR YOUR INSTALLATION 

//* ******************************************** 

//* JCL TO INSTALL THE JCL LIBRARY 

//* ******************************************** 

// EXEC PGM=IEBUPDTE,PARM=NEW 

//SYSPRINT DD SYSOUT=* 

//SYSIN DD UNIT=CART,VOL=(,RETAIN,SER=VVVVVV), 

// LABEL=(1,NL),DISP=OLD, 

// DCB=(LRECL=80,BLKSIZE=3120,RECFM=FB) 

//SYSUT2 DD UNIT=SYSDA,DISP=(NEW,CATLG,DELETE), 

// DSN=YOURID.MCE260.JCL, 

// DCB=(RECFM=FB,LRECL=80,BLKSIZE=3120), 

// SPACE=(TRK,(2,1,3),RLSE) 

/* 

Figure 3–1. Sample JCL to install the JCL library 


October 2009



File 2 - library of object 

programs 

File 2 on the installation media contains an object library of all MCE 

programs. Table 3–4 lists the members of the object library. 

Table 3–4. Object library members 

Number Name Description 

1 MCE260CN The main control program 

(standard interface) 

2 MCE260DT Date calculation program 

3 MCE260ED Editor program 

4 MCE260RT The editor tables 

5 MCE260PA Print program 

6 MCE260PB Print program 

7 MCE260PC Print program 

8 MCE260VS VSAM code description program 

9 MCE260CA The main control program 

(alternate interface) 

Members 1 through 8 comprise the main MCE executor using the 

standard interface. Substitute MCE260CA for MCE260CN to compile 

the main grouper executor using the alternate (re-entrant, 

macro-free) interface. 

All the programs contained in the object library were written in IBM 

Basic Assembly Language (BAL). The programs were written and 

tested on an IBM 7060 computer. 

Figure 3–2 shows the JCL necessary to copy the object library to disk 

as a partitioned data set. 


//* ******************************************** 

//* JCL TO INSTALL THE OBJECT LIBRARY 

//* ******************************************** 







// DSN=YOURID.MCE260.OBJLIB, 


// SPACE=(CYL,(3,1,2),RLSE) 

/* 

Figure 3–2. Sample JCL to install the program object library (file 2) 

October 2009 




File 3 - installation test 

database 

File 3 contains a test database that is used to verify the integrity of 

the installed MCE program. The format of the test database is shown 

in table 3–5. 

Table 3–5. Test database format 

Field# Description Datatype Location 

1 Age CL3 1-3 

2 Sex CL1 4 

3 Discharge Status CL2 5-6 

4 Discharge date CL8 7-14 

5 Diagnoses (26) 26CL8 15-222 

6 Procedures (25) 25CL7 223-397 

7 Provider CL15 398-412 

8 PPS CL1 413-413 

9 Version CL3 414-416 

10 ADXFLAG CL1 417-417 

11 DXFLAGS 25XL14 418-767 

12 SGFLAGS 25XL16 768-1167 

13 MCEBUFF CL138 1168-1305 

Figure 3–3 shows the JCL for copying the test database to disk. 


//* ******************************************** 

//* JCL TO INSTALL THE TEST DATABASE 

//* ******************************************** 

// EXEC PGM=IEBGENER 


//SYSIN DD DUMMY 

//SYSUT1 DD UNIT=CART,VOL=(,RETAIN,SER=VVVVVV), 




// DSN=YOURID.MCE260.TESTDB, 

// DCB=(LRECL=1305,BLKSIZE=127405,RECFM=FB), 

// SPACE=(TRK,(12,2),RLSE) 

/* 

Figure 3–3. Sample JCL to install the test database (file 3) 


October 2009



File 4 - English description 

VSAM file 

File 4, the I9DSCRP file, is written as a key-sequenced data set, and 

the input file is sorted. This file replaces any English description files 

that may have been installed for other versions of MCE software. It 

combines all codes into one file, and has an additional identifier as 

part of the key. 

Downloading the description file is optional. The report programs 

that use the I9DSCRP file give you the option to bypass descriptions 

(see DSCPTR narrative in chapter 5). 

Figure 3–4 is an example of how to load the English description file. 

The layout of the description file follows the figure. 


//* ******************************************** 

//* JCL TO INSTALL THE ENGLISH DESCRIPTION FILE 

//* ******************************************** 

// EXEC PGM=IDCAMS,REGION=1024K 


//INPUT DD UNIT=CART,VOL=SER=VVVVVV, 


// LABEL=(4,NL),DISP=OLD 

//SYSIN DD * 

DEFINE CLUSTER (NAME(YOURID.MCE260.VSFILE) - 

VOLUMES(VVVVVV) - 

CISZ(2048) - 

RECORDS(19612)) - 

DATA (KEYS(10 0) - 

RECORDSIZE(50 50) - 

NAME(YOURID.MCE260.VSFILE.DATA)) - 

INDEX (NAME(YOURID.MCE260.VSFILE.INDEX)) 

REPRO INFILE(INPUT) - 

OUTDATASET(YOURID.MCE260.VSFILE) 

/* 

Figure 3–4. Sample JCL to install the English description file (file 4) 

Layout of the description file 

The layout of the description file follows: 

◆ 

◆ 

◆ 

◆ 

◆ 

◆ 

The first byte indicates whether the code is a diagnosis (1) or 

procedure (2). 

The next seven bytes (bytes 2-8) contain the code. 

The next two bytes contain the sequence number. When sequence 

number equals 00, the code description is valid for all MCE versions 

(first to current). 

The next eight bytes contain the “from” date. 

The next eight bytes contain the “to” date. 

The remaining bytes contain the code description. 

October 2009 




An example of the description file layout is shown below. 

From date To date 

Sequence # 

Type of code 

Code 

Description 

Line 2 

Line 3 

1 E8841 00 19851001 20080930 FALL FROM CLIFF 

1 E8842 01 19851001 19950930 FALL FROM CHAIR OR BED 

1 E8842 02 19951001 20080930 FALL FROM CHAIR 

➤ 

Note: As illustrated in the example above, the “from” and “to” version 

numbers are replaced with “from” and “to” dates. 

In the first line, the description for diagnosis code E8841 is valid for 

all MCE versions; therefore, the sequence number zero. 

Diagnosis code E8842 has two entries on lines 2 and 3 because the 

description changed on 19951001. Since there are two entries, each 

entry is given a sequence number. The description for sequence number 

01 is valid for MCE from 19851001 through 19950930. The 

description for sequence number 02 is valid from 19951001 to 

20080930. 


October 2009


File 5 - library of source 

programs and tables 

The source library in file 5 consists of the source for the COBOL test 

programs and the sources for the MCE editor and print routine 

programs. 

Table 3–6 lists the members of the source library. 

Table 3–6. Source library members (file 5) 

Number Name Description 

1 ALTTEST Sample COBOL program (alternate 

interface) 

2 COBTEST Sample COBOL (standard interface) 

program 

3 MCE260CA Control program (alternate interface) 

4 MCE260CN Control program (standard interface) 

5 MCE260DT Date calculation program 

6 MCE260ED Editor program 

7 MCE260PA Print program to the table 

8 MCE260PB Print program 

9 MCE260PC Print program 

10 MCE260PR Print macro 

11 MCE260RT Editor tables 

12 MCE260VS VSAM description file program 

Figure 3–5 shows the JCL necessary to copy the source library to 

disk as a partitioned data set. The sources for all of the MCE executor 

programs are included. 


//* ******************************************** 

//* JCL TO INSTALL THE SOURCE LIBRARY 

//* ******************************************** 







// DSN=YOURID.MCE260.SRCLIB, 


// SPACE=(CYL,(5,1,4),RLSE) 

/* 

Figure 3–5. Sample JCL to install the program source library (file 5) 

October 2009 




Files 6 and 7 - MCE v26.0 

EBCDIC tables 

The tables that drive the MCE are expressed in Extended Binary 

Coded Decimal Interchange Code (EBCDIC) as two files: 

Diagnosis table. Contains one row per ICD-9-CM diagnosis, with 

diagnosis attributes. 

Procedure table. Contains one row per ICD-9-CM procedure, with 

procedure attributes. 

In the layouts in this section, each field is identified by its position 

(first column is position 1) and length in a table row. Criteria fields 

(length 1) are one when the criteria are met and zero otherwise. 

Files 6 and 7 contain the diagnosis and procedure tables. Sample JCL 

for downloading the EBCDIC tables is shown in figure 3–6 on page 

3.16. 

EBCDIC Diagnosis table 

File 6, shown in table 3–7, contains the EBCDIC Diagnosis table. 

Table 3–7. Diagnosis table 

Name Pos Len Description 

dx 1 5 ICD-9-CM diagnosis 

effdate 6 8 edit effective date 

termdate 14 8 edit termination date 

pediatric 22 1 diagnosis for pediatric only 

msp 23 1 medicare as secondary payer 

maternity 24 1 diagnosis for maternity only 

nonspecific 25 1 nonspecific diagnosis 

newborn 26 1 diagnosis for newborn only 

manifestation 27 1 manifestation 

female 28 1 diagnosis for female only 

male 29 1 diagnosis for male only 

mdc08 30 1 MDC 8 

reqsdx 31 1 requires secondary diagnosis 

ncov2 32 1 ncov2 

qadm 33 1 questionable admission 

unacceptable 34 1 unacceptable diagnosis 

adult 35 1 diagnosis for adult only 

cc 36 1 cc 




October 2009



Table 3–7. Diagnosis table (continued) 



ncov2agelt78 40 1 ncov2agelt78 

ncov2agelt64 41 1 ncov2agelt64 




diabtypeI 45 1 diabetes 

UNUSED 46 1 UNUSED 


clintrial 48 1 clinical trial 

wrnproc 49 1 wrong procedure performed 





















October 2009 




EBCDIC Procedure table 

File 7, shown in table 3–8, contains the EBCDIC Procedure table. 

Table 3–8. Procedure table 


sg 1 5 ICD-9-CM procedure 

effdate 6 8 edit effective date 

termdate 14 8 edit termination date 

noncovered 22 1 noncovered procedure 

biopsy 23 1 biopsy 


bilateral 25 1 bilateral procedure 

nonspecific 26 1 nonspecific procedure 

or 27 1 or indicator 

female 28 1 procedure for female only 

male 29 1 procedure for male only 

kidneyxp 30 1 kidney transplant 







lcov_lvrs 37 1 limited coverage - LVRS 

lcov_lungxp 38 1 limited coverage - lung transplant 

lcov_heartlungxl 39 1 limited coverage - heart/lung transplant 

lcov_heartxp 40 1 limited coverage - heart transplant 

lcov_heartsys 41 1 limited coverage - heart system 

transplant 

lcov_intxp 42 1 limited coverage - intestine transplant 

lcov_liver 43 1 limited coverage - liver transplant 


ncov10a 45 1 ncov10a 

ncov10b 46 1 ncov10b 

ncov10c 47 1 ncov10c 


ncov12agele60 49 1 ncov12agele60 


October 2009



Table 3–8. Procedure table (continued) 


lcov_kidneyxp 50 1 limited coverage - kidney transplant 

lcov_pancreasx 

p 

51 1 limited coverage - pancreas transplant 


ncov13b 53 1 ncov13b 


lcov_artheartxp 55 1 limited coverage - artificial heart 

transplant 















October 2009 




Figure 3–6 shows sample JCL for downloading the EBCDIC 

tables. 


//* ******************************************** 

//* JCL TO INSTALL THE DIAGNOSIS EBCDIC TABLE 

//* ******************************************** 





// LABEL=(6,NL),DISP=(OLD,PASS), 



// DSN=YOURID.MCE260.DXEBC, 


// SPACE=(CYL,(3),RLSE) 

/* 

//* ******************************************** 

//* JCL TO INSTALL THE PROCEDURE EBCDIC TABLE 

//* ******************************************** 







//SYSUT2 DD UNIT=C21USR,DISP=(NEW,CATLG,DELETE), 

// DSN=YOURID.MCE260.SGEBC, 


// SPACE=(TRK,(6),RLSE) 

/* 

Figure 3–6. Sample JCL for downloading the EBCDIC tables 


October 2009


Running the test program 


➤ 

Note: We strongly recommend running the test program to ensure 

that the software is correctly installed. 

A copy of the COBOL test program and the test database are 

included on the cartridge to allow you to test the results of the installation 

procedure. Figure 3–7 is an example of a compile-link-go to 

execute the COBOL test program. 

If you have not installed the ICD-9-CM description file, change line 

55 in the COBOL test program to read: 

77 DSCFLAG PIC S9(8) COMP VALUE IS +0. 

Also, exclude the marked (†) line from the JCL in figure 3–7. 

October 2009 




//* ****************************************************** 

//* THIS JOB IS USED TO COMPILE, LINK AND RUN THE MCE 

//* COBOL TEST PROGRAM, COBTEST. 

//* 

//* BOTH OBJECT AND LOAD MODULES ARE TEMPORARY. 

//* ****************************************************** 

//COBUCLG PROC SYSOUT='*' 

//* COBOL FOR MVS COMPILE AND LINK 

//COB EXEC PGM=IGYCRCTL,PARM='RENT,NODYNAM' 

//STEPLIB DD DSN=IGY.V2R2M0.SIGYCOMP,DISP=SHR 

//SYSLIB DD DSN=YOURID.&PROD..SRCLIB,DISP=SHR 

//SYSPRINT DD SYSOUT=&SYSOUT 

//SYSIN DD DSN=YOURID.&PROD..SRCLIB(COBTEST),DISP=SHR 

//SYSUT1 DD UNIT=SYSDA,SPACE=(CYL,(1,1)) 







//SYSLIN DD DSN=&&LOADSET,UNIT=SYSDA,DISP=(MOD,PASS), 

// SPACE=(TRK,(3,3)),DCB=BLKSIZE=800 

//* 

//LKED EXEC PGM=IEWL,PARM='LIST,MAP,AMODE=31,RMODE=ANY', 

// COND=(5,LT,COB) 

//SYSLIB DD DSN=CEE.SCEELKED,DISP=SHR 

//SYSLMOD DD DSN=&&GOSET(COBTEST),UNIT=SYSDA,DISP=(,PASS), 

// SPACE=(CYL,(5,1,5)) 



//SYSLIN DD DSN=&&LOADSET,DISP=(OLD,DELETE) 

// DD DDNAME=SYSIN 

//OBJECT DD DSN=YOURID.&PROD..OBJLIB,DISP=OLD 

//* 

//GO EXEC PGM=COBTEST,COND=((5,LT,COB),(5,LT,LKED)) 

//STEPLIB DD DISP=SHR,DSN=&&GOSET 

// DD DISP=SHR,DSN=CEE.SCEERUN 

//INFILE DD DSN=YOURID.&PROD..TESTDB,DISP=SHR 


//MCE260I9 DD DSN=YOURID.&PROD..VSFILE,DISP=SHR† 

//RPTFILE DD SYSOUT=&SYSOUT,DCB=(RECFM=FA,BLKSIZE=81,BUFNO=1) 

// PEND 

//* 

//PROG1 EXEC COBUCLG,PROD=MCE260 

//* 

//LKED.SYSIN DD * 

INCLUDE OBJECT(MCE260CN,MCE260ED,MCE260RT) 

INCLUDE OBJECT(MCE260PA,MCE260VS,MCE260DT) 

ENTRY COBTEST 

NAME COBTEST 

/* 

Figure 3–7. Sample JCL to execute the COBOL test program 

If the test is successful, all return results should match the expected 

results on the test database input, and the report 




output should match the printout shown in figure 3–8. There should 

be 576 records processed. The test should take less than 5 CPU 

seconds. 

Note that the DISCHARGE DATE output field displays in the same 

format as the date is entered (yyyymmdd). 

MEDICARE CODE EDITOR - V26.0 mm/dd/yyyy PAGE 1 

LAST RECORD 

PROVIDER: 000000000000576 (PPS) 

AGE: 43 

SEX: 1 MALE 

DISCHARGE STATUS: 01 HOME 

DISCHARGE DATE: 20091001 

ADMITTING DIAGNOSIS 

V579 REHABILITATION PROC NOS 0 

PRINCIPAL DIAGNOSIS 

V579 REHABILITATION PROC NOS 00000000001000 

NO SECONDARY DIAGNOSES 

NO PROCEDURES 

Figure 3–8. COBOL test program output 

October 2009 





Chapter 4 

4Running the program


Contents Running the program 4.3 

Calling the editor 4.3 

JCL for executing the program 4.4 

Using the alternate interface 4.7 


October 2009


Chapter 4 

Running the program 

TO EXECUTE THE Medicare Code Editor (MCE) program, you 

must write an interface program that will perform the following 

functions: 

◆ Read the input file records. 

◆ Construct the MCE control block (see chapter 5). 

◆ 

◆ 

◆ 

◆ 

Move diagnoses and procedures into contiguous locations if they 

were not recorded that way on input. 

Recode the discharge status if the coding scheme is not UB-04 

standard. 

Call the MCE program, and optionally, one of the report 

programs. 

Write output records, if applicable. 

Note that the MCE system assumes that provider number, PPS indicator, 

age, sex, discharge status, date, diagnoses and procedures are 

all EBCDIC (character) data. 

Calling the editor 

Once the interface program is done and specifies the pointers in the 

control block where the input data is located, the MCE program is 

invoked by calling the controller program MCE260CN that determines 

the MCE version to be called based on the date of discharge. 

October 2009 

Running the program 4.3


MCE260CN then calls the appropriate MCE version and returns control 

to your interface program. If a date is not valid, or is not within 

the range of the MCE versions (15.0 through 26.0), an error message 

is displayed and the claim stops processing. 

The process is then repeated for each record to be edited. At the call 

to the control program, general purpose Register 1 must be set to 

point to the control block. The control block is discussed in chapter 5. 

JCL for executing the program 

By implementing the CALL...USING statement, COBOL programmers 

will have Register 1 set by the CALL statement. 

Figure 4–1 is an example of compile-link-go JCL to edit only. 

For an example of JCL to edit and call the report program, refer to 

figure 4–2. 

If you have not installed the ICD-9-CM description file, exclude the 

marked (†) line from the JCL in figure 4–2. 




//* ****************************************************** 



//* 


//* ****************************************************** 

















//* 





// SPACE=(CYL,(5,1,5)) 






//* 







// PEND 

//* 


//* 



ENTRY COBTEST 

NAME COBTEST 

/* 

Figure 4–1. Sample JCL for edit-only procedure 

October 2009 




//* ****************************************************** 



//* 


//* ****************************************************** 

















//* 





// SPACE=(CYL,(5,1,5)) 






//* 






//MCE260I9 DD DSN=YOURID.&PROD..VSFILE,DISP=SHR † 


// PEND 

//* 


//* 




ENTRY COBTEST 

NAME COBTEST 

/* 

Figure 4–2. Sample JCL for edit-print procedure 



Using the alternate interface 

The alternate editor control program, (MCE260CA) operates the 

same as the standard editor control program (MCE260CN) except 

that it does not contain any macros and is written to be re-entrant, so 

it should run in a wider variety of mainframe environments. Whereas 

the standard interface uses GETMAINS to obtain a 16,384 byte work 

area, the alternate interface requires that the calling program provide 

the work area. It must do so by providing two additional addresses in 

the list pointed to by general register 1 (see table 5–1.) 

Table 4–1 gives the additional work area parameters required by the 

alternate interface. 

Table 4–1. Work area parameters 

Element 

number 

Editor 

pointers 

Full word pointer to... 

16 WORKAREA A buffer of at least 20,000 bytes. 

17 WORKSIZE 4-byte binary (PIC 9(8) comp) field 

containing the actual length in bytes of the 

work area. The value of this field should not 

be less than 20,000 bytes, though larger 

values are acceptable. 

To use the alternate interface, substitute MCE260CA for MCE260CN 

and provide these two extra parameters. See the COBOL program 

ALTTEST, provided in the source library, for an example of how to 

set up a work area and pass it to MCE260CA. 

Assembler programmers should note that the length of the work area 

is not given in the full word at element number 17 but rather a 

pointer to the full word containing the length is given at element 

number 17. 

Sample JCL for running ALTTEST may be created by modifying the 

JCL shown in figure 4–1 or 4–2. To modify the JCL, change all 

occurrences of COBTEST to ALTTEST and change MCE260CN to 

MCE260CA. 

October 2009 





Chapter 5 

5The control block


Contents The control block 5.3 

DXPTR 5.4 

NDXPTR 5.4 

SGPTR 5.5 

NSGPTR 5.5 

AGEPTR 5.5 

SEXPTR 5.5 

DSTATPTR 5.5 

PROVPTR 5.6 

PPSPTR 5.6 

DATEPTR 5.6 

VPTR 5.7 

ADXFLGPTR 5.7 

DXFLGPTR 5.7 

PRFLGPTR 5.8 

BUFFPTR 5.9 

Flag values 5.11 

DSCPTR 5.11 

OPTPTR 5.11 


October 2009


Chapter 5 

The control block 

THE CONTROL BLOCK IS a block of fullwords which serves as 

the main reference point for each of the programs in the Medicare 

Code Editor (MCE) system. Each program uses the control block to 

locate required input data and to establish the locations of return 

information. 

Table 5–1 lists the control block and elements required for each system 

component. The first 15 elements are the same for both the editor 

and the print programs. The pointers from element number 16 on 

have different meanings depending on which component is being 

called. 

Table 5–1. Control block and elements of MCE system 

Element Number Editor pointers Print program pointers 

1 DXPTR DXPTR 

2 NDXPTR NDXPTR 

3 PRPTR PRPTR 

4 NPRPTR NPRPTR 

5 AGEPTR AGEPTR 

6 SEXPTR SEXPTR 

7 DSTATPTR DSTATPTR 

8 PROVPTR PROVPTR 

9 PPSPTR PPSPTR 

October 2009 

The control block 5.3


Table 5–1. Control block and elements of MCE system (continued) 

Element Number Editor pointers Print program pointers 

10 DATEPTR DATEPTR 

11 VPTR VPTR 

12 ADXFLGPTR ADXFLGPTR 

13 DXFLGPTR DXFLGPTR 

14 PRFLGPTR PRFLGPTR 

15 BUFFPTR BUFFPTR 

16 DSCPTR 

17 OPTPTR1 

18 OPTPTR2 

19 OPTPTR3 

20 OPTPTR4 

21 OPTPTR5 

22 OPTPTR6 

23 OPTPTR7 

24 OPTPTR8 

25 OPTPTR9 

26 OPTPTR10 

27 OPTPTR11 

The following pages explain the pointers listed in table 5–1. Bit values, 

where documented, are numbered in a left-to-right order, with bit 

0 being the left-most bit. 

DXPTR 

Address of the area containing contiguous ICD-9-CM diagnosis 

codes. Each diagnosis must be left justified and blank filled in an 

8-byte field. The eighth byte represents the POA indicator. The first 

of these codes is presumed to be the admitting diagnosis and the second 

is presumed to be the principal diagnosis. These codes must be 

present. 

NDXPTR 

Address of a fullword containing the count of diagnoses entered into 

the area pointed to by DXPTR. Do not count blank space after the 

last filled diagnosis. The actual number of valid diagnoses must be 

entered. The editor only uses diagnoses up to the first blank field it 

finds and will reduce the number you give it accordingly. The number 

must be a binary (PIC 9(8) COMP) fullword. This must be a 

value of at least 2 (admit diagnosis and principal diagnosis), as at 

least two diagnoses must be present. The maximum number of codes 



allowed is 26. If greater than 26, the software uses only the first 26 

fields in the buffer and ignores the rest. 

SGPTR 

Address of the area containing contiguous ICD-9-CM procedure 

codes. Each code must be seven bytes. Procedures are handled in the 

same manner as diagnoses by the system. 

NSGPTR 

Address of a fullword containing the number of procedure codes. 

This is the maximum number that the area pointed to by SGPTR can 

hold. The number must be a binary (PIC 9(8) COMP) fullword. The 

maximum number of codes allowed is 25. 

AGEPTR 

Address of a 3-byte variable containing the numeric age in years. The 

variable must be right-adjusted, with either zero or blank filling 

allowed. Values in the range 0-124 are valid. 

SEXPTR 

Address of a 1-byte variable containing the numeric sex. The variable 

must contain the value 1 for males, 2 for females or 0 for unknown. 

DSTATPTR 

Address of a 2-byte variable containing the numeric discharge status 

code, which must be coded according to the UB-04 code scheme. If 

discharge status is not available, DSTATPTR should point to a constant 

with a value of 00. Table 5–2 lists the valid UB-04 discharge 

status codes in the software. 

Table 5–2. UB-04 discharge status codes 


Description 

00 Unknown 

01 Home, self care (routine) 

02 Short term hospital 

03 SNF 

04 ICF 

05 Other facility (valid until 03/31/08) 

Canc/child hosp (effective 04/01/08) 

06 Home health service 

07 Left against medical advice 

08 Home IV service (deleted 10/01/05) 

20 Died 

21 Court/law enfrc (added 10/01/09) 

October 2009 



Table 5–2. UB-04 discharge status codes (continued) 


Description 

30 Still a patient 

43 Fed hospital (added 10/01/03) 

50 Hospice - home 

51 Hospice - medical facility 

61 Swing bed (added 10/01/01) 

62 Rehab fac/unit (added 10/01/01) 

63 LTC hospital (added 10/01/01) 

64 Nursing facility-Medicaid certified (added 10/01/02) 

65 Psych hosp/unit (added 10/01/03) 

66 Critical access hospital (added 10/01/05) 

70 Oth institution (effective 04/01/08) 

71 OP services-other facility (10/01/01–09/30/03 only) 

72 OP services-this facility (10/01/01–09/30/03 only) 

PROVPTR 

Address of an area containing the 15-byte Medicare provider number. 

This information is required for the summary record. Refer to BUFF- 

PTR above for a detailed explanation. 

PPSPTR 

Address of a 1-byte numeric variable which must be set to one of the 

values shown in table 5–3. This information is required for the summary 

record. Refer to BUFFPTR above for details. 

Table 5–3. PPS values 

Value 

Description 

0 PPS status unknown 

1 PPS provider 

2 Non-PPS provider 

DATEPTR 

Address of the calendar discharge date (yyyymmdd) which is used 

for determining which MCE version to call. Each of the three components 

of the date must be numeric and left zero filled. There are no 

separators. If this date is not valid, the claim stops processing, and 

the edit flag (see BUFFPTR) will be set to 4. Since the date edit is not 

a part of the “official” MCE edits, there is no accumulator provided. 

The flag is included for your convenience only. 



VPTR 

Address of a 3-byte area (Pic 9(3)) where the version identification 

number is placed by the program. This area contains the number of 

the MCE version that was run. Selection of an MCE version is determined 

by the date passed in DATEPTR. Table 5–4 lists the versions 

and date ranges. 

Table 5–4. Versions 

MCE version 

Date range 

16.0 10/01/1999 – 09/30/2000 

17.0 10/01/2000 – 09/30/2001 

18.0 10/01/2001 – 09/30/2002 

19.0 10/01/2002 – 09/30/2003 

20.0 10/01/2003 – 09/30/2004 

21.0 10/01/2004 – 09/30/2005 

22.0 10/01/2005 – 09/30/2006 

23.0 10/01/2006 – 09/30/2007 

24.0 10/01/2007 – 03/31/2008 

24.1 04/01/2008 – 09/30/2008 

25.0 10/01/2008 – 09/30/2009 

26.0 10/01/2009 – 09/30/2010 

ADXFLGPTR 

Address of a 1-byte variable containing the admitting diagnosis edit. 

The variable will contain the value 0 if the admitting diagnosis is 

valid or 1 if the admitting diagnosis is invalid. 

DXFLGPTR 

Address of a 350-byte field containing the diagnosis code edits starting 

with the principal diagnosis. 14 bytes for each of 25 diagnosis 

codes. The variable will contain the value 0 if the edit was not applicable 

or 1 if the edit was applicable. Table 5–5 provides a description 

for each of the 14 edit bytes. 

October 2009 



Table 5–5. MCE diagnosis code edits 

Byte 

MCE diagnosis edit 

1 Invalid diagnosis code 

2 Sex conflict 

3 Age conflict 

4 Questionable admission 

5 Manifestation code as principal diagnosis 

6 Nonspecific principal diagnosis 

7 E-code as principal diagnosis 

8 Unacceptable principal diagnosis 

9 Duplicate of principal diagnosis 

10 Medicare is secondary payer 

11 Requires secondary diagnosis 

12 Type of age conflict: 

0 = No age conflict 

1 = Newborn 

2 = Pediatric 

3 = Maternity 

4 = Adult 

13 POA indicator invalid or missing (for future use) 

14 Wrong procedure performed 

PRFLGPTR Address of a 400-byte field containing the procedure code edits. 16 

bytes for each of 25 procedure codes. The variable will contain the 

value 0 if the edit was not applicable or 1 if the edit was applicable. 

Table 5–6 provides a description for each of the 16 edit bytes. 

Table 5–6. MCE procedure code edits 

Byte 

MCE procedure edit 

1 Invalid procedure code 

2 Sex conflict 

3 Nonspecific O.R. procedure 

4 Open biopsy check 

5 Non-covered procedure 

6 Bilateral procedure 

7 Limited coverage – Lung volume reduction surgery (LVRS) 

8 Limited coverage – Lung transplant 



Table 5–6. MCE procedure code edits 

Byte 

MCE procedure edit 

9 Limited coverage – Combination heart/lung transplant 

10 Limited coverage – Heart transplant 

11 Limited coverage – Implant of heart assist system 

12 Limited coverage – Intestine/multi-visceral transplant 

13 Limited coverage – Liver transplant 

14 Limited coverage – Kidney transplant 

15 Limited coverage – Pancreas transplant 

16 Limited coverage – Artificial heart transplant 

BUFFPTR 

Address of a 138-byte buffer (MCEBUFF) that must be allocated by 

your interface program. The software will produce a summary of 

errors for each record and will put the summarized information in 

this buffer, along with the provider number, PPS indicator, and edit 

flag. Table 5–7 is a description of the buffer. 

The accumulators at positions 17 through 62, and 69 through 76, contain 

the counts of the number of occurrences of each of the error 

conditions related to diagnoses and/or procedures. Those for which 

the count cannot exceed 1 are designated with an asterisk (*). 

Table 5–7. Buffer description 

Byte Datatype Description 

1 pic 9(15). Medicare provider number 

16 pic 9. PPS indicator 

17 pic 99. Invalid ICD-9-CM code 

19 pic 99. Sex conflict 

21 pic 99. Age conflict 

23 pic 99. * Questionable admission 

25 pic 99. * Manifestation as principal dx 

27 pic 99. * Non-specific principal dx (versions 2.0-23.0 only) 

29 pic 99. * E-code as principal dx 

31 pic 99. * Unacceptable principal dx 

33 pic 99. Duplicate of principal dx 

35 pic 99. MSP alert (versions 15.0–17.0 only) 

37 pic 99. Principal dx requires secondary dx 

39 pic 99. Non-specific procedure (versions 15.0-23.0 only) 

October 2009 



Table 5–7. Buffer description (continued) (continued) 

Byte Datatype Description 

41 pic 99. Open biopsy check 

43 pic 99. Non-covered procedure 

45 pic 99. *Bilateral procedure 

47 pic 99. LVRS - Limited coverage 

49 pic 99. Lung transplant - Limited coverage 

51 pic 99. Combo heart/lung transpl - Limited coverage 

53 pic 99. Heart transplant - Limited coverage 

55 pic 99. Implantable hrt assist - Limited coverage 

57 pic 99. Intest/M. visceral transpl - Limited coverage 

59 pic 99. Liver transplant - Limited coverage 

61 pic 99. * Invalid admit dx 

63 pic 99. * Invalid age (not between 0 and 124 years) 

65 pic 99. * Invalid sex (not 1 or 2) 

67 pic 99. * Invalid or missing discharge status code (not 

01-08, 20, 30, 43, 50, 51, 61–66) 

Note: Some discharge status codes are not valid for 

all date ranges. See table 5–2 on page 5.5. 

69 pic 99. Kidney transplant - Limited coverage 

71 pic 99. Pancreas transplant - Limited coverage 

73 pic 99. POA indicators invalid or missing (for future use) 

75 pic 99. Artificial heart transplant - Limited coverage 

77 pic 99. Wrong procedure performed 

137 pic 99. MCE edit flag 

The accumulators at positions 45 and 63 through 68 will have a count 

of 1 if the error is present, and 0 otherwise. They are effectively the 

flag bytes for these errors. 



Flag values 

The MCE edit flag is set by the software to values shown in table 

5–8. 

Table 5–8. Edit flag values 

Value 

Description 

0 No errors 

1 Pre-payment error 

Non-covered procedure 

Questionable admission 

Age conflict 

Sex conflict 

Invalid ICD-9-CM code 

E-code as principal diagnosis 

Manifestation as principal diagnosis 

Unacceptable principal diagnosis 

Invalid age, sex or discharge status 

Duplicate of PDX, 

Requires secondary dx 

Limited coverage 

Wrong procedure performed 

2 Post-payment error 

Non-specific diagnosis 

Non-specific procedure 

Bilateral procedure 

Biopsy check 

MSP alert (versions 2.0–17.0 only) 

3 Both pre-payment and post-payment errors 

4 Discharge date invalid or missing 

50 MCE table (MCE260RT) could not be opened or is 

corrupted 

EDflag is not set for admitting diagnosis. 

DSCPTR 

Used with the report programs. This is the address of a binary 

(PIC 9(8) COMP) fullword indicating whether the ICD-9-CM 

English description file will be accessed. A value of 0 (zero) indicates 

that no English descriptions are wanted, while a value of 1 

indicates that descriptions will be printed. If descriptions are 

bypassed, their area in the print line is blanked out. No change in 

print format occurs. 

OPTPTR 

Used with the report programs. Up to 11 OPTPTRs may be present, 

with each one pointing to a 40-byte user-allocated area containing 

additional patient information (patient I.D., length of stay, etc.) that is 

October 2009 



to be included as a line of output on the report. The report program 

will print the entire 40 bytes “as is” for each option line present. 

These lines will be printed immediately below the title line and 

before the standard information (provider number, PPS status, age, 

sex, discharge status, date, diagnosis and procedures) is reported. 

For MCE260PB and MCE260PC, at least two OPTPTRs must be 

present, and they must be the 17th and 18th pointers in the control 

block. The first OPTPTR (#17) must be the address of an area allocated 

to hold report lines. The second OPTPTR (#18) must be the 

address of a fullword into which the report programs (MCE260PB or 

MCE260PC) will place a binary (PIC 9(8) COMP) count of the 

actual number of report lines used. The remaining OPTPTRs can be 

used as described above. See 

chapter 6 for a full explanation of the report programs. 

It is the user’s responsibility to set a flag in the last pointer to indicate 

the end of the pointer list. To set the end-of-list flag the high-order bit 

of the last pointer must be turned on. For COBOL programmers, the 

CALL... USING statement automatically sets the end-of-list 

indicator. 



Chapter 6 

6The report programs


Contents The report programs 6.3 

MCE260PA 6.3 

MCE260PB 6.3 

MCE260PC 6.4 

Uses for the report programs 6.5 

MCE260PA 6.5 

MCE260PB 6.5 

MCE260PC 6.5 


October 2009


Chapter 6 

The report programs 

THREE REPORT PROGRAMS ARE INCLUDED in the Medicare 

Code Editor (MCE) program. All versions of the software are compatible 

with the report programs discussed below. 

MCE260PA 

This standard report program (format A) prints each patient record on 

a separate page. MCE260PA output is written to a file with the DD 

name RPTFILE which can be allocated to the printer, a disk, or tape 

file. RPTFILE is opened on the initial call to MCE260PA. In order to 

close RPTFILE, MCE260PA must be called with Register 1 set to a 

value of zero (for COBOL, a CALL MCE260PA with no parameters 

will have this effect). If you are blocking RPTFILE records, closing 

the file is essential, or the last block of output may be lost. 

MCE260PB 

This report program (format B) is the same as above, except instead 

of printing, a mirror of the report page is returned with a count of 

lines. The first position of each line is the carriage control character, 

having one of the values shown in table 6–1. 

Table 6–1. Carriage control character values 

Value 

Explanation 

1 Skip to new page before printing line 

0 Space two lines before printing current line 

Blank 

Normal print spacing 

October 2009 

The report programs 6.3


MCE260PC 

This report program (format C) returns a series of taglines, one 

tagline for each diagnosis and procedure on the patient record. The 

tagline will include any error messages. Each line follows a coded 

tag which explains the tagline. The tag numbers are 4-byte numerics. 

There will be two or more lines with the same tag number if more 

than one error is found for the same diagnosis or procedure. Taglines 

are explained in table 6–2. 

Table 6–2. MCE260PC tagline format 

Tag number 

Tagline 

0101-0116 Diagnosis line, with 101 as the admitting diagnosis, 

102 as the principal diagnosis, 103 as the first 

secondary diagnosis, etc. 

0201-0215 Procedure line, with 201 as the first listed procedure, 

202 the second, etc. 

0301 Line indicating invalid discharge disposition 

0401 Line indicating invalid age 

0501 Line indicating invalid sex 

Table 6–3 is an example of the taglines that might be returned by 

MCE260PC. 

Table 6–3. MCE260PC tagline example 

Positions 1-4 Positions 5-84 

0101 V1087 Hx of thyroid malignancy 

0102 V1087 Hx of thyroid malignancy 

Unacceptable principal diagnosis 

0103 462 Acute pharyngitis 

0201 064 Complete thyroidectomy 

0202 403 Regional lymph node exc 

0301 Invalid discharge disposition 



Uses for the report programs 

The MCE user may utilize the report programs in a variety of ways. 

Some uses are suggested below. In each example, your interface program 

would do the flag testing and decide whether or not to call one 

of the print programs. 

Remember that for MCE260PB and MCE260PC, the first two OPTP- 

TRs are used for passing and receiving line information. Refer to 

chapter 5 for an explanation of the OPTPTRs. 

To run the report programs, Register 1 must again be pointing to the 

control block. 

MCE260PA MCE260PA could be called each time the edit flag (position 137-138 

in the MCEBUFF) was returned with a value greater than zero 

(remember that invalid admitting diagnosis does not set this flag). 

This would generate a one-page report for the patient record on 

which errors were detected. 

Alternatively, MCE260PA could be called for each record, whether 

or not any flags were set, which could produce a large volume of 

print output. 

MCE260PA output could be written to a tape or disk file for later 

printing. 

MCE260PB 

MCE260PB could be called if you wanted to have all of the basic 

information in the standard report, but wanted to insert lines or edit 

the report before printing. Your interface program must allocate sufficient 

space for holding a full report. It must also control all I/O to the 

printer, as MCE260PB does not actually generate any printing. 

The allocated area can be calculated by multiplying the expected 

maximum number of lines by 81 (the maximum number of characters 

per line). 

MCE260PC 

MCE260PC could be called if you wanted the editor information for 

each diagnosis and procedure, but wanted to integrate it with other 

information tailored to your own reporting requirements. 

Your interface program must allocate space. In this instance, the 

space requirement would be: 

(maximum diagnosis (NDXPTR value) + maximum procedures (NSGPTR value) +3) x 84. 

October 2009 




If English descriptions are bypassed, the above statement is excluded. 

For more information, see DSCPTR in chapter 5. 

Figure 6–1 illustrates a compile-link-go including the standard report 

program (MCE260PA). If English descriptions are bypassed, the line 

marked with the dagger (†) is excluded. 


October 2009




//* ****************************************************** 



//* 


//* ****************************************************** 

















//* 





// SPACE=(CYL,(5,1,5)) 






//* 






//MCE260I9 DD DSN=YOURID.&PROD..VSFILE,DISP=SHR † 


// PEND 

//* 


//* 




ENTRY COBTEST 

NAME COBTEST 

/* 

Figure 6–1. Example of print JCL using a COBOL interface program 

October 2009 





Appendix A 

AMCE software edits


Contents MCE software edits A.3 

1. Invalid diagnosis or procedure code A.4 

2. E-code as principal diagnosis A.4 

3. Duplicate of PDX A.4 

4. Age conflict A.4 

5. Sex conflict A.4 

6. Manifestation code as principal diagnosis A.5 

7. Non-specific principal diagnosis A.5 

8. Questionable admission A.5 

9. Unacceptable principal diagnosis A.5 

10. Non-specific O.R. procedure A.5 

11. Non-covered procedure A.5 

12. Open biopsy check A.6 

13. Bilateral procedure A.6 

14. Invalid age A.6 

15. Invalid sex A.6 

16. Invalid discharge status A.6 

17. Limited coverage A.6 

18. Wrong procedure performed A.6 

A.2 Medicare Code Editor Software 

October 2009


Appendix A 

MCE software edits 

THE EDITS CONTAINED in the current Medicare Code Editor 

(MCE) software are listed here with their descriptions. These edits 

are the official MCE edits specified by the Centers for Medicare and 

Medicaid Services (CMS). 

Below is a list of edit messages described in this appendix: 

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 

13. Bilateral procedure 

14. Invalid age 

15. Invalid sex 

16. Invalid discharge status 

17. Limited coverage 

18. Wrong procedure performed 

October 2009 

MCE software edits A.3


➤ 

➤ 

Note: Effective 10/01/01, the MSP (Medicare as secondary payer) 

alert edit was discontinued and will appear for claims processed 

using MCE versions 2.0–17.0 only. 

Note: Effective 10/01/07, the non-specific principal diagnosis 

edits and non-specific O.R. procedure edits were discontinued 

and will appear for claims processed using MCE version 2.0-23.0 

only. 

1. Invalid diagnosis or 

procedure code 

➤ 

MCE software checks each diagnosis code, including the admitting 

diagnosis, and each procedure code against a table of valid 

ICD-9-CM codes. If an entered code does not agree with any code on 

the internal list, the entered code is considered invalid or as having an 

invalid or missing 4th, 5th, or 6th digit. 

Note: Effective 10/01/1994, the Invalid 4th or 5th digit edit was 

discontinued and the Invalid diagnosis or procedure code edit 

displayed in its place. 

2. E-code as principal 

diagnosis 

E-codes describe the circumstance(s) that caused an injury, not the 

nature of the injury (e.g., fall from bed), and therefore should not be 

used as a principal diagnosis. E-codes are all ICD-9-CM diagnosis 

codes that begin with the letter E. 

3. Duplicate of PDX Whenever a secondary diagnosis is coded the same as the principal 

diagnosis, the secondary diagnosis is identified by MCE software as 

a duplicate of the principal diagnosis. This is because the diagnosis 

code may be considered a complication or comorbidity (CC) and will 

create an error in DRG assignment if the DRG is affected by the presence 

of a CC. 

4. Age conflict MCE software detects inconsistencies between a patient’s age and 

any diagnosis on the patient’s record. Examples of age conflicts are a 

five-year-old patient with benign prostatic hypertrophy, and a 78 

year-old patient with a delivery. In such cases, either the diagnosis or 

age is presumed to be incorrect. There are four age code categories: 

newborn (less than one year), pediatric (0–17 years inclusive), maternity 

(12–55 years inclusive), and adult (15–124 years inclusive). 

5. Sex conflict MCE software detects inconsistencies between a patient’s sex and 

any diagnosis or procedure on the patient’s record. Examples of sex 

conflicts are a male patient with cervical cancer (diagnosis) and a 

male patient with a hysterectomy (procedure). In such cases, either 

the diagnosis, procedure, or sex is presumed to be incorrect. 

A.4 Medicare Code Editor Software October 2009


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. 

7. Non-specific principal 

diagnosis 

Discontinued as of 10/01/07. 

A set of diagnosis codes, particularly those described as “not otherwise 

specified” (NOS), are identified by the software as non-specific. 

While these codes are valid ICD-9-CM codes, more precise codes 

should be used for the principal diagnosis. It should be noted that a 

diagnosis is considered non-specific only if the patient was discharged 

alive; patients who have died often do not receive a complete 

diagnostic workup, and specification of a precise principal diagnosis 

may not be possible.Non-specific principal diagnosis. 

8. Questionable admission There are some diagnoses which are not usually sufficient justification 

for admission to an acute care hospital (e.g., benign 

hypertension). In these cases, the diagnosis code is flagged. 

9. Unacceptable principal 

diagnosis 

There are selected codes that describe a circumstance which influences 

an individual’s health status but is not a current illness or injury 

(e.g., family history of ischemic heart disease) or codes that are not 

specific manifestations but may be due to an underlying cause. Such 

codes are considered unacceptable as a principal diagnosis. In a few 

cases, some unacceptable codes will be acceptable as principal diagnosis 

if any secondary diagnosis is coded; for these codes, the 

software displays a “Requires secondary dx” message next to the 

code in place of the “Unacceptable principal diagnosis” edit. 

10. Non-specific O.R. 

procedure 

Discontinued as of 10/01/07. 

A set of O.R. procedure codes, particularly those described as “not 

otherwise specified” (NOS), are identified by the software as 

non-specific. While these codes are valid ICD-9-CM codes, more 

precise codes should be used. It should be noted that the non-specific 

O.R. procedure condition is reported only if all the O.R. procedures 

performed have been coded as non-specific; if a patient had several 

O.R. procedures and only one was non-specific, the edit would not be 

generated. 

11. Non-covered procedure Medicare does not provide reimbursement for some procedures and 

their codes are flagged by the software. Some non-covered procedures 

are covered under certain circumstances with particular 

principal or secondary diagnoses, as specified by CMS. 

October 2009 

MCE software edits A.5


12. Open biopsy check Biopsies can be performed as open (i.e., a body cavity entered surgically), 

percutaneous, or endoscopic procedures. Patients are assigned 

to different DRGs depending on whether or not the biopsy was open. 

ICD-9-CM codes are explicit for open and non-open biopsies; however, 

the distinction made by the codes is not applied uniformly. 

MCE software identifies all biopsies that are coded as open biopsies, 

and suggests the corresponding non-open biopsy code to use, if 

applicable. 

13. Bilateral procedure Certain codes do not accurately reflect procedures that are performed 

in one admission on two or more different bilateral joints of 

the lower extremities. A combination of these codes shows a bilateral 

procedure when, in fact, they could be procedures performed on a 

single joint (i.e., duplicate procedures). When two or more different 

joint replacement procedures are coded, this edit instructs the fiscal 

intermediary to make sure that these procedures were performed on 

two separate joints. 

14. Invalid age A patient’s age is usually needed for correct DRG grouping. If the 

age reported is outside the valid range (0–124 years), the software 

assumes the age is in error. 

15. Invalid sex A patient’s sex is sometimes needed for correct DRG grouping. The 

sex code reported must be either 1 (male) or 2 (female). If the entry is 

not either of these values, the software flags the record. 

16. Invalid discharge status A patient’s discharge status is sometimes needed for correct DRG 

grouping. Discharge status must be coded according to the UB–04 

conventions. Note that when an invalid discharge status is reported, 

the patient is presumed to have been discharged alive for the purpose 

of performing the non-specific principal diagnosis check. 

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 edit applies to such procedures 

as lung volume reduction surgery (LVRS), an implantable heart assist 

system, and major organ transplants. 

18. Wrong procedure 

performed 

Certain E-codes indicate that the wrong procedure was 

performed. 

A.6 Medicare Code Editor Software October 2009


Appendix B 

BSummary of changes


Contents Summary of changes B.3 

Software B.3 

Tables B.3 

Documentation B.4 

B.2 Medicare Code Editor Software 

October 2009


Appendix B 

Summary of changes 

MODIFICATIONS MADE to the Medicare Code Editor (MCE) 

software and effective in the current release are summarized below. 

Software ◆ Basic changes to accommodate table and date range 

modifications. 

◆ New version 26.0 with an effective date range of 

10/01/2009–09/30/2010. 

Tables 

The tables have been updated with information for MCE 

software versions 2.0 through 26.0. 

October 2009 

Summary of changes B.3


Documentation 

The following code lists for edits were updated. For more 

information, refer to chapter 2 of the Definitions of Medicare Code 

Edits guide. 

◆ Diagnoses for Newborns 

◆ Diagnoses for Pediatrics - (age 0-17) 

◆ Diagnoses for Maternity -age 12-55 years old 

◆ Diagnoses for Females Only 

◆ Diagnoses for Males Only 

◆ Procedures Allowed for Females Only 

◆ Manifestations Not Allowed as Principal Diagnoses 

◆ Unacceptable Principal Diagnoses 

◆ E-Code as Principal Diagnosis 

◆ Bilateral Procedure 

The following new edit was added. For more information, refer to 

chapter 2 of the Definitions of Medicare Code Edits guide. 

◆ Wrong Procedure Performed 

B.4 Medicare Code Editor Software October 2009


Index 

A 

Admit diagnosis (ADXFLGPTR), 5.7 

Admitting diagnosis code, 2.5 

ADXFLGPTR (admit diagnosis), 5.7 

Age conflict, A.4 

Age data type, 4.3 

Age in years (AGEPTR), 5.5 

AGEPTR (age in years), 5.5 

Alternate interface, 4.7 

ALTTEST, 3.6 

B 

Bilateral procedure, A.6 

Buffer (BUFFPTR), 5.9 

Buffer description, 5.9 

BUFFPTR (buffer), 5.9 

C 

Calling the editor, 4.3 

Carriage control character, 6.3 

CBTSTJCL (run sample COBOL program), 3.6 

Changes, summary of, B.3 

Clinical edits, 1.4 

COBOL program, 3.6 

COBOL test program, 3.17 

output, 3.19 

COBOLPRT (run sample COBOL program and print output), 

3.6 

COBTEST, 3.6 

Code edits, 1.3 

Coding errors, 1.4 

Copying 

object library, 3.7 

sample JCL to disk, 3.6 

source library, 3.11 

test database, 3.8 

Coverage edits, 1.3 

D 

Data elements of the output report, 2.4 

Date data type, 4.3 

Date format, 5.6 

Date of report, 2.4 

Date ranges for all versions, 1.4 

DATEPTR (discharge date), 5.6 

DBLOAD (load test database), 3.6 

Description file 

layout, 3.9 

loading, 3.9 

Diagnoses data type, 4.3 

Diagnosis 

moving, 4.3 

tagline, 6.4 

Diagnosis code description, 2.5 

Diagnosis code edit (DXFLGPTR), 5.7 

Diagnosis codes (DXPTR), 5.4 

October 2009 

Index I.1


Diagnosis table, 3.12 

Discharge date 

and version used, 1.4 

format, 2.5 

Discharge date (DATEPTR), 5.6 

Discharge date ranges, 1.4 

Discharge dispositions, 2.5 

Discharge status, 4.3 

valid codes, 5.5 

Discharge status code (DSTATPTR), 5.5 

Discharge status data type, 4.3 

Discontinued edit 

invalid 4th or 5th digit, A.4 

Discontinued edits 

MSP alert, A.4 

Documentation 

changes in this release, B.4 

Downloading the program files, 3.5 

DRG versions in software, 1.4 

DRGs, how determined, 1.3 

DSCPTR (report descriptions), 5.11 

DSTATPTR (discharge status code), 5.5 

Duplicate of PDX, A.4 

DXFLGPTR (diagnosis code edit), 5.7 

DXPTR (diagnosis codes), 5.4 

E 

EBCDIC data format, 4.3 

EBCDIC Procedure table, 3.12, 3.14 

EBCDIC tables, load, 3.6 

EBCLOAD, 3.6 

EBCLOAD (load test database), 3.6 

E-code as principal diagnosis, A.4 

Edit 

age conflict, A.4 

bilateral procedure, A.6 

duplicate of PDX, A.4 

E-code as principal diagnosis, A.4 

invalid 4th or 5th digit, A.4 

invalid age, A.6 

invalid diagnosis or procedure code, A.4 

invalid discharge status, A.6 

invalid sex, A.6 

limited coverage, A.6 

manifestation code as principal diagnosis, A.5 

non-covered procedure, A.5 

non-specific principal diagnosis, A.5 

open biopsy check, A.6 

questionable admission, A.5 

sex conflict, A.4 

unacceptable principal diagnosis, A.5 

Edit changes in this release, B.3 

Edit flag values, 5.11 

Edit messages 


Edits 

clinical, 1.4 

codes, 1.3 

coverage, 1.3 

discontinued, A.4 

types of, 1.3 

Elements of the output report, 2.4 

English description 

diagnosis code, 2.5 

procedure code, 2.5 

English description file, 3.9 

English description file (file 4), 3.9 

English description files, 3.3 

Error messages, tagline, 6.4 

Example 

compile-link-go, 6.7 

output report, 2.4 

print JCL with a COBOL interface, 6.7 

F 

File 1, JCL library, 3.6 

File 2, library of object programs, 3.7 

File 3, installation test database, 3.8 

File 4, description file, 3.9 

File 4, English description file, 3.9 

File 5, library of source programs and tables, 3.11 

Files 

description, 3.3 

on installation media, 3.4 

Fiscal intermediary, 1.3 

Flag values 

edit, 5.11 

Format 

for entering dates, 5.6 

of test database, 3.8 

Format A report program, 6.3 

Format B report program, 6.3 

Format C report program, 6.4 

Format of date entry, 2.5 

H 

Hospital type, 2.4 

How to determine MCE version for claim processing, 2.5 

I 

ICD-9-CM codes, 1.3, 2.5 

ICD-9-CM description file, 3.6, 3.17, 4.4 

I.2 Medicare Code Editor Software 

October 2009


Input file records, 4.3 

Installation media, 3.3 

Installation of English description file, 3.9 

Installing the software, 3.3 

Interface 

alternate, 4.7 

Interface program 

requirements, 4.3 

Invalid 4th or 5th digit, A.4 

Invalid age, A.6 

Invalid diagnosis or procedure code, A.4 

Invalid discharge status, A.6 

Invalid sex, A.6 

Invoking the program, 4.3 

J 

JCL library (file 1), 3.6 

JCL using a COBOL interface program, 6.7 

L 

Layout of description file, 3.9 

Library 

object programs (file 2), 3.7 

source programs and tables (file 5), 3.11 

Limited coverage, A.6 

List of MCE edits, A.3 

Load 

ICD-9-CM description files (VSAMLOAD), 3.6 

object library (OBJLOAD), 3.6 

source library (SRCLOAD), 3.6 

test database (DBLOAD), 3.6 

test database (EBCLOAD), 3.6 

M 

Manifestation code as principal diagnosis, A.5 

MCE 

control block, 4.3, 5.3 

edit list, A.3 

files installed, 3.4 

characteristics, 3.5 

installation, 3.3 

report programs, 6.3 

MCE tables, 3.3 

MCE v24.1 EBCDIC tables, 3.12 

MCE versions 

list of, 1.4 

on output reports, 2.4 

MCExxxPA report program, 6.3 

MCExxxPB report program, 6.3 

MCExxxPC report program, 6.4 

tagline example, 6.4 

tagline format, 6.4 

Medicare patients, 1.3 

Medicare provider (PROVPTR), 5.6 


N 

NDXPTR (number of dx codes), 5.4 

Non-covered procedure, A.5 

Non-specific principal diagnosis, A.5 

NSGPTR (number of procedure codes), 5.5 

Number of dx codes (NDXPTR), 5.4 

Number of procedure codes (NSGPTR), 5.5 

O 

Object library, 3.6 

copying to disk, 3.7 

members, 3.7 

OBJLOAD (load object library), 3.6 

Open biopsy check, A.6 

Optional information 

patient, 2.4 

Optional information (OPTPTR), 5.11 

OPTPTR (optional information), 5.11 

Output 

COBOL test program, 3.19 

MCExxxPA report program, 6.3 

records, 4.3 

Output report, 2.3 

data elements, 2.4 

date generated, 2.4 

diagnosis codes, 2.5 

error message location, 2.3 

example, 2.4 

MCE version, 2.4 

optional information, 2.4 

patient information, 2.5 

procedure codes, 2.5 

provider number, 2.4 

title line, 2.4 

P 

Patient information, 2.5 

Patient record, printing, 6.3 

Physician number, 2.4 

PPS indicator data type, 4.3 

PPS status (PPSPTR), 5.6 

PPS values, 5.6 

October 2009 

Index I.3


PPSPTR (PPS status), 5.6 

PRFLGPTR (procedure code edit), 5.8 

Principal diagnosis code, 2.5 

Print programs, 3.3 

Printing 

patient record, 6.3 

Procedure 

moving, 4.3 

tagline, 6.4 

Procedure code, 2.5 

Procedure code description, 2.5 

Procedure code edit PRFLGPTR), 5.8 

Procedure codes (SGPTR), 5.5 

Procedure table, 3.14 

Procedures data type, 4.3 

Program edits, A.3 

Program tables, 3.3 

Prospective payment system, 1.3 

Provider number, 2.4 

Provider number data type, 4.3 

PROVPTR (Medicare provider), 5.6 

Purpose of the software, 1.4 

Q 

Questionable admission, A.5 

R 

Ranges for valid data entry, 1.4 

Report 

example, 2.4 

generated claim summary, 2.3 

Report descriptions (DSCPTR), 5.11 

Report programs, 6.3 

control block, 5.11 

format A, 6.3 

uses of, 6.5 

format B, 6.3 

uses of, 6.5 

format C, 6.4 

uses of, 6.5 

how to use, 6.5 

optional lines, 5.11 

Requires secondary dx, A.5 

Run 

sample COBOL program (CBTSTJCL), 3.6 

sample COBOL program and print output 

(COBOLPRT), 3.6 

S 

Sample JCL 

for edit-only procedure, 4.5 

for edit-print procedure, 4.6 

to edit test database in COBOL environment, 3.18 

to install English description file, 3.9 

to install JCL library, 3.6 

to install object library, 3.7 

to install program source library, 3.11 

to install test databases, 3.8 

Secondary diagnosis code, 2.5 

Sex (SEXPTR), 5.5 

Sex conflict, A.4 

Sex data type, 4.3 

SEXPTR (sex), 5.5 

SGPTR (procedure codes), 5.5 

Software edits, A.3 

Source library, 3.6, 3.11 


members, 3.11 

SRCLOAD (load source library), 3.6 

Summary of changes, B.3 

T 

Tables installed, 3.3 

Tables, changes in this release, B.3 

Taglines, 6.4 

diagnosis, 6.4 

error messages, 6.4 

procedure, 6.4 

Test database, 3.6 


format, 3.8 

Test database installation (file 3), 3.8 

Title line, 2.4 

Title VI, Social Security Amendment, 1.3 

U 

UB-04 discharge disposition codes, 2.5 

UB-92 discharge status codes, 5.5 

Unacceptable principal diagnosis, A.5 

Uses for the report programs, 6.5 

V 

Version ID and date flag (VPTR), 5.7 

Version to use, what determines, 1.4 

Versions 

in the software, 1.4 


October 2009


of DRGs, 1.4 

Versions of the program 

changes in this release, B.3 

VPTR (version ID and date flag), 5.7 

VSAMLOAD (load ICD-9-CM description files), 3.6 

October 2009 

Index I.5



October 2009


Definitions of Medicare Code Edits 

PBL–011 October 2009


Document number 

October 2009 

PBL–011 

ii Definitions of Medicare Code Edits 

October 2009


About this document 

THE 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-9-CM code 

lists. 

The coding edit information in this manual is effective from 

10/01/2009 to 09/30/2010. 

October 2009 

iii


iv Definitions of Medicare Code Edits 

October 2009


Contents 

Preface 

About this document iii 

Chapter 1 Edit code lists 1.3 

1. Invalid diagnosis or procedure code 1.4 

2. E-code as principal diagnosis 1.4 

3. Duplicate of PDX 1.4 

4. Age conflict 1.4 

5. Sex conflict 1.19 

6. Manifestation code as principal diagnosis 1.38 

7. Non-specific principal diagnosis 1.41 

8. Questionable admission 1.41 

9. Unacceptable principal diagnosis 1.42 

10. Non-specific O.R. procedure 1.50 

11. Non-covered procedure 1.50 

12. Open biopsy check 1.53 

13. Bilateral procedure 1.54 

14. Invalid age 1.55 

15. Invalid sex 1.55 

16. Invalid discharge status 1.55 

17. Limited coverage 1.56 

18. Wrong procedure performed 1.57 

Chapter 2 Code list changes 2.3 

Changes to existing edits 2.3 

New edit 2.13 

Index I.1 

October 2009 

Contents v


vi Definitions of Medicare Code Edits 

October 2009

Chapter 1 

1Edit code lists

Contents Edit code lists 1.3 

1. Invalid diagnosis or procedure code 1.4 

2. E-code as principal diagnosis 1.4 

3. Duplicate of PDX 1.4 

4. Age conflict 1.4 

5. Sex conflict 1.19 

6. Manifestation code as principal diagnosis 1.38 

7. Non-specific principal diagnosis 1.41 

8. Questionable admission 1.41 

9. Unacceptable principal diagnosis 1.42 

10. Non-specific O.R. procedure 1.50 

11. Non-covered procedure 1.50 

12. Open biopsy check 1.53 

13. Bilateral procedure 1.54 

14. Invalid age 1.55 

15. Invalid sex 1.55 

16. Invalid discharge status 1.55 

17. Limited coverage 1.56 

18. Wrong procedure performed 1.57 

1.2 Definitions of Medicare Code Edits October 2009

Chapter 1 

Edit code lists 

BELOW IS A LIST of current edits described in this chapter. 

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 

13. Bilateral procedure 

14. Invalid age 

15. Invalid sex 

16. Invalid discharge status 

17. Limited coverage 

18. Wrong procedure performed 

October 2009 

Edit code lists 1.3

1. Invalid 1. diagnosis Invalid or diagnosis procedure code or The Medicare Code Editor checks each diagnosis including the admitting 

diagnosis and each procedure against a table of valid ICD-9-CM 

procedure code 

codes. If an entered code does not agree with any code on the internal 

list, it is assumed to be invalid or that the 4th or 5th digit of the code is 

invalid or missing. 

2. 2. E-code E-code as principal as principal 

diagnosis For a list of all valid ICD-9-CM codes, see volumes 2 (diseases) and 3 

diagnosis (procedures) of the International Classification of Diseases, 9th Revision, 

Fourth Edition, Clinical Modification (ICD-9-CM). 

E-codes are ICD-9-CM codes beginning with the letter E. 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 E-codes, see volume 2 (diseases) of the International 

Classification of Diseases, 9th Revision, Fourth Edition, Clinical 

Modification (ICD-9-CM). 

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 


4. Age conflict The Medicare Code Editor detects inconsistencies between a patient’s 

age and any diagnosis on the patient’s 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: 

◆ 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 0–17 years inclusive (e.g., Reye’s syndrome, 

routine child health exam). 

◆ Maternity. Age range is 12–55 years inclusive (e.g., diabetes in 

pregnancy, antepartum pulmonary complication). 

◆ Adult. Age range is 15–124 years inclusive (e.g., senile delirium, 

mature cataract). 

The following pages contain lists of ICD-9-CM diagnosis codes with 

corresponding English descriptions for each of the age categories 

described above. 


Newborn diagnoses 

27701 Cystic fibrosis w ileus 

74783 Persistent fetal circ 

76077 Mat anticonv aff NB/fet 

76078 Mat antimetabol aff NB 

7620 Placenta previa aff NB 

7621 Placenta hem NEC aff NB 

7622 Abn plac NEC/NOS aff NB 

7623 Placent transfusion syn 

7624 Prolapsed cord aff NB 

7625 Oth umbil cord compress 

7626 Umbil cond NEC aff NB 

7627 Chorioamnionitis aff NB 

7628 Abn amnion NEC aff NB 

7629 Abn amnion NOS aff NB 

7630 Breech del/extrac aff NB 

7631 Malpos/dispro NEC aff NB 

7632 Forceps delivery aff NB 

7633 Vacuum extrac del aff NB 

7634 Cesarean delivery aff NB 

7635 Mat anesth/analg aff NB 

7636 Precipitate del aff NB 

7637 Abn uterine contr aff NB 

76381 Ab ftl hrt rt/rh b/f lab 

76382 Ab ftl hrt rt/rh dur lab 

76383 Ab ftl hrt rt/rhy NOS 

76384 Meconium dur del aff NB 

76389 Compl del NEC aff NB 

7639 Compl deliv NOS aff NB 

76400 Light-for-dates wtNOS 

76401 Light-for-dates


77013 Amniotc asp w/o resp sym 

77014 Amniotic asp w resp sym 

77015 Blood asp w/o resp sympt 

77016 Blood asp w resp sympt 

77017 NB asp w/o resp symp NEC 

77018 NB asp w resp symp NEC 

7702 NB interstit emphysema 

7703 NB pulmonary hemorrhage 

7704 Primary atelectasis 

7705 NB atelectasis NEC/NOS 

7706 NB transitory tachypnea 

77081 Primary apnea of newborn 

77082 Other apnea of newborn 

77083 Cyanotic attack, newborn 

77084 Resp failure of newborn 

77085 Stomch cont asp w/o resp 

77086 Stomach cont asp w resp 

77087 NB respiratory arrest 

77088 NB hypoxia 

77089 Resp prob after brth NEC 

7709 NB respiratory cond NOS 

7710 Congenital rubella 

7711 Cong cytomegalovirus inf 

7712 Congenital infec NEC 

7713 Tetanus neonatorum 

7714 Omphalitis of newborn 

7715 Neonatal infec mastitis 

7716 Neonatal conjunctivitis 

7717 Neonatal candida infect 

77181 NB septicemia [sepsis] 

77182 NB urinary tract infectn 

77183 Bacteremia of newborn 

77189 Perinatal infection NEC 

7720 NB fetal blood loss NEC 

77210 NB intraven hem NOS 

77211 NB intraven hem,grade i 

77212 NB intraven hem,grade ii 

77213 NB intravn hem,grade iii 

77214 NB intraven hem,grade iv 

7722 NB subarachnoid hemorr 

7723 Post-birth umbil hemorr 

7724 NB GI hemorrhage 

7725 NB adrenal hemorrhage 

7726 NB cutaneous hemorrhage 

7728 Neonatal hemorrhage NEC 

7729 Neonatal hemorrhage NOS 

7730 NB hemolyt dis:rh isoimm 

7731 NB hemolyt dis-abo isoim 

7732 NB hemolyt dis-isoim NEC 

7733 Hydrops fetalis:isoimm 

7734 NB kernicterus:isoimmun 

7735 NB late anemia:isoimmun 

7740 Perinat jaund-hered anem 

7741 Perinat jaund:hemolysis 

7742 Neonat jaund preterm del 

77430 Delay conjugat jaund NOS 

77431 Neonat jaund in oth dis 

77439 Delay conjugat jaund NEC 

7744 Fetal/neonatal hepatitis 

7745 Perinatal jaundice NEC 

7746 Fetal/neonatal jaund NOS 

7747 NB kernicterus 

7750 Infant diabet mother syn 

7751 Neonat diabetes mellitus 

7752 Neonat myasthenia gravis 

7753 Neonatal thyrotoxicosis 

7754 Hypocalcem/hypomagnes NB 

7755 Neonatal dehydration 

7756 Neonatal hypoglycemia 

7757 Late metab acidosis NB 

77581 NB acidosis NEC 

77589 Neonat endo/met dis NEC 

7759 Transient met dis NB NOS 

7760 NB hemorrhagic disease 

7761 Neonatal thrombocytopen 

7762 Dissem intravasc coag NB 

7763 Oth neonatal coag dis 

7764 Polycythemia neonatorum 

7765 Congenital anemia 

7766 Anemia of prematurity 

7767 Neonatal neutropenia 

7768 Transient hemat dis NEC 

7769 NB hematological dis NOS 

7771 Meconium obstruction 

7772 Intest obst-inspiss milk 

7773 Swallowed blood syndrome 

7774 Transitory ileus of NB 

77750 Nec enterocoltis NB NOS 

77751 Stg I nec enterocol NB 

77752 Stg II nec enterocol NB 

77753 Stg III nec enterocol NB 

7776 Perinatal intest perfor 

7778 Perinat GI sys dis NEC 

7779 Perinat GI sys dis NOS 

7780 Hydrops fetalis no isoim 

7781 Sclerema neonatorum 

7782 NB cold injury syndrome 

7783 NB hypothermia NEC 

7784 NB temp regulat dis NEC 

7785 Edema of newborn NEC/NOS 

7787 NB breast engorgement 

7788 NB integument cond NEC 

7789 NB integument cond NOS 

7790 Convulsions in newborn 

7791 NB cereb irrit NEC/NOS 

7792 Cns dysfunction syn NB 

77931 NB feeding problems 

77932 NB bilious vomiting 

77933 NB other vomiting 

77934 NB failure to thrive 

7794 NB drug reaction/intoxic 

7795 NB drug withdrawal syndr 

7796 Termination of pregnancy 

77981 Neonatal bradycardia 

77982 Neonatal tachycardia 

77983 Delay separate umbl cord 

77984 Meconium staining 

77985 NB cardiac arrest 

77989 Perinatal condition NEC 

7799 Perinatal condition NOS 

78092 Excess cry infant/baby 

7966 Abnorm neonate screening 

V2031 Health supvsn nb


V3200 

V3201 

V321 

V3300 

V3301 

V331 

V3400 

V3401 

V341 

V3500 

V3501 

V351 

V3600 

V3601 

V361 

V3700 

V3701 

V371 

V3900 

V3901 

V391 

Twin-mate sb-hosp w/o cs 

Twin-mate sb-hosp w cs 

Twin, mate sb-before adm 

Twin-NOS-in hosp w/o cs 

Twin-NOS-in hosp w cs 

Twin NOS-before admissn 

Oth mult lb-hosp w/o cs 

Oth mult lb-in hosp w cs 

Oth mult nb-before adm 

Oth mult sb-hosp w/o cs 

Oth mult sb-in hosp w cs 

Oth mult sb-before adm 

Mult lb/sb-in hos w/o cs 

Mult lb/sb-in hosp w cs 

Mult nb/sb-before adm 

Mult brth NOS-hos w/o cs 

Mult birth NOS-hosp w cs 

Mult brth NOS-before adm 

Liveborn NOS-hosp w/o cs 

Liveborn NOS-hosp w cs 

Liveborn NOS-before adm 

October 2009 

Edit code lists 1.7

Pediatric diagnoses (age 0 through 17) 

04041 Infant botulism 

05810 Roseola infantum NOS 

05811 Roseola infant d/t HHV-6 

05812 Roseola infant d/t HHV-7 

2591 Sexual precocity NEC 

31389 Emotional dis child NEC 

3139 Emotional dis child NOS 

33181 Reye's syndrome 

69011 Seborrhea capitis 

69012 Sbrheic infantl drmtitis 

7511 Atresia small intestine 

7512 Atresia large intestine 

75161 Biliary atresia 

78091 Fussy infant/baby 

78341 Failure to thrive-child 

78342 Delayed milestones 

7897 Colic 

7980 Sudden infant death synd 

79982 Appar life threat-infant 

99550 Child abuse NOS 

99551 Child emotnl/psych abuse 

99552 Child neglect-nutrition 

99553 Child sexual abuse 

99554 Child physical abuse 

99555 Shaken infant syndrome 

99559 Child abuse/neglect NEC 

V200 Foundling health care 

V201 Care of healthy chld NEC 

V202 Routin child health exam 

V695 Behav insomnia-childhood 

V8551 BMI,pediatric

Maternity diagnoses (age 12 through 55) 

630 Hydatidiform mole 

631 Oth abn prod conception 

632 Missed abortion 

63300 Abd preg w/o intrau preg 

63301 Abd preg w intraut preg 

63310 Tubal preg w/o intra prg 

63311 Tubal preg w intra preg 

63320 Ovarn preg w/o intra prg 

63321 Ovarian preg w intra prg 

63380 Ect preg NEC w/o int prg 

63381 Ectpc prg NEC w int preg 

63390 Ect preg NOS w/o int prg 

63391 Ectp preg NOS w int preg 

63400 Spon abor w pel inf-unsp 

63401 Spon abor w pelv inf-inc 

63402 Spon abor w pel inf-comp 

63410 Spon abort w hemorr-unsp 

63411 Spon abort w hemorr-inc 

63412 Spon abort w hemorr-comp 

63420 Spon ab w pel damag-unsp 

63421 Spon ab w pelv damag-inc 

63422 Spon ab w pel damag-comp 

63430 Spon ab w ren fail-unsp 

63431 Spon ab w ren fail-inc 

63432 Spon ab w ren fail-comp 

63440 Spon ab w metab dis-unsp 

63441 Spon ab w metab dis-inc 

63442 Spon ab w metab dis-comp 

63450 Spon abort w shock-unsp 

63451 Spon abort w shock-inc 

63452 Spon abort w shock-comp 

63460 Spon abort w embol-unsp 

63461 Spon abort w embol-inc 

63462 Spon abort w embol-comp 

63470 Spon ab w compl NEC-unsp 

63471 Spon ab w compl NEC-inc 

63472 Spon ab w compl NEC-comp 

63480 Spon ab w compl NOS-unsp 

63481 Spon ab w compl NOS-inc 

63482 Spon ab w compl NOS-comp 

63490 Spon abort uncompl-unsp 

63491 Spon abort uncompl-inc 

63492 Spon abort uncompl-comp 

63500 Leg abor w pelv inf-unsp 

63501 Leg abor w pelv inf-inc 

63502 Leg abor w pelv inf-comp 

63510 Legal abor w hemorr-unsp 

63511 Legal abort w hemorr-inc 

63512 Legal abor w hemorr-comp 

63520 Leg ab w pelv damag-unsp 

63521 Leg ab w pelv damag-inc 

63522 Leg ab w pelv damag-comp 

63530 Leg abor w ren fail-unsp 

63531 Leg abor w ren fail-inc 

63532 Leg abor w ren fail-comp 

63540 Leg ab w metab dis-unsp 

63541 Leg ab w metab dis-inc 

63542 Leg ab w metab dis-comp 

63550 Legal abort w shock-unsp 

63551 Legal abort w shock-inc 

63552 Legal abort w shock-comp 

63560 Legal abort w embol-unsp 

63561 Legal abort w embol-inc 

63562 Legal abort w embol-comp 

63570 Leg ab w compl NEC-unsp 

63571 Leg ab w compl NEC-inc 

63572 Leg ab w compl NEC-comp 

63580 Leg ab w compl NOS-unsp 

63581 Leg ab w compl NOS-inc 

63582 Leg ab w compl NOS-comp 

63590 Legal abort uncompl-unsp 

63591 Legal abort uncompl-inc 

63592 Legal abort uncompl-comp 

63600 Illeg ab w pelv inf-unsp 

63601 Illeg ab w pelv inf-inc 

63602 Illeg ab w pelv inf-comp 

63610 Illeg ab w hemorr-unspec 

63611 Illeg ab w hemorr-inc 

63612 Illeg ab w hemorr-comp 

63620 Illeg ab w pel damg-unsp 

63621 Illeg ab w pel damag-inc 

63622 Illeg ab w pel damg-comp 

63630 Illeg ab w ren fail-unsp 

63631 Illeg ab w ren fail-inc 

63632 Illeg ab w ren fail-comp 

63640 Illeg ab w met dis-unsp 

63641 Illeg ab w metab dis-inc 

63642 Illeg ab w met dis-comp 

63650 Illeg abort w shock-unsp 

63651 Illeg abort w shock-inc 

63652 Illeg abort w shock-comp 

63660 Illeg ab w embolism-unsp 

63661 Illeg ab w embolism-inc 

63662 Illeg ab w embolism-comp 

63670 Illg ab w compl NEC-unsp 

63671 Illeg ab w compl NEC-inc 

63672 Illg ab w compl NEC-comp 

63680 Illg ab w compl NOS-unsp 

63681 Illeg ab w compl NOS-inc 

63682 Illg ab w compl NOS-comp 

63690 Illeg abort uncompl-unsp 

63691 Illeg abort uncompl-inc 

63692 Illeg abort uncompl-comp 

63700 Abort NOS w pel inf-unsp 

63701 Abort NOS w pel inf-inc 

63702 Abort NOS w pel inf-comp 

63710 Abort NOS w hemorr-unsp 

63711 Abort NOS w hemorr-inc 

63712 Abort NOS w hemorr-comp 

63720 Ab NOS w pelv damag-unsp 

63721 Ab NOS w pelv damag-inc 

63722 Ab NOS w pelv damag-comp 

63730 Ab NOS w renal fail-unsp 

63731 Ab NOS w renal fail-inc 

63732 Ab NOS w renal fail-comp 

63740 Ab NOS w metab dis-unsp 

63741 Ab NOS w metab dis-inc 

63742 Ab NOS w metab dis-comp 

63750 Abort NOS w shock-unsp 

63751 Abort NOS w shock-inc 

63752 Abort NOS w shock-comp 

63760 Ab NOS w embolism-unsp 

63761 Ab NOS w embolism-inc 

63762 Ab NOS w embolism-comp 

63770 Ab NOS w compl NEC-unsp 

63771 Ab NOS w compl NEC-inc 

63772 Ab NOS w compl NEC-comp 

63780 Ab NOS w compl NOS-unsp 

63781 Ab NOS w compl NOS-inc 

63782 Ab NOS w compl NOS-comp 

October 2009 

Edit code lists 1.9


63790 Ab NOS uncomplicat-unsp 

63791 Ab NOS uncomplicat-inc 

63792 Ab NOS uncomplicat-comp 

6380 Attem abort w pelvic inf 

6381 Attem abort w hemorrhage 

6382 Attem abort w pelv damag 

6383 Attem abort w renal fail 

6384 Attem abor w metabol dis 

6385 Attem abortion w shock 

6386 Attemp abort w embolism 

6387 Attemp abort w compl NEC 

6388 Attemp abort w compl NOS 

6389 Attempted abort uncompl 

6390 Postabortion gu infect 

6391 Postabortion hemorrhage 

6392 Postabort pelvic damage 

6393 Postabort kidney failure 

6394 Postabort metabolic dis 

6395 Postabortion shock 

6396 Postabortion embolism 

6398 Postabortion compl NEC 

6399 Postabortion compl NOS 

64000 Threatened abort-unspec 

64001 Threatened abort-deliver 

64003 Threaten abort-antepart 

64080 Hem early preg NEC-unsp 

64081 Hem early preg NEC-deliv 

64083 Hem early pg NEC-antepar 

64090 Hemorr early preg-unspec 

64091 Hem early preg-delivered 

64093 Hem early preg-antepart 

64100 Placenta previa-unspec 

64101 Placenta previa-deliver 

64103 Placenta previa-antepart 

64110 Placenta prev hem-unspec 

64111 Placenta prev hem-deliv 

64113 Placen prev hem-antepart 

64120 Prem separ placen-unspec 

64121 Prem separ placen-deliv 

64123 Prem separ plac-antepart 

64130 Coag def hemorr-unspec 

64131 Coag def hemorr-deliver 

64133 Coag def hemorr-antepart 

64180 Antepart hem NEC-unspec 

64181 Antepartum hem NEC-deliv 

64183 Antepart hem NEC-antepar 

64190 Antepart hem NOS-unspec 

64191 Antepartum hem NOS-deliv 

64193 Antepart hem NOS-antepar 

64200 Essen hyperten preg-unsp 

64201 Essen hyperten-delivered 

64202 Essen hyperten-del w p/p 

64203 Essen hyperten-antepart 

64204 Essen hyperten-postpart 

64210 Renal hyperten preg-unsp 

64211 Renal hyperten pg-deliv 

64212 Renal hyperten-del p/p 

64213 Renal hyperten-antepart 

64214 Renal hyperten-postpart 

64220 Old hyperten preg-unspec 

64221 Old hyperten NEC-deliver 

64222 Old hyperten-deliv w p/p 

64223 Old hyperten NEC-antepar 

64224 Old hyperten NEC-postpar 

64230 Trans hyperten preg-unsp 

64231 Trans hyperten-delivered 

64232 Trans hyperten-del w p/p 

64233 Trans hyperten-antepart 

64234 Trans hyperten-postpart 

64240 Mild/NOS preeclamp-unsp 

64241 Mild/NOS preeclamp-deliv 

64242 Mild preeclamp-del w p/p 

64243 Mild/NOS preeclamp-antep 

64244 Mild/NOS preeclamp-p/p 

64250 Severe preeclamp-unspec 

64251 Severe preeclamp-deliver 

64252 Sev preeclamp-del w p/p 

64253 Sev preeclamp-antepartum 

64254 Sev preeclamp-postpartum 

64260 Eclampsia-unspecified 

64261 Eclampsia-delivered 

64262 Eclampsia-deliv w p/p 

64263 Eclampsia-antepartum 

64264 Eclampsia-postpartum 

64270 Tox w old hyperten-unsp 

64271 Tox w old hyperten-deliv 

64272 Tox w old hyp-del w p/p 

64273 Tox w old hyper-antepart 

64274 Tox w old hyper-postpart 

64290 Hyperten preg NOS-unspec 

64291 Hypertens NOS-delivered 

64292 Hypertens NOS-del w p/p 

64293 Hypertens NOS-antepartum 

64294 Hypertens NOS-postpartum 

64300 Mild hyperem grav-unspec 

64301 Mild hyperem grav-deliv 

64303 Mild hyperemesis-antepar 

64310 Hyperem w metab dis-unsp 

64311 Hyperem w metab dis-del 

64313 Hyperem w metab-antepart 

64320 Late vomit of preg-unsp 

64321 Late vomit of preg-deliv 

64323 Late vomit preg-antepart 

64380 Vomit compl preg-unspec 

64381 Vomit compl preg-deliver 

64383 Vomit compl preg-antepar 

64390 Vomit of preg NOS-unspec 

64391 Vomit of preg NOS-deliv 

64393 Vomit of pg NOS-antepart 

64400 Threat prem labor-unspec 

64403 Thrt prem labor-antepart 

64410 Threat labor NEC-unspec 

64413 Threat labor NEC-antepar 

64420 Early onset deliv-unspec 

64421 Early onset delivery-del 

64510 Post term preg-unsp 

64511 Post term preg-del 

64513 Post term preg-antepar 

64520 Prolonged preg-unsp 

64521 Prolonged preg-del 

64523 Prolonged preg-antepar 

64600 Papyraceous fetus-unspec 

64601 Papyraceous fetus-deliv 

64603 Papyraceous fet-antepar 

64610 Edema in preg-unspec 

64611 Edema in preg-delivered 

64612 Edema in preg-del w p/p 

64613 Edema in preg-antepartum 

64614 Edema in preg-postpartum 

64620 Renal dis preg NOS-unsp 

64621 Renal dis NOS-delivered 

64622 Renal dis NOS-del w p/p 

64623 Renal dis NOS-antepartum 

64624 Renal dis NOS-postpartum 

64630 Habitual aborter-unspec 

64631 Habitual aborter-deliver 



64633 Habitual abort-antepart 

64640 Neuritis of preg-unspec 

64641 Neuritis-delivered 

64642 Neuritis-delivered w p/p 

64643 Neuritis of preg-antepar 

64644 Neuritis of preg-postpar 

64650 Bacteriuria preg-unspec 

64651 Asym bacteriuria-deliver 

64652 Asy bacteruria-del w p/p 

64653 Asy bacteriuria-antepart 

64654 Asy bacteriuria-postpart 

64660 Gu infect in preg-unspec 

64661 Gu infection-delivered 

64662 Gu infection-deliv w p/p 

64663 Gu infection-antepartum 

64664 Gu infection-postpartum 

64670 Liver dis in preg-unspec 

64671 Liver disorder-delivered 

64673 Liver disorder-antepart 

64680 Preg compl NEC-unspec 

64681 Preg compl NEC-delivered 

64682 Preg compl NEC-del w p/p 

64683 Preg compl NEC-antepart 

64684 Preg compl NEC-postpart 

64690 Preg compl NOS-unspec 

64691 Preg compl NOS-delivered 

64693 Preg compl NOS-antepart 

64700 Syphilis in preg-unspec 

64701 Syphilis-delivered 

64702 Syphilis-delivered w p/p 

64703 Syphilis-antepartum 

64704 Syphilis-postpartum 

64710 Gonorrhea in preg-unspec 

64711 Gonorrhea-delivered 

64712 Gonorrhea-deliver w p/p 

64713 Gonorrhea-antepartum 

64714 Gonorrhea-postpartum 

64720 Other VD in preg-unspec 

64721 Other vd-delivered 

64722 Other vd-delivered w p/p 

64723 Other vd-antepartum 

64724 Other vd-postpartum 

64730 TB in preg-unspecified 

64731 Tuberculosis-delivered 

64732 Tuberculosis-deliv w p/p 

64733 Tuberculosis-antepartum 

64734 Tuberculosis-postpartum 

64740 Malaria in preg-unspec 

64741 Malaria-delivered 

64742 Malaria-delivered w p/p 

64743 Malaria-antepartum 

64744 Malaria-postpartum 

64750 Rubella in preg-unspec 

64751 Rubella-delivered 

64752 Rubella-delivered w p/p 

64753 Rubella-antepartum 

64754 Rubella-postpartum 

64760 Oth virus in preg-unspec 

64761 Oth viral dis-delivered 

64762 Oth viral dis-del w p/p 

64763 Oth viral dis-antepartum 

64764 Oth viral dis-postpartum 

64780 Inf dis in preg NEC-unsp 

64781 Infect dis NEC-delivered 

64782 Infect dis NEC-del w p/p 

64783 Infect dis NEC-antepart 

64784 Infect dis NEC-postpart 

64790 Infect in preg NOS-unsp 

64791 Infect NOS-delivered 

64792 Infect NOS-deliver w p/p 

64793 Infect NOS-antepartum 

64794 Infect NOS-postpartum 

64800 Diabetes in preg-unspec 

64801 Diabetes-delivered 

64802 Diabetes-delivered w p/p 

64803 Diabetes-antepartum 

64804 Diabetes-postpartum 

64810 Thyroid dysfun preg-unsp 

64811 Thyroid dysfunc-deliver 

64812 Thyroid dysfun-del w p/p 

64813 Thyroid dysfunc-antepart 

64814 Thyroid dysfunc-postpart 

64820 Anemia in preg-unspec 

64821 Anemia-delivered 

64822 Anemia-delivered w p/p 

64823 Anemia-antepartum 

64824 Anemia-postpartum 

64830 Drug depend preg-unspec 

64831 Drug dependence-deliver 

64832 Drug dependen-del w p/p 

64833 Drug dependence-antepart 

64834 Drug dependence-postpart 

64840 Mental dis preg-unspec 

64841 Mental disorder-deliver 

64842 Mental dis-deliv w p/p 

64843 Mental disorder-antepart 

64844 Mental disorder-postpart 

64850 Congen CV dis preg-unsp 

64851 Congen CV dis-delivered 

64852 Congen CV dis-del w p/p 

64853 Congen CV dis-antepartum 

64854 Congen CV dis-postpartum 

64860 CV dis NEC preg-unspec 

64861 CV dis NEC preg-deliver 

64862 CV dis NEC-deliver w p/p 

64863 CV dis NEC-antepartum 

64864 CV dis NEC-postpartum 

64870 Bone disord in preg-unsp 

64871 Bone disorder-delivered 

64872 Bone disorder-del w p/p 

64873 Bone disorder-antepartum 

64874 Bone disorder-postpartum 

64880 Abn glucose in preg-unsp 

64881 Abn glucose toler-deliv 

64882 Abn glucose-deliv w p/p 

64883 Abn glucose-antepartum 

64884 Abn glucose-postpartum 

64890 Oth curr cond preg-unsp 

64891 Oth curr cond-delivered 

64892 Oth curr cond-del w p/p 

64893 Oth curr cond-antepartum 

64894 Oth curr cond-postpartum 

64900 Tobacco use disord-unsp 

64901 Tobacco use disor-delliv 

64902 Tobacco use dis-del-p/p 

64903 Tobacco use dis-antepart 

64904 Tobacco use dis-postpart 

64910 Obesity-unspecified 

64911 Obesity-delivered 

64912 Obesity-delivered w p/p 

64913 Obesity-antepartum 

64914 Obesity-postpartum 

64920 Bariatric surg stat-unsp 

64921 Bariatric surg stat-del 

64922 Bariatric surg-del w p/p 

64923 Bariatrc surg stat-antep 

October 2009 

Edit code lists 1.11


64924 Bariatrc surg stat w p/p 

64930 Coagulation def-unspec 

64931 Coagulation def-deliv 

64932 Coagulatn def-del w p/p 

64933 Coagulation def-antepart 

64934 Coagulation def-postpart 

64940 Epilepsy-unspecified 

64941 Epilepsy-delivered 

64942 Epilepsy-delivered w p/p 

64943 Epilepsy-antepartum 

64944 Epilepsy-postpartum 

64950 Spotting-unspecified 

64951 Spotting-delivered 

64953 Spotting-antepartum 

64960 Uterine size descrp-unsp 

64961 Uterine size descrep-del 

64962 Uterine size-del w p/p 

64963 Uterine size des-antepar 

64964 Uterine size descrep-p/p 

64970 Cervical shortening-unsp 

64971 Cervical shortening-del 

64973 Cervical shortening-ante 

650 Normal delivery 

65100 Twin pregnancy-unspec 

65101 Twin pregnancy-delivered 

65103 Twin pregnancy-antepart 

65110 Triplet pregnancy-unspec 

65111 Triplet pregnancy-deliv 

65113 Triplet preg-antepartum 

65120 Quadruplet preg-unspec 

65121 Quadruplet preg-deliver 

65123 Quadruplet preg-antepart 

65130 Twins w fetal loss-unsp 

65131 Twins w fetal loss-del 

65133 Twins w fetal loss-ante 

65140 Triplets w fet loss-unsp 

65141 Triplets w fet loss-del 

65143 Triplets w fet loss-ante 

65150 Quads w fetal loss-unsp 

65151 Quads w fetal loss-del 

65153 Quads w fetal loss-ante 

65160 Mult ges w fet loss-unsp 

65161 Mult ges w fet loss-del 

65163 Mult ges w fet loss-ante 

65170 Mul gest-fet reduct unsp 

65171 Mult gest-fet reduct del 

65173 Mul gest-fet reduct ante 

65180 Multi gestat NEC-unspec 

65181 Multi gestat NEC-deliver 

65183 Multi gest NEC-antepart 

65190 Multi gestat NOS-unspec 

65191 Mult gestation NOS-deliv 

65193 Multi gest NOS-antepart 

65200 Unstable lie-unspecified 

65201 Unstable lie-delivered 

65203 Unstable lie-antepartum 

65210 Cephalic vers NOS-unspec 

65211 Cephalic vers NOS-deliv 

65213 Cephal vers NOS-antepart 

65220 Breech presentat-unspec 

65221 Breech presentat-deliver 

65223 Breech present-antepart 

65230 Transv/obliq lie-unspec 

65231 Transver/obliq lie-deliv 

65233 Transv/obliq lie-antepar 

65240 Face/brow present-unspec 

65241 Face/brow present-deliv 

65243 Face/brow pres-antepart 

65250 High head at term-unspec 

65251 High head at term-deliv 

65253 High head term-antepart 

65260 Mult gest malpresen-unsp 

65261 Mult gest malpres-deliv 

65263 Mult ges malpres-antepar 

65270 Prolapsed arm-unspec 

65271 Prolapsed arm-delivered 

65273 Prolapsed arm-antepart 

65280 Malposition NEC-unspec 

65281 Malposition NEC-deliver 

65283 Malposition NEC-antepart 

65290 Malposition NOS-unspec 

65291 Malposition NOS-deliver 

65293 Malposition NOS-antepart 

65300 Pelvic deform NOS-unspec 

65301 Pelvic deform NOS-deliv 

65303 Pelv deform NOS-antepart 

65310 Contract pelv NOS-unspec 

65311 Contract pelv NOS-deliv 

65313 Contrac pelv NOS-antepar 

65320 Inlet contraction-unspec 

65321 Inlet contraction-deliv 

65323 Inlet contract-antepart 

65330 Outlet contraction-unsp 

65331 Outlet contraction-deliv 

65333 Outlet contract-antepart 

65340 Fetopelv disprop-unspec 

65341 Fetopelv dispropor-deliv 

65343 Fetopel disprop-antepart 

65350 Fetal disprop NOS-unspec 

65351 Fetal disprop NOS-deliv 

65353 Fetal dispro NOS-antepar 

65360 Hydrocephal fetus-unspec 

65361 Hydroceph fetus-deliver 

65363 Hydroceph fetus-antepart 

65370 Oth abn fet disprop-unsp 

65371 Oth abn fet dispro-deliv 

65373 Oth abn fet dispro-antep 

65380 Disproportion NEC-unspec 

65381 Disproportion NEC-deliv 

65383 Dispropor NEC-antepartum 

65390 Disproportion NOS-unspec 

65391 Disproportion NOS-deliv 

65393 Dispropor NOS-antepartum 

65400 Cong abn uter preg-unsp 

65401 Congen abn uterus-deliv 

65402 Cong abn uter-del w p/p 

65403 Congen abn uter-antepart 

65404 Congen abn uter-postpart 

65410 Uter tumor in preg-unsp 

65411 Uterine tumor-delivered 

65412 Uterine tumor-del w p/p 

65413 Uterine tumor-antepartum 

65414 Uterine tumor-postpartum 

65420 Prev c-delivery unspec 

65421 Prev c-delivery-delivrd 

65423 Prev c-delivery-antepart 

65430 Retrovert uterus-unspec 

65431 Retrovert uterus-deliver 

65432 Retrovert uter-del w p/p 

65433 Retrovert uter-antepart 

65434 Retrovert uter-postpart 

65440 Abn grav uterus NEC-unsp 

65441 Abn uterus NEC-delivered 

65442 Abn uterus NEC-del w p/p 

65443 Abn uterus NEC-antepart 

65444 Abn uterus NEC-postpart 



65450 Cerv incompet preg-unsp 

65451 Cervical incompet-deliv 

65452 Cerv incompet-del w p/p 

65453 Cerv incompet-antepartum 

65454 Cerv incompet-postpartum 

65460 Abn cervix NEC preg-unsp 

65461 Abn cervix NEC-delivered 

65462 Abn cervix NEC-del w p/p 

65463 Abn cervix NEC-antepart 

65464 Abn cervix NEC-postpart 

65470 Abn vagina in preg-unsp 

65471 Abnorm vagina-delivered 

65472 Abnorm vagina-del w p/p 

65473 Abnorm vagina-antepartum 

65474 Abnorm vagina-postpartum 

65480 Abn vulva in preg-unspec 

65481 Abnormal vulva-delivered 

65482 Abnormal vulva-del w p/p 

65483 Abnormal vulva-antepart 

65484 Abnormal vulva-postpart 

65490 Abn pel NEC in preg-unsp 

65491 Abn pelv org NEC-deliver 

65492 Abn pelv NEC-deliv w p/p 

65493 Abn pelv org NEC-antepar 

65494 Abn pelv org NEC-postpar 

65500 Fetal cns malform-unspec 

65501 Fetal cns malform-deliv 

65503 Fetal cns malfor-antepar 

65510 Fetal chromos abn-unspec 

65511 Fetal chromoso abn-deliv 

65513 Fet chromo abn-antepart 

65520 Famil heredit dis-unspec 

65521 Famil heredit dis-deliv 

65523 Famil hered dis-antepart 

65530 Fet damg d/t virus-unsp 

65531 Fet damg d/t virus-deliv 

65533 Fet damg d/t virus-antep 

65540 Fet damg d/t dis-unspec 

65541 Fet damg d/t dis-deliver 

65543 Fet damg d/t dis-antepar 

65550 Fetal damg d/t drug-unsp 

65551 Fet damag d/t drug-deliv 

65553 Fet damg d/t drug-antepa 

65560 Radiat fetal damag-unsp 

65561 Radiat fetal damag-deliv 

65563 Radiat fet damag-antepar 

65570 Decrease fetl movmt unsp 

65571 Decrease fetal movmt del 

65573 Dec fetal movmt antepart 

65580 Fetal abnorm NEC-unspec 

65581 Fetal abnorm NEC-deliver 

65583 Fetal abnorm NEC-antepar 

65590 Fetal abnorm NOS-unspec 

65591 Fetal abnorm NOS-deliver 

65593 Fetal abnorm NOS-antepar 

65600 Fetal-maternal hem-unsp 

65601 Fetal-maternal hem-deliv 

65603 Fetal-matern hem-antepar 

65610 Rh isoimmunization-unsp 

65611 Rh isoimmunizat-deliver 

65613 Rh isoimmunizat-antepart 

65620 Abo isoimmunization-unsp 

65621 Abo isoimmunizat-deliver 

65623 Abo isoimmunizat-antepar 

65630 Fetal distress-unspec 

65631 Fetal distress-delivered 

65633 Fetal distress-antepart 

65640 Intrauterine death-unsp 

65641 Intrauter death-deliver 

65643 Intrauter death-antepart 

65650 Poor fetal growth-unspec 

65651 Poor fetal growth-deliv 

65653 Poor fetal grth-antepart 

65660 Excess fetal grth-unspec 

65661 Excess fetal grth-deliv 

65663 Excess fet grth-antepart 

65670 Oth placent cond-unspec 

65671 Oth placent cond-deliver 

65673 Oth placent cond-antepar 

65680 Fet/plac prob NEC-unspec 

65681 Fet/plac prob NEC-deliv 

65683 Fet/plac prob NEC-antepa 

65690 Fet/plac prob NOS-unspec 

65691 Fet/plac prob NOS-deliv 

65693 Fet/plac prob NOS-antepa 

65700 Polyhydramnios-unspec 

65701 Polyhydramnios-delivered 

65703 Polyhydramnios-antepart 

65800 Oligohydramnios-unspec 

65801 Oligohydramnios-deliver 

65803 Oligohydramnios-antepar 

65810 Prem rupt membran-unspec 

65811 Prem rupt membran-deliv 

65813 Prem rupt memb-antepart 

65820 Prolong rupt memb-unspec 

65821 Prolong rupt memb-deliv 

65823 Prolong rup memb-antepar 

65830 Artific rupt membr-unsp 

65831 Artific rupt membr-deliv 

65833 Artif rupt memb-antepart 

65840 Amniotic infection-unsp 

65841 Amniotic infection-deliv 

65843 Amniotic infect-antepart 

65880 Amniotic prob NEC-unspec 

65881 Amniotic prob NEC-deliv 

65883 Amnion prob NEC-antepart 

65890 Amniotic prob NOS-unspec 

65891 Amniotic prob NOS-deliv 

65893 Amnion prob NOS-antepart 

65900 Fail mechan induct-unsp 

65901 Fail mech induct-deliver 

65903 Fail mech induct-antepar 

65910 Fail induction NOS-unsp 

65911 Fail induction NOS-deliv 

65913 Fail induct NOS-antepart 

65920 Pyrexia in labor-unspec 

65921 Pyrexia in labor-deliver 

65923 Pyrexia in labor-antepar 

65930 Septicemia in labor-unsp 

65931 Septicem in labor-deliv 

65933 Septicem in labor-antepa 

65940 Grand multiparity-unspec 

65941 Grand multiparity-deliv 

65943 Grand multiparity-antepa 

65950 Elderly primigravid-unsp 

65951 Elderly primigravida-del 

65953 Elder primigravid-antepa 

65960 Elderly multigravida-uns 

65961 Elderly multigravida-del 

65963 Elderly multigravd-antep 

65970 Abn ftl hrt rate/rhy-uns 

65971 Abn ftl hrt rate/rhy-del 

65973 Abn ftl hrt rate/rhy-ant 

65980 Complic labor NEC-unsp 

65981 Complic labor NEC-deliv 

65983 Compl labor NEC-antepart 

October 2009 



65990 Complic labor NOS-unsp 

65991 Complic labor NOS-deliv 

65993 Compl labor NOS-antepart 

66000 Obstruct/fet malpos-unsp 

66001 Obstruc/fet malpos-deliv 

66003 Obstruc/fet malpos-antep 

66010 Bony pelv obstruc-unspec 

66011 Bony pelv obstruct-deliv 

66013 Bony pelv obstruc-antepa 

66020 Abn pelv tiss obstr-unsp 

66021 Abn pelv tis obstr-deliv 

66023 Abn pelv tis obstr-antep 

66030 Persist occipitpost-unsp 

66031 Persist occiptpost-deliv 

66033 Persist occiptpost-antep 

66040 Shoulder dystocia-unspec 

66041 Shoulder dystocia-deliv 

66043 Shoulder dystocia-antepa 

66050 Locked twins-unspecified 

66051 Locked twins-delivered 

66053 Locked twins-antepartum 

66060 Fail trial lab NOS-unsp 

66061 Fail trial lab NOS-deliv 

66063 Fail trial lab NOS-antep 

66070 Failed forcep NOS-unspec 

66071 Failed forceps NOS-deliv 

66073 Fail forceps NOS-antepar 

66080 Obstruc labor NEC-unspec 

66081 Obstruct labor NEC-deliv 

66083 Obstruc labor NEC-antepa 

66090 Obstruc labor NOS-unspec 

66091 Obstruct labor NOS-deliv 

66093 Obstruc labor NOS-antepa 

66100 Prim uterine inert-unsp 

66101 Prim uterine inert-deliv 

66103 Prim uter inert-antepart 

66110 Sec uterine inert-unspec 

66111 Sec uterine inert-deliv 

66113 Sec uterine inert-antepa 

66120 Uterine inertia NEC-unsp 

66121 Uterine inert NEC-deliv 

66123 Uterine inert NEC-antepa 

66130 Precipitate labor-unspec 

66131 Precipitate labor-deliv 

66133 Precipitate labor-antepa 

66140 Uter dystocia NOS-unspec 

66141 Uter dystocia NOS-deliv 

66143 Uter dystocia NOS-antepa 

66190 Abnormal labor NOS-unsp 

66191 Abnormal labor NOS-deliv 

66193 Abnorm labor NOS-antepar 

66200 Prolonged 1st stage-unsp 

66201 Prolong 1st stage-deliv 

66203 Prolong 1st stage-antepa 

66210 Prolonged labor NOS-unsp 

66211 Prolong labor NOS-deliv 

66213 Prolong labor NOS-antepa 

66220 Prolonged 2nd stage-unsp 

66221 Prolong 2nd stage-deliv 

66223 Prolong 2nd stage-antepa 

66230 Delay del 2nd twin-unsp 

66231 Delay del 2nd twin-deliv 

66233 Delay del 2 twin-antepar 

66300 Cord prolapse-unspec 

66301 Cord prolapse-delivered 

66303 Cord prolapse-antepartum 

66310 Cord around neck-unspec 

66311 Cord around neck-deliver 

66313 Cord around neck-antepar 

66320 Cord compress NEC-unspec 

66321 Cord compress NEC-deliv 

66323 Cord compres NEC-antepar 

66330 Cord entangle NEC-unspec 

66331 Cord entangle NEC-deliv 

66333 Cord entangl NEC-antepar 

66340 Short cord-unspecified 

66341 Short cord-delivered 

66343 Short cord-antepartum 

66350 Vasa previa-unspecified 

66351 Vasa previa-delivered 

66353 Vasa previa-antepartum 

66360 Vasc lesion cord-unspec 

66361 Vasc lesion cord-deliver 

66363 Vasc lesion cord-antepar 

66380 Cord complicat NEC-unsp 

66381 Cord complicat NEC-deliv 

66383 Cord compl NEC-antepart 

66390 Cord complicat NOS-unsp 

66391 Cord complicat NOS-deliv 

66393 Cord compl NOS-antepart 

66400 Del w 1 deg lacerat-unsp 

66401 Del w 1 deg lacerat-del 

66404 Del w 1 deg lac-postpart 










66440 Ob perineal lac NOS-unsp 

66441 Ob perineal lac NOS-del 

66444 Perineal lac NOS-postpar 

66450 Ob perineal hematom-unsp 

66451 Ob perineal hematoma-del 

66454 Perin hematoma-postpart 

66460 Anal sphincter tear NOS 

66461 Anal sphincter tear-del 

66464 Anal sphinctr tear w p/p 

66480 Ob perin traum NEC-unsp 

66481 Ob perineal trau NEC-del 

66484 Perin traum NEC-postpart 

66490 Ob perin traum NOS-unsp 

66491 Ob perineal trau NOS-del 

66494 Perin traum NOS-postpart 

66500 Prelabor rupt uter-unsp 

66501 Prelabor rupt uterus-del 

66503 Prelab rupt uter-antepar 

66510 Rupture uterus NOS-unsp 

66511 Rupture uterus NOS-deliv 

66520 Inversion of uterus-unsp 

66522 Invers uterus-del w p/p 

66524 Invers uterus-postpart 

66530 Lacerat of cervix-unspec 

66531 Lacerat of cervix-deliv 

66534 Lacer of cervix-postpart 

66540 High vaginal lacer-unsp 

66541 High vaginal lacer-deliv 

66544 High vaginal lac-postpar 

66550 Ob inj pelv org NEC-unsp 

66551 Ob inj pelv org NEC-del 

66554 Inj pelv org NEC-postpar 

66560 Damage to pelvic jt-unsp 

66561 Damage to pelvic jt-del 



67153 Thrombosis NEC-antepart 

67154 Thrombosis NEC-postpart 

67180 Ven compl preg NEC-unsp 

67181 Venous compl NEC-deliver 

67182 Ven comp NEC-deliv w p/p 

67183 Venous compl NEC-antepar 

67184 Venous compl NEC-postpar 

67190 Ven compl preg NOS-unsp 

67191 Venous compl NOS-deliver 

67192 Ven comp NOS-deliv w p/p 

67193 Venous compl NOS-antepar 

67194 Venous compl NOS-postpar 

67200 Puerperal pyrexia-unspec 

67202 Puerp pyrexia-del w p/p 

67204 Puerp pyrexia-postpartum 

67300 Ob air embolism-unspec 

67301 Ob air embolism-deliver 

67302 Ob air embol-deliv w p/p 

67303 Ob air embolism-antepart 

67304 Ob air embolism-postpart 

67310 Amniotic embolism-unspec 

67311 Amniotic embolism-deliv 

67312 Amniot embol-deliv w p/p 

67313 Amniotic embol-antepart 

67314 Amniotic embol-postpart 

67320 Ob pulm embol NOS-unspec 

67321 Pulm embol NOS-delivered 

67322 Pulm embol NOS-del w p/p 

67323 Pulm embol NOS-antepart 

67324 Pulm embol NOS-postpart 

67330 Ob pyemic embol-unspec 

67331 Ob pyemic embol-deliver 

67332 Ob pyem embol-del w p/p 

67333 Ob pyemic embol-antepart 

67334 Ob pyemic embol-postpart 

67380 Ob pulmon embol NEC-unsp 

67381 Pulmon embol NEC-deliver 

67382 Pulm embol NEC-del w p/p 

67383 Pulmon embol NEC-antepar 

67384 Pulmon embol NEC-postpar 

67400 Puerp cerebvasc dis-unsp 

67401 Puerp cerebvas dis-deliv 

67402 Cerebvas dis-deliv w p/p 

67403 Cerebrovasc dis-antepart 

67404 Cerebrovasc dis-postpart 

67410 Disrupt c-sect wnd-unsp 

67412 Disrupt c-sect-del w p/p 

67414 Disrupt c-sect-postpart 

67420 Disrupt perineum-unspec 

67422 Disrupt perin-del w p/p 

67424 Disrupt perineum-postpar 

67430 Ob surg compl NEC-unspec 

67432 Ob surg compl-del w p/p 

67434 Ob surg comp NEC-postpar 

67440 Placental polyp-unspec 

67442 Placent polyp-del w p/p 

67444 Placental polyp-postpart 

67450 Peripart cardiomy-unspec 

67451 Peripartum cardiomy-del 

67452 Peripart card del w p/p 

67453 Peripartum card-antepart 

67454 Peripartum card-postpart 

67480 Puerp compl NEC-unspec 

67482 Puerp comp NEC-del w p/p 

67484 Puerp compl NEC-postpart 

67490 Puerp compl NOS-unspec 

67492 Puerp comp NOS-del w p/p 

67494 Puerp compl NOS-postpart 

67500 Infect nipple preg-unsp 

67501 Infect nipple-delivered 

67502 Infect nipple-del w p/p 

67503 Infect nipple-antepartum 

67504 Infect nipple-postpartum 

67510 Breast abscess preg-unsp 

67511 Breast abscess-delivered 

67512 Breast abscess-del w p/p 

67513 Breast abscess-antepart 

67514 Breast abscess-postpart 

67520 Mastitis in preg-unspec 

67521 Mastitis-delivered 

67522 Mastitis-deliv w p/p 

67523 Mastitis-antepartum 

67524 Mastitis-postpartum 

67580 Breast inf preg NEC-unsp 

67581 Breast infect NEC-deliv 

67582 Breast inf NEC-del w p/p 

67583 Breast inf NEC-antepart 

67584 Breast inf NEC-postpart 

67590 Breast inf preg NOS-unsp 

67591 Breast infect NOS-deliv 

67592 Breast inf NOS-del w p/p 

67593 Breast inf NOS-antepart 

67594 Breast inf NOS-postpart 

67600 Retract nipple preg-unsp 

67601 Retracted nipple-deliver 

67602 Retract nipple-del w p/p 

67603 Retract nipple-antepart 

67604 Retract nipple-postpart 

67610 Cracked nipple preg-unsp 

67611 Cracked nipple-delivered 

67612 Cracked nipple-del w p/p 

67613 Cracked nipple-antepart 

67614 Cracked nipple-postpart 

67620 Breast engorge-unspec 

67621 Breast engorge-delivered 

67622 Breast engorge-del w p/p 

67623 Breast engorge-antepart 

67624 Breast engorge-postpart 

67630 Breast dis preg NEC-unsp 

67631 Breast dis NEC-delivered 

67632 Breast dis NEC-del w p/p 

67633 Breast dis NEC-antepart 

67634 Breast dis NEC-postpart 

67640 Lactation fail-unspec 

67641 Lactation fail-delivered 

67642 Lactation fail-del w p/p 

67643 Lactation fail-antepart 

67644 Lactation fail-postpart 

67650 Suppr lactation-unspec 

67651 Suppr lactation-deliver 

67652 Suppr lactat-del w p/p 

67653 Suppr lactation-antepar 

67654 Suppr lactation-postpart 

67660 Galactorrhea preg-unspec 

67661 Galactorrhea-delivered 

67662 Galactorrhea-del w p/p 

67663 Galactorrhea-antepartum 

67664 Galactorrhea-postpartum 

67680 Lactation dis NEC-unspec 

67681 Lactation dis NEC-deliv 

67682 Lactat dis NEC-del w p/p 

67683 Lactat dis NEC-antepart 

67684 Lactat dis NEC-postpart 

67690 Lactation dis NOS-unspec 

67691 Lactation dis NOS-deliv 

67692 Lactat dis NOS-del w p/p 

October 2009 



66564 Damage pelvic jt-postpar 

66570 Ob pelvic hematoma-unsp 

66571 Ob pelvic hematoma-deliv 

66572 Pelvic hematom-del w pp 

66574 Pelvic hematoma-postpart 

66580 Ob trauma NEC-unspec 

66581 Ob trauma NEC-delivered 

66582 Ob trauma NEC-del w p/p 

66583 Ob trauma NEC-antepartum 

66584 Ob trauma NEC-postpartum 

66590 Ob trauma NOS-unspec 

66591 Ob trauma NOS-delivered 

66592 Ob trauma NOS-del w p/p 

66593 Ob trauma NOS-antepartum 

66594 Ob trauma NOS-postpartum 

66600 Third-stage hem-unspec 

66602 Thrd-stage hem-del w p/p 

66604 Third-stage hem-postpart 

66610 Postpartum hem NEC-unsp 

66612 Postpa hem NEC-del w p/p 

66614 Postpart hem NEC-postpar 

66620 Delay p/part hem-unspec 

66622 Delay p/p hem-del w p/p 

66624 Delay p/part hem-postpar 

66630 Postpart coagul def-unsp 

66632 P/p coag def-del w p/p 

66634 Postpart coag def-postpa 

66700 Retain placenta NOS-unsp 

66702 Retnd plac NOS-del w p/p 

66704 Retain plac NOS-postpart 

66710 Retain prod concept-unsp 

66712 Ret prod conc-del w p/p 

66714 Ret prod concept-postpar 

66800 Pulm compl in del-unspec 

66801 Pulm compl in del-deliv 

66802 Pulm complic-del w p/p 

66803 Pulm complicat-antepart 

66804 Pulm complicat-postpart 

66810 Heart compl in del-unsp 

66811 Heart compl in del-deliv 

66812 Heart compl-del w p/p 

66813 Heart complic-antepart 

66814 Heart complic-postpart 

66820 Cns compl labor/del-unsp 

66821 Cns compl lab/del-deliv 

66822 Cns complic-del w p/p 

66823 Cns compl in del-antepar 

66824 Cns compl in del-postpar 

66880 Anesth comp del NEC-unsp 

66881 Anesth compl NEC-deliver 

66882 Anesth compl NEC-del p/p 

66883 Anesth compl antepartum 

66884 Anesth compl-postpartum 

66890 Anesth comp del NOS-unsp 

66891 Anesth compl NOS-deliver 

66892 Anesth compl NOS-del p/p 

66893 Anesth compl-antepartum 


66900 Maternal distress-unspec 

66901 Maternal distress-deliv 

66902 Matern distres-del w p/p 

66903 Matern distress-antepar 

66904 Matern distress-postpart 

66910 Obstetric shock-unspec 

66911 Obstetric shock-deliver 

66912 Obstet shock-deliv w p/p 

66913 Obstetric shock-antepar 

66914 Obstetric shock-postpart 

66920 Matern hypotens syn-unsp 

66921 Matern hypoten syn-deliv 

66922 Matern hypoten-del w p/p 

66923 Matern hypotens-antepar 

66924 Matern hypotens-postpart 

66930 Ac kidny fail w del-unsp 

66932 Ac kidney fail-del w p/p 

66934 Ac kidney fail-postpart 

66940 Oth ob surg compl-unspec 

66941 Oth ob compl-delivered 

66942 Oth ob compl-deliv w p/p 

66943 Complc ob surg anteprtm 

66944 Oth ob surg compl-postpa 

66950 Forcep deliv NOS-unspec 

66951 Forcep deliv NOS-deliver 

66960 Breech extr NOS-unspec 

66961 Breech extr NOS-deliver 

66970 Cesarean deliv NOS-unsp 

66971 Cesarean delivery NOS 

66980 Compl lab/deliv NEC-unsp 

66981 Comp lab/deliv NEC-deliv 

66982 Compl del NEC-del w p/p 

66983 Compl deliv NEC-antepar 

66984 Compl deliv NEC-postpart 

66990 Compl lab/deliv NOS-unsp 

66991 Comp lab/deliv NOS-deliv 

66992 Compl del NOS-del w p/p 

66993 Compl deliv NOS-antepar 

66994 Compl deliv NOS-postpart 

67000 Maj puerp inf NOS-unsp 

67002 Maj puer inf NOS-del p/p 

67004 Major puerp inf NOS-p/p 

67010 Puerp endometritis-unsp 

67012 Puerp endomet del w p/p 

67014 Puerp endomet-postpart 

67020 Puerperal sepsis-unsp 

67022 Puerprl sepsis-del w p/p 

67024 Puerperl sepsis-postpart 

67030 Puerp septc thromb-unsp 

67032 Prp sptc thrmb-del w p/p 

67034 Prp septc thrmb-postpart 

67080 Maj prp infec NEC-unspec 

67082 Maj prp inf NEC-dl w p/p 

67084 Maj puerp infec NEC-p/p 

67100 Varic vein leg preg-unsp 

67101 Varicose vein leg-deliv 

67102 Varic vein leg-del w p/p 

67103 Varic vein leg-antepart 

67104 Varic vein leg-postpart 

67110 Varic vulva preg-unspec 

67111 Varicose vulva-delivered 

67112 Varicose vulva-del w p/p 

67113 Varicose vulva-antepart 

67114 Varicose vulva-postpart 

67120 Thrombophleb preg-unspec 

67121 Thrombophlebitis-deliver 

67122 Thrombophleb-deliv w p/p 

67123 Thrombophlebit-antepart 

67124 Thrombophlebit-postpart 

67130 Deep thromb antepar-unsp 

67131 Deep throm antepar-deliv 

67133 Deep vein thromb-antepar 

67140 Deep thromb postpar-unsp 

67142 Thromb postpar-del w p/p 

67144 Deep vein thromb-postpar 

67150 Thrombosis NEC preg-unsp 

67151 Thrombosis NEC-delivered 

67152 Thromb NEC-deliv w p/p 



67693 Lactat dis NOS-antepart 

67694 Lactat dis NOS-postpart 

67800 Fetal hematologic-unspec 

67801 Fetal hematologic-deliv 

67803 Fetal hematologic-ante 

67810 Fetal conjoin twins-unsp 

67811 Fetal conjoin twins-del 

67813 Fetal conjoin twins-ante 

67900 Mat comp in utero-unsp 

67901 Mat comp in utero-del 

67902 Mat comp in utro-del-p/p 

67903 Mat comp in utero-ante 

67904 Mat comp in utero-p/p 

67910 Fetal comp in utero-unsp 

67911 Fetal comp in utero-del 

67912 Ftl cmp in utro-del-p/p 

67913 Fetal comp in utero-ante 

67914 Fetal comp in utero-p/p 

7923 Abn find-amniotic fluid 

7965 Abn find antenatl screen 

V230 Preg w hx of infertility 

V231 Preg w hx-trophoblas dis 

V232 Preg w hx of abortion 

V233 Grand multiparity 

V2341 Preg w hx pre-term labor 

V2349 Preg w poor obs hx NEC 

V235 Preg w poor reproduct hx 

V237 Insufficnt prenatal care 

V2381 Suprv elderly primigrav 

V2382 Suprv elderly multigrav 

V2383 Suprv young primigravida 

V2384 Suprv young multigravida 

V2385 Pregnt-assist repro tech 

V2386 Preg-hx in utro prev prg 

V2389 Suprv high-risk preg NEC 

V239 Suprv high-risk preg NOS 

V240 Postpart care after del 

V270 Deliver-single liveborn 

V271 Deliver-single stillborn 

V272 Deliver-twins, both live 

V273 Del-twins, 1 nb, 1 sb 

V274 Deliver-twins, both sb 

V275 Del-mult birth, all live 

V276 Del-mult brth, some live 

V277 Del-mult birth, all sb 

V279 Outcome of delivery NOS 

V280 Screening-chromosom anom 

V281 Screen-alphafetoprotein 

V282 Screen by amniocent NEC 

V286 Antenatal screen strep b 

V2881 Scrn fetal anatmc survey 

V2882 Scrn risk preterm labor 

V2889 Antenatal screening NEC 

V616 Illegitimate pregnancy 

V617 Unwanted pregnancy NEC 

V7242 Pregnancy test-positive 

V8901 Sus amntc cav/mem nt fnd 

V8902 Sus placentl prob nt fnd 

V8903 Sus fetal anomaly nt fnd 

V8904 Sus fetal growth not fnd 

V8905 Sus cervcl shortn nt fnd 

V8909 Oth sus mat/ftl nt fnd 

October 2009 


Adult diagnoses (age greater than 14) 

25631 Premature menopause 

2900 Senile dementia uncomp 

29010 Presenile dementia 

29011 Presenile delirium 

29012 Presenile delusion 

29013 Presenile depression 

29020 Senile delusion 

29021 Senile depressive 

2903 Senile delirium 

29040 Vascular dementia,uncomp 

29041 Vasc dementia w delirium 

29042 Vasc dementia w delusion 

29043 Vasc dementia w depressn 

2909 Senile psychot cond NOS 

33520 Amyotrophic sclerosis 

36610 Senile cataract NOS 

36611 Pseudoexfol lens capsule 

36612 Incipient cataract 

36613 Ant subcaps senile catar 

36614 Post subcap senile catar 

36615 Cortical senile cataract 

36616 Senile nuclear cataract 

36617 Mature cataract 

36618 Hypermature cataract 

36619 Senile cataract NEC 

37401 Senile entropion 

37411 Senile ectropion 

41400 Cor ath unsp vsl ntv/gft 

41401 Crnry athrscl natve vssl 

41402 Crn ath atlg vn bps grft 

41403 Crn ath nonatlg blg grft 

41404 Cor ath artry bypas grft 

41405 Cor ath bypass graft NOS 

41407 Cor ath bps graft tp hrt 

4143 Cor ath d/t lpd rch plaq 

42971 Acq cardiac septl defect 

42979 Other sequelae of MI NEC 

4370 Cerebral atherosclerosis 

4400 Aortic atherosclerosis 

4401 Renal artery atheroscler 

44020 Athscl extrm ntv art NOS 

44021 Ath ext ntv at w claudct 

44022 Ath ext ntv at w rst pn 

44023 Ath ext ntv art ulcrtion 

44029 Athrsc extrm ntv art oth 

44030 Athscl extrm bps gft NOS 

44031 Ath ext autologs bps gft 

44032 Ath ext nonautlg bps gft 

4408 Atherosclerosis NEC 

4409 Atherosclerosis NOS 

4540 Leg varicosity w ulcer 

4541 Leg varicosity w inflam 

4542 Varicos leg ulcer/inflam 

4549 Asympt varicose veins 

4570 Postmastect lymphedema 

500 Coal workers' pneumocon 

501 Asbestosis 

5710 Alcoholic fatty liver 

5711 Ac alcoholic hepatitis 

5712 Alcohol cirrhosis liver 

5713 Alcohol liver damage NOS 

60000 BPH w/o urinary obs/LUTS 

60001 BPH w urinary obs/LUTS 

60010 Nod prostate w/o ur obst 

60011 Nod prostate w ur obst 

60020 BPH loc w/o ur obs/LUTS 

60021 BPH loc w urin obs/LUTS 

6003 Cyst of prostate 

60090 BPH NOS w/o ur obs/LUTS 

60091 BPH NOS w ur obs/LUTS 

6010 Acute prostatitis 

6011 Chronic prostatitis 

6012 Abscess of prostate 

6013 Prostatocystitis 

6014 Prostatitis in oth dis 

6018 Prostatic inflam dis NEC 

6019 Prostatitis NOS 

6020 Calculus of prostate 

6021 Prostatic congest/hemorr 

6022 Atrophy of prostate 

6028 Prostatic disorders NEC 

6029 Prostatic disorder NOS 

6060 Azoospermia 

6061 Oligospermia 

6068 Male infertility NEC 

6069 Male infertility NOS 

60784 Impotence, organic orign 

6101 Diffus cystic mastopathy 

61181 Ptosis of breast 

61182 Hypoplasia of breast 

61183 Capslr contrctr brst imp 

6120 Deformity reconst breast 

6121 Disproportn reconst brst 

7286 Contracted palmar fascia 

7837 Failure to thrive-adult 

79093 Elvtd prstate spcf antgn 

79981 Decreased libido 

99580 Adult maltreatment NOS 

99581 Adult physical abuse 

99582 Adult emotnl/psych abuse 

99583 Adult sexual abuse 

99584 Adult neglect-nutrition 

99585 Oth adult abuse/neglect 

V2385 Pregnt-assist repro tech 

V4981 Asympt postmeno status 

V510 Brst reconst fol mastect 

V6221 Hx military deployment 

V6222 Hx retrn military deploy 

V6229 Occupationl circumst NEC 

V7101 Obsv-adult antisoc behav 

V850 BMI less than 19,adult 

V851 BMI between 19-24,adult 

V8521 BMI 25.0-25.9,adult 

V8522 BMI 26.0-26.9,adult 

V8523 BMI 27.0-27.9,adult 

V8524 BMI 28.0-28.9,adult 

V8525 BMI 29.0-29.9,adult 

V8530 BMI 30.0-30.9,adult 

V8531 BMI 31.0-31.9,adult 

V8532 BMI 32.0-32.9,adult 

V8533 BMI 33.0-33.9,adult 

V8534 BMI 34.0-34.9,adult 

V8535 BMI 35.0-35.9,adult 

V8536 BMI 36.0-36.9,adult 

V8537 BMI 37.0-37.9,adult 

V8538 BMI 38.0-38.9,adult 

V8539 BMI 39.0-39.9,adult 

V854 BMI 40 and over,adult 


5. Sex conflict Medicare Code Editor detects inconsistencies between a patient’s sex 

and any diagnosis or procedure on the patient’s 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 patient’s diagnosis, 

procedure or sex is presumed to be incorrect. 

The following pages contain lists of male and female related 

ICD-9-CM diagnosis and procedure codes with corresponding 

English descriptions. 

October 2009 


Diagnoses allowed for females only 

01660 TB ovary & tube-unspec 

01661 TB ovary & tube-no exam 

01662 TB ovary/tube-exam unkn 

01663 TB ovary & tube-micro dx 

01664 TB ovary & tube-cult dx 

01665 TB ovary & tube-histo dx 

01666 TB ovary & tube-oth test 

01670 TB female gen NEC-unspec 

01671 TB fem gen NEC-no exam 

01672 TB fem gen NEC-exam unkn 

01673 TB fem gen NEC-micro dx 

01674 TB fem gen NEC-cult dx 

01675 TB fem gen NEC-histo dx 

01676 TB fem gen NEC-oth test 

05411 Herpetic vulvovaginitis 

05412 Herpetic ulcer of vulva 

09815 Gc cervicitis (acute) 

09816 Gc endometritis (acute) 

09817 Acute gc salpingitis 

09835 Gc cervicitis, chronic 

09836 Gc endometritis, chronic 

09837 Gc salpingitis (chronic) 

1121 Candidal vulvovaginitis 

13101 Trichomonal vaginitis 

1740 Malig neo nipple 

1741 Mal neo breast-central 

1742 Mal neo breast up-inner 

1743 Mal neo breast low-inner 

1744 Mal neo breast up-outer 

1745 Mal neo breast low-outer 

1746 Mal neo breast-axillary 

1748 Malign neopl breast NEC 

1749 Malign neopl breast NOS 

179 Malig neopl uterus NOS 

1800 Malig neo endocervix 

1801 Malig neo exocervix 

1808 Malig neo cervix NEC 

1809 Mal neo cervix uteri NOS 

181 Malignant neopl placenta 

1820 Malig neo corpus uteri 

1821 Mal neo uterine isthmus 

1828 Mal neo body uterus NEC 

1830 Malign neopl ovary 

1832 Mal neo fallopian tube 

1833 Mal neo broad ligament 

1834 Malig neo parametrium 

1835 Mal neo round ligament 

1838 Mal neo adnexa NEC 

1839 Mal neo adnexa NOS 

1840 Malign neopl vagina 

1841 Mal neo labia majora 

1842 Mal neo labia minora 

1843 Malign neopl clitoris 

1844 Malign neopl vulva NOS 

1848 Mal neo female genit NEC 

1849 Mal neo female genit NOS 

1986 Second malig neo ovary 

2180 Submucous leiomyoma 

2181 Intramural leiomyoma 

2182 Subserous leiomyoma 

2189 Uterine leiomyoma NOS 

2190 Benign neo cervix uteri 

2191 Benign neo corpus uteri 

2198 Benign neo uterus NEC 

2199 Benign neo uterus NOS 

220 Benign neoplasm ovary 

2210 Ben neo fallopian tube 

2211 Benign neoplasm vagina 

2212 Benign neoplasm vulva 

2218 Ben neo fem genital NEC 

2219 Ben neo fem genital NOS 

2331 Ca in situ cervix uteri 

2332 Ca in situ uterus NEC 

23330 Ca in situ fem gen NOS 

23331 Carcinoma in situ vagina 

23332 Carcinoma in situ vulva 

23339 Ca in situ fem gen NEC 

2360 Uncert behav neo uterus 

2361 Unc behav neo placenta 

2362 Unc behav neo ovary 

2363 Unc behav neo female NEC 

2560 Hyperestrogenism 

2561 Ovarian hyperfunc NEC 

2562 Postablativ ovarian fail 

25631 Premature menopause 

25639 Ovarian failure NEC 

2564 Polycystic ovaries 

2568 Ovarian dysfunction NEC 

2569 Ovarian dysfunction NOS 

30273 Female orgasmic disorder 

30276 Dyspareunia,psychogenic 

30651 Psychogenic vaginismus 

30652 Psychogenic dysmenorrhea 

34640 Menst mgr wo ntrc wo st 

34641 Menstl mgrn w ntrc wo st 

34642 Menstl mgr wo ntrc w st 

34643 Menstl mgrn w ntrc w st 

4566 Vulval varices 

6140 Ac salpingo-oophoritis 

6141 Chr salpingo-oophoritis 

6142 Salpingo-oophoritis NOS 

6143 Acute parametritis 

6144 Chronic parametritis 

6145 Ac pelv peritonitis-fem 

6146 Fem pelvic periton adhes 

6147 Chr pelv periton NEC-fem 

6148 Fem pelv inflam dis NEC 

6149 Fem pelv inflam dis NOS 

6150 Ac uterine inflammation 

6151 Chr uterine inflammation 

6159 Uterine inflam dis NOS 

6160 Cervicitis 

61610 Vaginitis NOS 

61611 Vaginitis in oth disease 

6162 Bartholin's gland cyst 

6163 Bartholin's glnd abscess 

6164 Abscess of vulva NEC 

61650 Ulceration of vulva NOS 

61651 Vulvar ulcer in oth dis 

61681 Mucositis cerv,vag,vulva 

61689 Inflm cerv,vag,vulva NEC 

6169 Female gen inflam NOS 

6170 Uterine endometriosis 

6171 Ovarian endometriosis 

6172 Tubal endometriosis 

6173 Pelv perit endometriosis 

6174 Vaginal endometriosis 

6175 Intestinal endometriosis 

6176 Endometriosis in scar 

6178 Endometriosis NEC 



6179 Endometriosis NOS 

61800 Vaginal wall prolpse NOS 

61801 Cystocele, midline 

61802 Cystocele, lateral 

61803 Urethrocele 

61804 Rectocele 

61805 Perineocele 

61809 Cystourethrocele 

6181 Uterine prolapse 

6182 Uterovag prolaps-incompl 

6183 Uterovag prolaps-complet 

6184 Utervaginal prolapse NOS 

6185 Postop vaginal prolapse 

6186 Vaginal enterocele 

6187 Old lacer pelvic muscle 

61881 Incomptnce pubocerv tiss 

61882 Incomptnce rectovag tiss 

61883 Pelvic muscle wasting 

61884 Cervical stump prolapse 

61889 Genital prolapse NEC 

6189 Genital prolapse NOS 

6190 Urin-genital fistul, fem 

6191 Digest-genit fistul, fem 

6192 Genital-skin fistul, fem 

6198 Fem genital fistula NEC 

6199 Fem genital fistula NOS 

6200 Follicular cyst of ovary 

6201 Corpus luteum cyst 

6202 Ovarian cyst NEC/NOS 

6203 Acq atrophy ovary & tube 

6204 Prolapse of ovary & tube 

6205 Torsion of ovary or tube 

6206 Broad ligament lacer syn 

6207 Broad ligament hematoma 

6208 Noninfl dis ova/adnx NEC 

6209 Noninfl dis ova/adnx NOS 

6210 Polyp of corpus uteri 

6211 Chr uterine subinvolutn 

6212 Hypertrophy of uterus 

62130 Endometrial hyperpla NOS 

62131 Simp endo hyper w/o atyp 

62132 Comp endo hyper w/o atyp 

62133 Endomet hyperpla w atyp 

62134 Ben endomet hyperplasia 

62135 Endomet intraepithl neop 

6214 Hematometra 

6215 Intrauterine synechiae 

6216 Malposition of uterus 

6217 Chr inversion of uterus 

6218 Disorders of uterus NEC 

6219 Disorder of uterus NOS 

6220 Erosion/ectropion cervix 

62210 Dysplasia of cervix NOS 

62211 Mild dysplasia of cervix 

62212 Mod dysplasia of cervix 

6222 Leukoplakia of cervix 

6223 Old laceration of cervix 

6224 Stricture of cervix 

6225 Incompetence of cervix 

6226 Hypertrophic elong cervx 

6227 Mucous polyp of cervix 

6228 Noninflam dis cervix NEC 

6229 Noninflam dis cervix NOS 

6230 Dysplasia of vagina 

6231 Leukoplakia of vagina 

6232 Stricture of vagina 

6233 Tight hymenal ring 

6234 Old vaginal laceration 

6235 Noninfect vag leukorrhea 

6236 Vaginal hematoma 

6237 Polyp of vagina 

6238 Noninflam dis vagina NEC 

6239 Noninflam dis vagina NOS 

62401 Vulvar intraeph neopl I 

62402 Vulvr intraepth neopl II 

62409 Dystrophy of vulva NEC 

6241 Atrophy of vulva 

6242 Hypertrophy of clitoris 

6243 Hypertrophy of labia 

6244 Old laceration of vulva 

6245 Hematoma of vulva 

6246 Polyp of labia and vulva 

6248 Noninflam dis vulva NEC 

6249 Noninflam dis vulva NOS 

6250 Dyspareunia 

6251 Vaginismus 

6252 Mittelschmerz 

6253 Dysmenorrhea 

6254 Premenstrual tension 

6255 Pelvic congestion synd 

6256 Fem stress incontinence 

62570 Vulvodynia NOS 

62571 Vulvar vestibulitis 

62579 Other vulvodynia 

6258 Fem genital symptoms NEC 

6259 Fem genital symptoms NOS 

6260 Absence of menstruation 

6261 Scanty menstruation 

6262 Excessive menstruation 

6263 Pubertal menorrhagia 

6264 Irregular menstruation 

6265 Ovulation bleeding 

6266 Metrorrhagia 

6267 Postcoital bleeding 

6268 Menstrual disorder NEC 

6269 Menstrual disorder NOS 

6270 Premenopause menorrhagia 

6271 Postmenopausal bleeding 

6272 Sympt fem climact state 

6273 Atrophic vaginitis 

6274 Sympt state w artif meno 

6278 Menopausal disorder NEC 

6279 Menopausal disorder NOS 

6280 Infertility-anovulation 

6281 Infertil-pituitary orig 

6282 Infertility-tubal origin 

6283 Infertility-uterine orig 

6284 Infertil-cervical orig 

6288 Female infertility NEC 

6289 Female infertility NOS 

6290 Hematocele, female NEC 

6291 Hydrocele canal nuck-fem 

62920 Genital mutilation NOS 

62921 Genital mutilatn type I 

62922 Genital mutilatn type II 

62923 Genital muilatn type III 

62929 Fem genital mutilate NEC 

62981 Hab abortr w/o curr preg 

62989 Female genital disor NEC 

6299 Female genital dis NOS 

630 Hydatidiform mole 

631 Oth abn prod conception 

632 Missed abortion 

63300 Abd preg w/o intrau preg 

63301 Abd preg w intraut preg 

63310 Tubal preg w/o intra prg 

October 2009 



63311 Tubal preg w intra preg 

63320 Ovarn preg w/o intra prg 

63321 Ovarian preg w intra prg 

63380 Ect preg NEC w/o int prg 

63381 Ectpc prg NEC w int preg 

63390 Ect preg NOS w/o int prg 

63391 Ectp preg NOS w int preg 

63400 Spon abor w pel inf-unsp 

63401 Spon abor w pelv inf-inc 

63402 Spon abor w pel inf-comp 

63410 Spon abort w hemorr-unsp 

63411 Spon abort w hemorr-inc 

63412 Spon abort w hemorr-comp 

63420 Spon ab w pel damag-unsp 

63421 Spon ab w pelv damag-inc 

63422 Spon ab w pel damag-comp 

63430 Spon ab w ren fail-unsp 

63431 Spon ab w ren fail-inc 

63432 Spon ab w ren fail-comp 

63440 Spon ab w metab dis-unsp 

63441 Spon ab w metab dis-inc 

63442 Spon ab w metab dis-comp 

63450 Spon abort w shock-unsp 

63451 Spon abort w shock-inc 

63452 Spon abort w shock-comp 

63460 Spon abort w embol-unsp 

63461 Spon abort w embol-inc 

63462 Spon abort w embol-comp 

63470 Spon ab w compl NEC-unsp 

63471 Spon ab w compl NEC-inc 

63472 Spon ab w compl NEC-comp 

63480 Spon ab w compl NOS-unsp 

63481 Spon ab w compl NOS-inc 

63482 Spon ab w compl NOS-comp 

63490 Spon abort uncompl-unsp 

63491 Spon abort uncompl-inc 

63492 Spon abort uncompl-comp 

63500 Leg abor w pelv inf-unsp 

63501 Leg abor w pelv inf-inc 

63502 Leg abor w pelv inf-comp 

63510 Legal abor w hemorr-unsp 

63511 Legal abort w hemorr-inc 

63512 Legal abor w hemorr-comp 

63520 Leg ab w pelv damag-unsp 

63521 Leg ab w pelv damag-inc 

63522 Leg ab w pelv damag-comp 

63530 Leg abor w ren fail-unsp 

63531 Leg abor w ren fail-inc 

63532 Leg abor w ren fail-comp 

63540 Leg ab w metab dis-unsp 

63541 Leg ab w metab dis-inc 

63542 Leg ab w metab dis-comp 

63550 Legal abort w shock-unsp 

63551 Legal abort w shock-inc 

63552 Legal abort w shock-comp 

63560 Legal abort w embol-unsp 

63561 Legal abort w embol-inc 

63562 Legal abort w embol-comp 

63570 Leg ab w compl NEC-unsp 

63571 Leg ab w compl NEC-inc 

63572 Leg ab w compl NEC-comp 

63580 Leg ab w compl NOS-unsp 

63581 Leg ab w compl NOS-inc 

63582 Leg ab w compl NOS-comp 

63590 Legal abort uncompl-unsp 

63591 Legal abort uncompl-inc 

63592 Legal abort uncompl-comp 

63600 Illeg ab w pelv inf-unsp 

63601 Illeg ab w pelv inf-inc 

63602 Illeg ab w pelv inf-comp 

63610 Illeg ab w hemorr-unspec 

63611 Illeg ab w hemorr-inc 

63612 Illeg ab w hemorr-comp 

63620 Illeg ab w pel damg-unsp 

63621 Illeg ab w pel damag-inc 

63622 Illeg ab w pel damg-comp 

63630 Illeg ab w ren fail-unsp 

63631 Illeg ab w ren fail-inc 

63632 Illeg ab w ren fail-comp 

63640 Illeg ab w met dis-unsp 

63641 Illeg ab w metab dis-inc 

63642 Illeg ab w met dis-comp 

63650 Illeg abort w shock-unsp 

63651 Illeg abort w shock-inc 

63652 Illeg abort w shock-comp 

63660 Illeg ab w embolism-unsp 

63661 Illeg ab w embolism-inc 

63662 Illeg ab w embolism-comp 

63670 Illg ab w compl NEC-unsp 

63671 Illeg ab w compl NEC-inc 

63672 Illg ab w compl NEC-comp 

63680 Illg ab w compl NOS-unsp 

63681 Illeg ab w compl NOS-inc 

63682 Illg ab w compl NOS-comp 

63690 Illeg abort uncompl-unsp 

63691 Illeg abort uncompl-inc 

63692 Illeg abort uncompl-comp 

63700 Abort NOS w pel inf-unsp 

63701 Abort NOS w pel inf-inc 

63702 Abort NOS w pel inf-comp 

63710 Abort NOS w hemorr-unsp 

63711 Abort NOS w hemorr-inc 

63712 Abort NOS w hemorr-comp 

63720 Ab NOS w pelv damag-unsp 

63721 Ab NOS w pelv damag-inc 

63722 Ab NOS w pelv damag-comp 

63730 Ab NOS w renal fail-unsp 

63731 Ab NOS w renal fail-inc 

63732 Ab NOS w renal fail-comp 

63740 Ab NOS w metab dis-unsp 

63741 Ab NOS w metab dis-inc 

63742 Ab NOS w metab dis-comp 

63750 Abort NOS w shock-unsp 

63751 Abort NOS w shock-inc 

63752 Abort NOS w shock-comp 

63760 Ab NOS w embolism-unsp 

63761 Ab NOS w embolism-inc 

63762 Ab NOS w embolism-comp 

63770 Ab NOS w compl NEC-unsp 

63771 Ab NOS w compl NEC-inc 

63772 Ab NOS w compl NEC-comp 

63780 Ab NOS w compl NOS-unsp 

63781 Ab NOS w compl NOS-inc 

63782 Ab NOS w compl NOS-comp 

63790 Ab NOS uncomplicat-unsp 

63791 Ab NOS uncomplicat-inc 

63792 Ab NOS uncomplicat-comp 

6380 Attem abort w pelvic inf 

6381 Attem abort w hemorrhage 

6382 Attem abort w pelv damag 

6383 Attem abort w renal fail 

6384 Attem abor w metabol dis 

6385 Attem abortion w shock 

6386 Attemp abort w embolism 

6387 Attemp abort w compl NEC 

6388 Attemp abort w compl NOS 



6389 Attempted abort uncompl 

6390 Postabortion gu infect 

6391 Postabortion hemorrhage 

6392 Postabort pelvic damage 

6393 Postabort kidney failure 

6394 Postabort metabolic dis 

6395 Postabortion shock 

6396 Postabortion embolism 

6398 Postabortion compl NEC 

6399 Postabortion compl NOS 

64000 Threatened abort-unspec 

64001 Threatened abort-deliver 

64003 Threaten abort-antepart 

64080 Hem early preg NEC-unsp 

64081 Hem early preg NEC-deliv 

64083 Hem early pg NEC-antepar 

64090 Hemorr early preg-unspec 

64091 Hem early preg-delivered 

64093 Hem early preg-antepart 

64100 Placenta previa-unspec 

64101 Placenta previa-deliver 

64103 Placenta previa-antepart 

64110 Placenta prev hem-unspec 

64111 Placenta prev hem-deliv 

64113 Placen prev hem-antepart 

64120 Prem separ placen-unspec 

64121 Prem separ placen-deliv 

64123 Prem separ plac-antepart 

64130 Coag def hemorr-unspec 

64131 Coag def hemorr-deliver 

64133 Coag def hemorr-antepart 

64180 Antepart hem NEC-unspec 

64181 Antepartum hem NEC-deliv 

64183 Antepart hem NEC-antepar 

64190 Antepart hem NOS-unspec 

64191 Antepartum hem NOS-deliv 

64193 Antepart hem NOS-antepar 

64200 Essen hyperten preg-unsp 

64201 Essen hyperten-delivered 

64202 Essen hyperten-del w p/p 

64203 Essen hyperten-antepart 

64204 Essen hyperten-postpart 

64210 Renal hyperten preg-unsp 

64211 Renal hyperten pg-deliv 

64212 Renal hyperten-del p/p 

64213 Renal hyperten-antepart 

64214 Renal hyperten-postpart 

64220 Old hyperten preg-unspec 

64221 Old hyperten NEC-deliver 

64222 Old hyperten-deliv w p/p 

64223 Old hyperten NEC-antepar 

64224 Old hyperten NEC-postpar 

64230 Trans hyperten preg-unsp 

64231 Trans hyperten-delivered 

64232 Trans hyperten-del w p/p 

64233 Trans hyperten-antepart 

64234 Trans hyperten-postpart 

64240 Mild/NOS preeclamp-unsp 

64241 Mild/NOS preeclamp-deliv 

64242 Mild preeclamp-del w p/p 

64243 Mild/NOS preeclamp-antep 

64244 Mild/NOS preeclamp-p/p 

64250 Severe preeclamp-unspec 

64251 Severe preeclamp-deliver 

64252 Sev preeclamp-del w p/p 

64253 Sev preeclamp-antepartum 

64254 Sev preeclamp-postpartum 

64260 Eclampsia-unspecified 

64261 Eclampsia-delivered 

64262 Eclampsia-deliv w p/p 

64263 Eclampsia-antepartum 

64264 Eclampsia-postpartum 

64270 Tox w old hyperten-unsp 

64271 Tox w old hyperten-deliv 

64272 Tox w old hyp-del w p/p 

64273 Tox w old hyper-antepart 

64274 Tox w old hyper-postpart 

64290 Hyperten preg NOS-unspec 

64291 Hypertens NOS-delivered 

64292 Hypertens NOS-del w p/p 

64293 Hypertens NOS-antepartum 

64294 Hypertens NOS-postpartum 

64300 Mild hyperem grav-unspec 

64301 Mild hyperem grav-deliv 

64303 Mild hyperemesis-antepar 

64310 Hyperem w metab dis-unsp 

64311 Hyperem w metab dis-del 

64313 Hyperem w metab-antepart 

64320 Late vomit of preg-unsp 

64321 Late vomit of preg-deliv 

64323 Late vomit preg-antepart 

64380 Vomit compl preg-unspec 

64381 Vomit compl preg-deliver 

64383 Vomit compl preg-antepar 

64390 Vomit of preg NOS-unspec 

64391 Vomit of preg NOS-deliv 

64393 Vomit of pg NOS-antepart 

64400 Threat prem labor-unspec 

64403 Thrt prem labor-antepart 

64410 Threat labor NEC-unspec 

64413 Threat labor NEC-antepar 

64420 Early onset deliv-unspec 

64421 Early onset delivery-del 

64510 Post term preg-unsp 

64511 Post term preg-del 

64513 Post term preg-antepar 

64520 Prolonged preg-unsp 

64521 Prolonged preg-del 

64523 Prolonged preg-antepar 

64600 Papyraceous fetus-unspec 

64601 Papyraceous fetus-deliv 

64603 Papyraceous fet-antepar 

64610 Edema in preg-unspec 

64611 Edema in preg-delivered 

64612 Edema in preg-del w p/p 

64613 Edema in preg-antepartum 

64614 Edema in preg-postpartum 

64620 Renal dis preg NOS-unsp 

64621 Renal dis NOS-delivered 

64622 Renal dis NOS-del w p/p 

64623 Renal dis NOS-antepartum 

64624 Renal dis NOS-postpartum 

64630 Habitual aborter-unspec 

64631 Habitual aborter-deliver 

64633 Habitual abort-antepart 

64640 Neuritis of preg-unspec 

64641 Neuritis-delivered 

64642 Neuritis-delivered w p/p 

64643 Neuritis of preg-antepar 

64644 Neuritis of preg-postpar 

64650 Bacteriuria preg-unspec 

64651 Asym bacteriuria-deliver 

64652 Asy bacteruria-del w p/p 

64653 Asy bacteriuria-antepart 

64654 Asy bacteriuria-postpart 

64660 Gu infect in preg-unspec 

October 2009 



64661 Gu infection-delivered 

64662 Gu infection-deliv w p/p 

64663 Gu infection-antepartum 

64664 Gu infection-postpartum 

64670 Liver dis in preg-unspec 

64671 Liver disorder-delivered 

64673 Liver disorder-antepart 

64680 Preg compl NEC-unspec 

64681 Preg compl NEC-delivered 

64682 Preg compl NEC-del w p/p 

64683 Preg compl NEC-antepart 

64684 Preg compl NEC-postpart 

64690 Preg compl NOS-unspec 

64691 Preg compl NOS-delivered 

64693 Preg compl NOS-antepart 

64700 Syphilis in preg-unspec 

64701 Syphilis-delivered 

64702 Syphilis-delivered w p/p 

64703 Syphilis-antepartum 

64704 Syphilis-postpartum 

64710 Gonorrhea in preg-unspec 

64711 Gonorrhea-delivered 

64712 Gonorrhea-deliver w p/p 

64713 Gonorrhea-antepartum 

64714 Gonorrhea-postpartum 

64720 Other VD in preg-unspec 

64721 Other vd-delivered 

64722 Other vd-delivered w p/p 

64723 Other vd-antepartum 

64724 Other vd-postpartum 

64730 TB in preg-unspecified 

64731 Tuberculosis-delivered 

64732 Tuberculosis-deliv w p/p 

64733 Tuberculosis-antepartum 

64734 Tuberculosis-postpartum 

64740 Malaria in preg-unspec 

64741 Malaria-delivered 

64742 Malaria-delivered w p/p 

64743 Malaria-antepartum 

64744 Malaria-postpartum 

64750 Rubella in preg-unspec 

64751 Rubella-delivered 

64752 Rubella-delivered w p/p 

64753 Rubella-antepartum 

64754 Rubella-postpartum 

64760 Oth virus in preg-unspec 

64761 Oth viral dis-delivered 

64762 Oth viral dis-del w p/p 

64763 Oth viral dis-antepartum 

64764 Oth viral dis-postpartum 

64780 Inf dis in preg NEC-unsp 

64781 Infect dis NEC-delivered 

64782 Infect dis NEC-del w p/p 

64783 Infect dis NEC-antepart 

64784 Infect dis NEC-postpart 

64790 Infect in preg NOS-unsp 

64791 Infect NOS-delivered 

64792 Infect NOS-deliver w p/p 

64793 Infect NOS-antepartum 

64794 Infect NOS-postpartum 

64800 Diabetes in preg-unspec 

64801 Diabetes-delivered 

64802 Diabetes-delivered w p/p 

64803 Diabetes-antepartum 

64804 Diabetes-postpartum 

64810 Thyroid dysfun preg-unsp 

64811 Thyroid dysfunc-deliver 

64812 Thyroid dysfun-del w p/p 

64813 Thyroid dysfunc-antepart 

64814 Thyroid dysfunc-postpart 

64820 Anemia in preg-unspec 

64821 Anemia-delivered 

64822 Anemia-delivered w p/p 

64823 Anemia-antepartum 

64824 Anemia-postpartum 

64830 Drug depend preg-unspec 

64831 Drug dependence-deliver 

64832 Drug dependen-del w p/p 

64833 Drug dependence-antepart 

64834 Drug dependence-postpart 

64840 Mental dis preg-unspec 

64841 Mental disorder-deliver 

64842 Mental dis-deliv w p/p 

64843 Mental disorder-antepart 

64844 Mental disorder-postpart 

64850 Congen CV dis preg-unsp 

64851 Congen CV dis-delivered 

64852 Congen CV dis-del w p/p 

64853 Congen CV dis-antepartum 

64854 Congen CV dis-postpartum 

64860 CV dis NEC preg-unspec 

64861 CV dis NEC preg-deliver 

64862 CV dis NEC-deliver w p/p 

64863 CV dis NEC-antepartum 

64864 CV dis NEC-postpartum 

64870 Bone disord in preg-unsp 

64871 Bone disorder-delivered 

64872 Bone disorder-del w p/p 

64873 Bone disorder-antepartum 

64874 Bone disorder-postpartum 

64880 Abn glucose in preg-unsp 

64881 Abn glucose toler-deliv 

64882 Abn glucose-deliv w p/p 

64883 Abn glucose-antepartum 

64884 Abn glucose-postpartum 

64890 Oth curr cond preg-unsp 

64891 Oth curr cond-delivered 

64892 Oth curr cond-del w p/p 

64893 Oth curr cond-antepartum 

64894 Oth curr cond-postpartum 

64900 Tobacco use disord-unsp 

64901 Tobacco use disor-delliv 

64902 Tobacco use dis-del-p/p 

64903 Tobacco use dis-antepart 

64904 Tobacco use dis-postpart 

64910 Obesity-unspecified 

64911 Obesity-delivered 

64912 Obesity-delivered w p/p 

64913 Obesity-antepartum 

64914 Obesity-postpartum 

64920 Bariatric surg stat-unsp 

64921 Bariatric surg stat-del 

64922 Bariatric surg-del w p/p 

64923 Bariatrc surg stat-antep 

64924 Bariatrc surg stat w p/p 

64930 Coagulation def-unspec 

64931 Coagulation def-deliv 

64932 Coagulatn def-del w p/p 

64933 Coagulation def-antepart 

64934 Coagulation def-postpart 

64940 Epilepsy-unspecified 

64941 Epilepsy-delivered 

64942 Epilepsy-delivered w p/p 

64943 Epilepsy-antepartum 

64944 Epilepsy-postpartum 

64950 Spotting-unspecified 



64951 Spotting-delivered 

64953 Spotting-antepartum 

64960 Uterine size descrp-unsp 

64961 Uterine size descrep-del 

64962 Uterine size-del w p/p 

64963 Uterine size des-antepar 

64964 Uterine size descrep-p/p 

64970 Cervical shortening-unsp 

64971 Cervical shortening-del 

64973 Cervical shortening-ante 

650 Normal delivery 

65100 Twin pregnancy-unspec 

65101 Twin pregnancy-delivered 

65103 Twin pregnancy-antepart 

65110 Triplet pregnancy-unspec 

65111 Triplet pregnancy-deliv 

65113 Triplet preg-antepartum 

65120 Quadruplet preg-unspec 

65121 Quadruplet preg-deliver 

65123 Quadruplet preg-antepart 

65130 Twins w fetal loss-unsp 

65131 Twins w fetal loss-del 

65133 Twins w fetal loss-ante 

65140 Triplets w fet loss-unsp 

65141 Triplets w fet loss-del 

65143 Triplets w fet loss-ante 

65150 Quads w fetal loss-unsp 

65151 Quads w fetal loss-del 

65153 Quads w fetal loss-ante 

65160 Mult ges w fet loss-unsp 

65161 Mult ges w fet loss-del 

65163 Mult ges w fet loss-ante 

65170 Mul gest-fet reduct unsp 

65171 Mult gest-fet reduct del 

65173 Mul gest-fet reduct ante 

65180 Multi gestat NEC-unspec 

65181 Multi gestat NEC-deliver 

65183 Multi gest NEC-antepart 

65190 Multi gestat NOS-unspec 

65191 Mult gestation NOS-deliv 

65193 Multi gest NOS-antepart 

65200 Unstable lie-unspecified 

65201 Unstable lie-delivered 

65203 Unstable lie-antepartum 

65210 Cephalic vers NOS-unspec 

65211 Cephalic vers NOS-deliv 

65213 Cephal vers NOS-antepart 

65220 Breech presentat-unspec 

65221 Breech presentat-deliver 

65223 Breech present-antepart 

65230 Transv/obliq lie-unspec 

65231 Transver/obliq lie-deliv 

65233 Transv/obliq lie-antepar 

65240 Face/brow present-unspec 

65241 Face/brow present-deliv 

65243 Face/brow pres-antepart 

65250 High head at term-unspec 

65251 High head at term-deliv 

65253 High head term-antepart 

65260 Mult gest malpresen-unsp 

65261 Mult gest malpres-deliv 

65263 Mult ges malpres-antepar 

65270 Prolapsed arm-unspec 

65271 Prolapsed arm-delivered 

65273 Prolapsed arm-antepart 

65280 Malposition NEC-unspec 

65281 Malposition NEC-deliver 

65283 Malposition NEC-antepart 

65290 Malposition NOS-unspec 

65291 Malposition NOS-deliver 

65293 Malposition NOS-antepart 

65300 Pelvic deform NOS-unspec 

65301 Pelvic deform NOS-deliv 

65303 Pelv deform NOS-antepart 

65310 Contract pelv NOS-unspec 

65311 Contract pelv NOS-deliv 

65313 Contrac pelv NOS-antepar 

65320 Inlet contraction-unspec 

65321 Inlet contraction-deliv 

65323 Inlet contract-antepart 

65330 Outlet contraction-unsp 

65331 Outlet contraction-deliv 

65333 Outlet contract-antepart 

65340 Fetopelv disprop-unspec 

65341 Fetopelv dispropor-deliv 

65343 Fetopel disprop-antepart 

65350 Fetal disprop NOS-unspec 

65351 Fetal disprop NOS-deliv 

65353 Fetal dispro NOS-antepar 

65360 Hydrocephal fetus-unspec 

65361 Hydroceph fetus-deliver 

65363 Hydroceph fetus-antepart 

65370 Oth abn fet disprop-unsp 

65371 Oth abn fet dispro-deliv 

65373 Oth abn fet dispro-antep 

65380 Disproportion NEC-unspec 

65381 Disproportion NEC-deliv 

65383 Dispropor NEC-antepartum 

65390 Disproportion NOS-unspec 

65391 Disproportion NOS-deliv 

65393 Dispropor NOS-antepartum 

65400 Cong abn uter preg-unsp 

65401 Congen abn uterus-deliv 

65402 Cong abn uter-del w p/p 

65403 Congen abn uter-antepart 

65404 Congen abn uter-postpart 

65410 Uter tumor in preg-unsp 

65411 Uterine tumor-delivered 

65412 Uterine tumor-del w p/p 

65413 Uterine tumor-antepartum 

65414 Uterine tumor-postpartum 

65420 Prev c-delivery unspec 

65421 Prev c-delivery-delivrd 

65423 Prev c-delivery-antepart 

65430 Retrovert uterus-unspec 

65431 Retrovert uterus-deliver 

65432 Retrovert uter-del w p/p 

65433 Retrovert uter-antepart 

65434 Retrovert uter-postpart 

65440 Abn grav uterus NEC-unsp 

65441 Abn uterus NEC-delivered 

65442 Abn uterus NEC-del w p/p 

65443 Abn uterus NEC-antepart 

65444 Abn uterus NEC-postpart 

65450 Cerv incompet preg-unsp 

65451 Cervical incompet-deliv 

65452 Cerv incompet-del w p/p 

65453 Cerv incompet-antepartum 

65454 Cerv incompet-postpartum 

65460 Abn cervix NEC preg-unsp 

65461 Abn cervix NEC-delivered 

65462 Abn cervix NEC-del w p/p 

65463 Abn cervix NEC-antepart 

65464 Abn cervix NEC-postpart 

65470 Abn vagina in preg-unsp 

65471 Abnorm vagina-delivered 

October 2009 



65472 Abnorm vagina-del w p/p 

65473 Abnorm vagina-antepartum 

65474 Abnorm vagina-postpartum 

65480 Abn vulva in preg-unspec 

65481 Abnormal vulva-delivered 

65482 Abnormal vulva-del w p/p 

65483 Abnormal vulva-antepart 

65484 Abnormal vulva-postpart 

65490 Abn pel NEC in preg-unsp 

65491 Abn pelv org NEC-deliver 

65492 Abn pelv NEC-deliv w p/p 

65493 Abn pelv org NEC-antepar 

65494 Abn pelv org NEC-postpar 

65500 Fetal cns malform-unspec 

65501 Fetal cns malform-deliv 

65503 Fetal cns malfor-antepar 

65510 Fetal chromos abn-unspec 

65511 Fetal chromoso abn-deliv 

65513 Fet chromo abn-antepart 

65520 Famil heredit dis-unspec 

65521 Famil heredit dis-deliv 

65523 Famil hered dis-antepart 

65530 Fet damg d/t virus-unsp 

65531 Fet damg d/t virus-deliv 

65533 Fet damg d/t virus-antep 

65540 Fet damg d/t dis-unspec 

65541 Fet damg d/t dis-deliver 

65543 Fet damg d/t dis-antepar 

65550 Fetal damg d/t drug-unsp 

65551 Fet damag d/t drug-deliv 

65553 Fet damg d/t drug-antepa 

65560 Radiat fetal damag-unsp 

65561 Radiat fetal damag-deliv 

65563 Radiat fet damag-antepar 

65570 Decrease fetl movmt unsp 

65571 Decrease fetal movmt del 

65573 Dec fetal movmt antepart 

65580 Fetal abnorm NEC-unspec 

65581 Fetal abnorm NEC-deliver 

65583 Fetal abnorm NEC-antepar 

65590 Fetal abnorm NOS-unspec 

65591 Fetal abnorm NOS-deliver 

65593 Fetal abnorm NOS-antepar 

65600 Fetal-maternal hem-unsp 

65601 Fetal-maternal hem-deliv 

65603 Fetal-matern hem-antepar 

65610 Rh isoimmunization-unsp 

65611 Rh isoimmunizat-deliver 

65613 Rh isoimmunizat-antepart 

65620 Abo isoimmunization-unsp 

65621 Abo isoimmunizat-deliver 

65623 Abo isoimmunizat-antepar 

65630 Fetal distress-unspec 

65631 Fetal distress-delivered 

65633 Fetal distress-antepart 

65640 Intrauterine death-unsp 

65641 Intrauter death-deliver 

65643 Intrauter death-antepart 

65650 Poor fetal growth-unspec 

65651 Poor fetal growth-deliv 

65653 Poor fetal grth-antepart 

65660 Excess fetal grth-unspec 

65661 Excess fetal grth-deliv 

65663 Excess fet grth-antepart 

65670 Oth placent cond-unspec 

65671 Oth placent cond-deliver 

65673 Oth placent cond-antepar 

65680 Fet/plac prob NEC-unspec 

65681 Fet/plac prob NEC-deliv 

65683 Fet/plac prob NEC-antepa 

65690 Fet/plac prob NOS-unspec 

65691 Fet/plac prob NOS-deliv 

65693 Fet/plac prob NOS-antepa 

65700 Polyhydramnios-unspec 

65701 Polyhydramnios-delivered 

65703 Polyhydramnios-antepart 

65800 Oligohydramnios-unspec 

65801 Oligohydramnios-deliver 

65803 Oligohydramnios-antepar 

65810 Prem rupt membran-unspec 

65811 Prem rupt membran-deliv 

65813 Prem rupt memb-antepart 

65820 Prolong rupt memb-unspec 

65821 Prolong rupt memb-deliv 

65823 Prolong rup memb-antepar 

65830 Artific rupt membr-unsp 

65831 Artific rupt membr-deliv 

65833 Artif rupt memb-antepart 

65840 Amniotic infection-unsp 

65841 Amniotic infection-deliv 

65843 Amniotic infect-antepart 

65880 Amniotic prob NEC-unspec 

65881 Amniotic prob NEC-deliv 

65883 Amnion prob NEC-antepart 

65890 Amniotic prob NOS-unspec 

65891 Amniotic prob NOS-deliv 

65893 Amnion prob NOS-antepart 

65900 Fail mechan induct-unsp 

65901 Fail mech induct-deliver 

65903 Fail mech induct-antepar 

65910 Fail induction NOS-unsp 

65911 Fail induction NOS-deliv 

65913 Fail induct NOS-antepart 

65920 Pyrexia in labor-unspec 

65921 Pyrexia in labor-deliver 

65923 Pyrexia in labor-antepar 

65930 Septicemia in labor-unsp 

65931 Septicem in labor-deliv 

65933 Septicem in labor-antepa 

65940 Grand multiparity-unspec 

65941 Grand multiparity-deliv 

65943 Grand multiparity-antepa 

65950 Elderly primigravid-unsp 

65951 Elderly primigravida-del 

65953 Elder primigravid-antepa 

65960 Elderly multigravida-uns 

65961 Elderly multigravida-del 

65963 Elderly multigravd-antep 

65970 Abn ftl hrt rate/rhy-uns 

65971 Abn ftl hrt rate/rhy-del 

65973 Abn ftl hrt rate/rhy-ant 

65980 Complic labor NEC-unsp 

65981 Complic labor NEC-deliv 

65983 Compl labor NEC-antepart 

65990 Complic labor NOS-unsp 

65991 Complic labor NOS-deliv 

65993 Compl labor NOS-antepart 

66000 Obstruct/fet malpos-unsp 

66001 Obstruc/fet malpos-deliv 

66003 Obstruc/fet malpos-antep 

66010 Bony pelv obstruc-unspec 

66011 Bony pelv obstruct-deliv 

66013 Bony pelv obstruc-antepa 

66020 Abn pelv tiss obstr-unsp 

66021 Abn pelv tis obstr-deliv 

66023 Abn pelv tis obstr-antep 



66030 Persist occipitpost-unsp 

66031 Persist occiptpost-deliv 

66033 Persist occiptpost-antep 

66040 Shoulder dystocia-unspec 

66041 Shoulder dystocia-deliv 

66043 Shoulder dystocia-antepa 

66050 Locked twins-unspecified 

66051 Locked twins-delivered 

66053 Locked twins-antepartum 

66060 Fail trial lab NOS-unsp 

66061 Fail trial lab NOS-deliv 

66063 Fail trial lab NOS-antep 

66070 Failed forcep NOS-unspec 

66071 Failed forceps NOS-deliv 

66073 Fail forceps NOS-antepar 

66080 Obstruc labor NEC-unspec 

66081 Obstruct labor NEC-deliv 

66083 Obstruc labor NEC-antepa 

66090 Obstruc labor NOS-unspec 

66091 Obstruct labor NOS-deliv 

66093 Obstruc labor NOS-antepa 

66100 Prim uterine inert-unsp 

66101 Prim uterine inert-deliv 

66103 Prim uter inert-antepart 

66110 Sec uterine inert-unspec 

66111 Sec uterine inert-deliv 

66113 Sec uterine inert-antepa 

66120 Uterine inertia NEC-unsp 

66121 Uterine inert NEC-deliv 

66123 Uterine inert NEC-antepa 

66130 Precipitate labor-unspec 

66131 Precipitate labor-deliv 

66133 Precipitate labor-antepa 

66140 Uter dystocia NOS-unspec 

66141 Uter dystocia NOS-deliv 

66143 Uter dystocia NOS-antepa 

66190 Abnormal labor NOS-unsp 

66191 Abnormal labor NOS-deliv 

66193 Abnorm labor NOS-antepar 

66200 Prolonged 1st stage-unsp 

66201 Prolong 1st stage-deliv 

66203 Prolong 1st stage-antepa 

66210 Prolonged labor NOS-unsp 

66211 Prolong labor NOS-deliv 

66213 Prolong labor NOS-antepa 

66220 Prolonged 2nd stage-unsp 

66221 Prolong 2nd stage-deliv 

66223 Prolong 2nd stage-antepa 

66230 Delay del 2nd twin-unsp 

66231 Delay del 2nd twin-deliv 

66233 Delay del 2 twin-antepar 

66300 Cord prolapse-unspec 

66301 Cord prolapse-delivered 

66303 Cord prolapse-antepartum 

66310 Cord around neck-unspec 

66311 Cord around neck-deliver 

66313 Cord around neck-antepar 

66320 Cord compress NEC-unspec 

66321 Cord compress NEC-deliv 

66323 Cord compres NEC-antepar 

66330 Cord entangle NEC-unspec 

66331 Cord entangle NEC-deliv 

66333 Cord entangl NEC-antepar 

66340 Short cord-unspecified 

66341 Short cord-delivered 

66343 Short cord-antepartum 

66350 Vasa previa-unspecified 

66351 Vasa previa-delivered 

66353 Vasa previa-antepartum 

66360 Vasc lesion cord-unspec 

66361 Vasc lesion cord-deliver 

66363 Vasc lesion cord-antepar 

66380 Cord complicat NEC-unsp 

66381 Cord complicat NEC-deliv 

66383 Cord compl NEC-antepart 

66390 Cord complicat NOS-unsp 

66391 Cord complicat NOS-deliv 

66393 Cord compl NOS-antepart 













66440 Ob perineal lac NOS-unsp 

66441 Ob perineal lac NOS-del 

66444 Perineal lac NOS-postpar 

66450 Ob perineal hematom-unsp 

66451 Ob perineal hematoma-del 

66454 Perin hematoma-postpart 

66460 Anal sphincter tear NOS 

66461 Anal sphincter tear-del 

66464 Anal sphinctr tear w p/p 

66480 Ob perin traum NEC-unsp 

66481 Ob perineal trau NEC-del 

66484 Perin traum NEC-postpart 

66490 Ob perin traum NOS-unsp 

66491 Ob perineal trau NOS-del 

66494 Perin traum NOS-postpart 

66500 Prelabor rupt uter-unsp 

66501 Prelabor rupt uterus-del 

66503 Prelab rupt uter-antepar 

66510 Rupture uterus NOS-unsp 

66511 Rupture uterus NOS-deliv 

66520 Inversion of uterus-unsp 

66522 Invers uterus-del w p/p 

66524 Invers uterus-postpart 

66530 Lacerat of cervix-unspec 

66531 Lacerat of cervix-deliv 

66534 Lacer of cervix-postpart 

66540 High vaginal lacer-unsp 

66541 High vaginal lacer-deliv 

66544 High vaginal lac-postpar 

66550 Ob inj pelv org NEC-unsp 

66551 Ob inj pelv org NEC-del 

66554 Inj pelv org NEC-postpar 

66560 Damage to pelvic jt-unsp 

66561 Damage to pelvic jt-del 

66564 Damage pelvic jt-postpar 

66570 Ob pelvic hematoma-unsp 

66571 Ob pelvic hematoma-deliv 

66572 Pelvic hematom-del w pp 

66574 Pelvic hematoma-postpart 

66580 Ob trauma NEC-unspec 

66581 Ob trauma NEC-delivered 

66582 Ob trauma NEC-del w p/p 

66583 Ob trauma NEC-antepartum 

66584 Ob trauma NEC-postpartum 

66590 Ob trauma NOS-unspec 

66591 Ob trauma NOS-delivered 

October 2009 



66592 Ob trauma NOS-del w p/p 

66593 Ob trauma NOS-antepartum 

66594 Ob trauma NOS-postpartum 

66600 Third-stage hem-unspec 

66602 Thrd-stage hem-del w p/p 

66604 Third-stage hem-postpart 

66610 Postpartum hem NEC-unsp 

66612 Postpa hem NEC-del w p/p 

66614 Postpart hem NEC-postpar 

66620 Delay p/part hem-unspec 

66622 Delay p/p hem-del w p/p 

66624 Delay p/part hem-postpar 

66630 Postpart coagul def-unsp 

66632 P/p coag def-del w p/p 

66634 Postpart coag def-postpa 

66700 Retain placenta NOS-unsp 

66702 Retnd plac NOS-del w p/p 

66704 Retain plac NOS-postpart 

66710 Retain prod concept-unsp 

66712 Ret prod conc-del w p/p 

66714 Ret prod concept-postpar 

66800 Pulm compl in del-unspec 

66801 Pulm compl in del-deliv 

66802 Pulm complic-del w p/p 

66803 Pulm complicat-antepart 

66804 Pulm complicat-postpart 

66810 Heart compl in del-unsp 

66811 Heart compl in del-deliv 

66812 Heart compl-del w p/p 

66813 Heart complic-antepart 

66814 Heart complic-postpart 

66820 Cns compl labor/del-unsp 

66821 Cns compl lab/del-deliv 

66822 Cns complic-del w p/p 

66823 Cns compl in del-antepar 

66824 Cns compl in del-postpar 

66880 Anesth comp del NEC-unsp 

66881 Anesth compl NEC-deliver 

66882 Anesth compl NEC-del p/p 

66883 Anesth compl antepartum 


66890 Anesth comp del NOS-unsp 

66891 Anesth compl NOS-deliver 

66892 Anesth compl NOS-del p/p 

66893 Anesth compl-antepartum 


66900 Maternal distress-unspec 

66901 Maternal distress-deliv 

66902 Matern distres-del w p/p 

66903 Matern distress-antepar 

66904 Matern distress-postpart 

66910 Obstetric shock-unspec 

66911 Obstetric shock-deliver 

66912 Obstet shock-deliv w p/p 

66913 Obstetric shock-antepar 

66914 Obstetric shock-postpart 

66920 Matern hypotens syn-unsp 

66921 Matern hypoten syn-deliv 

66922 Matern hypoten-del w p/p 

66923 Matern hypotens-antepar 

66924 Matern hypotens-postpart 

66930 Ac kidny fail w del-unsp 

66932 Ac kidney fail-del w p/p 

66934 Ac kidney fail-postpart 

66940 Oth ob surg compl-unspec 

66941 Oth ob compl-delivered 

66942 Oth ob compl-deliv w p/p 

66943 Complc ob surg anteprtm 

66944 Oth ob surg compl-postpa 

66950 Forcep deliv NOS-unspec 

66951 Forcep deliv NOS-deliver 

66960 Breech extr NOS-unspec 

66961 Breech extr NOS-deliver 

66970 Cesarean deliv NOS-unsp 

66971 Cesarean delivery NOS 

66980 Compl lab/deliv NEC-unsp 

66981 Comp lab/deliv NEC-deliv 

66982 Compl del NEC-del w p/p 

66983 Compl deliv NEC-antepar 

66984 Compl deliv NEC-postpart 

66990 Compl lab/deliv NOS-unsp 

66991 Comp lab/deliv NOS-deliv 

66992 Compl del NOS-del w p/p 

66993 Compl deliv NOS-antepar 

66994 Compl deliv NOS-postpart 

67000 Maj puerp inf NOS-unsp 

67002 Maj puer inf NOS-del p/p 

67004 Major puerp inf NOS-p/p 

67010 Puerp endometritis-unsp 

67012 Puerp endomet del w p/p 

67014 Puerp endomet-postpart 

67020 Puerperal sepsis-unsp 

67022 Puerprl sepsis-del w p/p 

67024 Puerperl sepsis-postpart 

67030 Puerp septc thromb-unsp 

67032 Prp sptc thrmb-del w p/p 

67034 Prp septc thrmb-postpart 

67080 Maj prp infec NEC-unspec 

67082 Maj prp inf NEC-dl w p/p 

67084 Maj puerp infec NEC-p/p 

67100 Varic vein leg preg-unsp 

67101 Varicose vein leg-deliv 

67102 Varic vein leg-del w p/p 

67103 Varic vein leg-antepart 

67104 Varic vein leg-postpart 

67110 Varic vulva preg-unspec 

67111 Varicose vulva-delivered 

67112 Varicose vulva-del w p/p 

67113 Varicose vulva-antepart 

67114 Varicose vulva-postpart 

67120 Thrombophleb preg-unspec 

67121 Thrombophlebitis-deliver 

67122 Thrombophleb-deliv w p/p 

67123 Thrombophlebit-antepart 

67124 Thrombophlebit-postpart 

67130 Deep thromb antepar-unsp 

67131 Deep throm antepar-deliv 

67133 Deep vein thromb-antepar 

67140 Deep thromb postpar-unsp 

67142 Thromb postpar-del w p/p 

67144 Deep vein thromb-postpar 

67150 Thrombosis NEC preg-unsp 

67151 Thrombosis NEC-delivered 

67152 Thromb NEC-deliv w p/p 

67153 Thrombosis NEC-antepart 

67154 Thrombosis NEC-postpart 

67180 Ven compl preg NEC-unsp 

67181 Venous compl NEC-deliver 

67182 Ven comp NEC-deliv w p/p 

67183 Venous compl NEC-antepar 

67184 Venous compl NEC-postpar 

67190 Ven compl preg NOS-unsp 

67191 Venous compl NOS-deliver 

67192 Ven comp NOS-deliv w p/p 

67193 Venous compl NOS-antepar 

67194 Venous compl NOS-postpar 



67200 Puerperal pyrexia-unspec 

67202 Puerp pyrexia-del w p/p 

67204 Puerp pyrexia-postpartum 

67300 Ob air embolism-unspec 

67301 Ob air embolism-deliver 

67302 Ob air embol-deliv w p/p 

67303 Ob air embolism-antepart 

67304 Ob air embolism-postpart 

67310 Amniotic embolism-unspec 

67311 Amniotic embolism-deliv 

67312 Amniot embol-deliv w p/p 

67313 Amniotic embol-antepart 

67314 Amniotic embol-postpart 

67320 Ob pulm embol NOS-unspec 

67321 Pulm embol NOS-delivered 

67322 Pulm embol NOS-del w p/p 

67323 Pulm embol NOS-antepart 

67324 Pulm embol NOS-postpart 

67330 Ob pyemic embol-unspec 

67331 Ob pyemic embol-deliver 

67332 Ob pyem embol-del w p/p 

67333 Ob pyemic embol-antepart 

67334 Ob pyemic embol-postpart 

67380 Ob pulmon embol NEC-unsp 

67381 Pulmon embol NEC-deliver 

67382 Pulm embol NEC-del w p/p 

67383 Pulmon embol NEC-antepar 

67384 Pulmon embol NEC-postpar 

67400 Puerp cerebvasc dis-unsp 

67401 Puerp cerebvas dis-deliv 

67402 Cerebvas dis-deliv w p/p 

67403 Cerebrovasc dis-antepart 

67404 Cerebrovasc dis-postpart 

67410 Disrupt c-sect wnd-unsp 

67412 Disrupt c-sect-del w p/p 

67414 Disrupt c-sect-postpart 

67420 Disrupt perineum-unspec 

67422 Disrupt perin-del w p/p 

67424 Disrupt perineum-postpar 

67430 Ob surg compl NEC-unspec 

67432 Ob surg compl-del w p/p 

67434 Ob surg comp NEC-postpar 

67440 Placental polyp-unspec 

67442 Placent polyp-del w p/p 

67444 Placental polyp-postpart 

67450 Peripart cardiomy-unspec 

67451 Peripartum cardiomy-del 

67452 Peripart card del w p/p 

67453 Peripartum card-antepart 

67454 Peripartum card-postpart 

67480 Puerp compl NEC-unspec 

67482 Puerp comp NEC-del w p/p 

67484 Puerp compl NEC-postpart 

67490 Puerp compl NOS-unspec 

67492 Puerp comp NOS-del w p/p 

67494 Puerp compl NOS-postpart 

67500 Infect nipple preg-unsp 

67501 Infect nipple-delivered 

67502 Infect nipple-del w p/p 

67503 Infect nipple-antepartum 

67504 Infect nipple-postpartum 

67510 Breast abscess preg-unsp 

67511 Breast abscess-delivered 

67512 Breast abscess-del w p/p 

67513 Breast abscess-antepart 

67514 Breast abscess-postpart 

67520 Mastitis in preg-unspec 

67521 Mastitis-delivered 

67522 Mastitis-deliv w p/p 

67523 Mastitis-antepartum 

67524 Mastitis-postpartum 

67580 Breast inf preg NEC-unsp 

67581 Breast infect NEC-deliv 

67582 Breast inf NEC-del w p/p 

67583 Breast inf NEC-antepart 

67584 Breast inf NEC-postpart 

67590 Breast inf preg NOS-unsp 

67591 Breast infect NOS-deliv 

67592 Breast inf NOS-del w p/p 

67593 Breast inf NOS-antepart 

67594 Breast inf NOS-postpart 

67600 Retract nipple preg-unsp 

67601 Retracted nipple-deliver 

67602 Retract nipple-del w p/p 

67603 Retract nipple-antepart 

67604 Retract nipple-postpart 

67610 Cracked nipple preg-unsp 

67611 Cracked nipple-delivered 

67612 Cracked nipple-del w p/p 

67613 Cracked nipple-antepart 

67614 Cracked nipple-postpart 

67620 Breast engorge-unspec 

67621 Breast engorge-delivered 

67622 Breast engorge-del w p/p 

67623 Breast engorge-antepart 

67624 Breast engorge-postpart 

67630 Breast dis preg NEC-unsp 

67631 Breast dis NEC-delivered 

67632 Breast dis NEC-del w p/p 

67633 Breast dis NEC-antepart 

67634 Breast dis NEC-postpart 

67640 Lactation fail-unspec 

67641 Lactation fail-delivered 

67642 Lactation fail-del w p/p 

67643 Lactation fail-antepart 

67644 Lactation fail-postpart 

67650 Suppr lactation-unspec 

67651 Suppr lactation-deliver 

67652 Suppr lactat-del w p/p 

67653 Suppr lactation-antepar 

67654 Suppr lactation-postpart 

67660 Galactorrhea preg-unspec 

67661 Galactorrhea-delivered 

67662 Galactorrhea-del w p/p 

67663 Galactorrhea-antepartum 

67664 Galactorrhea-postpartum 

67680 Lactation dis NEC-unspec 

67681 Lactation dis NEC-deliv 

67682 Lactat dis NEC-del w p/p 

67683 Lactat dis NEC-antepart 

67684 Lactat dis NEC-postpart 

67690 Lactation dis NOS-unspec 

67691 Lactation dis NOS-deliv 

67692 Lactat dis NOS-del w p/p 

67693 Lactat dis NOS-antepart 

67694 Lactat dis NOS-postpart 

677 Late effct cmplcatn preg 

67800 Fetal hematologic-unspec 

67801 Fetal hematologic-deliv 

67803 Fetal hematologic-ante 

67810 Fetal conjoin twins-unsp 

67811 Fetal conjoin twins-del 

67813 Fetal conjoin twins-ante 

67900 Mat comp in utero-unsp 

67901 Mat comp in utero-del 

67902 Mat comp in utro-del-p/p 

October 2009 



67903 Mat comp in utero-ante 

67904 Mat comp in utero-p/p 

67910 Fetal comp in utero-unsp 

67911 Fetal comp in utero-del 

67912 Ftl cmp in utro-del-p/p 

67913 Fetal comp in utero-ante 

67914 Fetal comp in utero-p/p 

71630 Climact arthritis-unspec 

71631 Climact arthritis-shlder 

71632 Climact arthritis-up/arm 

71633 Climact arthrit-forearm 

71634 Climact arthritis-hand 

71635 Climact arthritis-pelvis 

71636 Climact arthritis-l/leg 

71637 Climact arthritis-ankle 

71638 Climact arthritis NEC 

71639 Climact arthritis-mult 

7520 Anomalies of ovaries 

75210 Tubal/broad lig anom NOS 

75211 Embryonic cyst of adnexa 

75219 Tubal/broad lig anom NEC 

7522 Doubling of uterus 

7523 Uterine anomaly NEC 

75240 Cervix/fem gen anom NOS 

75241 Embryon cyst fem gen NEC 

75242 Imperforate hymen 

75249 Cervix/fem gen anom NEC 

7923 Abn find-amniotic fluid 

79500 Abn glandular pap smear 

79501 Pap smear (ASC-US) 

79502 Pap smear (ASC-H) 

79503 Pap smear cervix w LGSIL 

79504 Pap smear cervix w HGSIL 

79505 Cervical (HPV) DNA pos 

79506 Pap smr cytol evid malig 

79507 Sat cerv smr-no trnsfrm 

79508 Unsat cerv cytlogy smear 

79509 Abn pap cervix HPV NEC 

79510 Abn gland pap smr vagina 

79511 Pap smear vag w ASC-US 

79512 Pap smear vagina w ASC-H 

79513 Pap smear vagina w LGSIL 

79514 Pap smear vagina w HGSIL 

79515 Vag hi risk HPV-DNA pos 

79516 Pap smr vag-cytol malig 

79518 Vaginl cytol smr unsatis 

79519 Oth abn Pap smr vag/HPV 

79582 Elev ca antigen 125 

7965 Abn find antenatl screen 

8674 Uterus injury-closed 

8675 Uterus injury-open 

8784 Open wound of vulva 

8785 Open wound vulva-compl 

8786 Open wound of vagina 

8787 Open wound vagina-compl 

90255 Injury uterine artery 

90256 Injury uterine vein 

90281 Injury ovarian artery 

90282 Injury ovarian vein 

9391 Foreign body uterus 

9392 Foreign bdy vulva/vagina 

9474 Burn of vagina & uterus 

99632 Malfunction iud 

V074 Hormone replace postmeno 

V1040 Hx-female genit malg NOS 

V1041 Hx-cervical malignancy 

V1042 Hx-uterus malignancy NEC 

V1043 Hx of ovarian malignancy 

V1044 

V131 

V1321 

V1322 

V1329 

V1521 

V220 

V221 

V222 

V230 

V231 

V232 

V233 

V2341 

V2349 

V235 

V237 

V2381 

V2382 

V2383 

V2384 

V2385 

V2386 

V2389 

V239 

V240 

V241 

V242 

V2501 

V251 

V253 

V2541 

V2542 

V2543 

V255 

V261 

V2631 

V2632 

V2651 

V2681 

V270 

V271 

V272 

V273 

V274 

V275 

V276 

V277 

V279 

V280 

V281 

V282 

V283 

V284 

V285 

V286 

V2881 

V2882 

V2889 

V289 

V4551 

V4981 

V5042 

V524 

V5970 

V5971 

V5972 

V5973 

Hx-female genit malg NEC 

Hx-trophoblastic disease 

History-pre-term labor 

Hx of cervical dysplasia 

Hx-genital/obs dis NEC 

Hx in utero proc in preg 

Supervis normal 1st preg 

Supervis oth normal preg 

Preg state, incidental 

Preg w hx of infertility 

Preg w hx-trophoblas dis 

Preg w hx of abortion 

Grand multiparity 

Preg w hx pre-term labor 

Preg w poor obs hx NEC 

Preg w poor reproduct hx 

Insufficnt prenatal care 

Suprv elderly primigrav 

Suprv elderly multigrav 

Suprv young primigravida 

Suprv young multigravida 

Pregnt-assist repro tech 

Preg-hx in utro prev prg 

Suprv high-risk preg NEC 

Suprv high-risk preg NOS 

Postpart care after del 

Postpart care-lactation 

Rout postpart follow-up 

Prescrip-oral contracept 

Insertion of iud 

Menstrual extraction 

Contracept pill surveill 

Iud surveillance 

Srvl mplnt sbdrm cntrcep 

Nsrt mplnt sbdrm cntrcep 

Artificial insemination 

Fem genetic test dis car 

Female genetic test NEC 

Tubal ligation status 

Assist repro fertility 

Deliver-single liveborn 

Deliver-single stillborn 

Deliver-twins, both live 

Del-twins, 1 nb, 1 sb 

Deliver-twins, both sb 

Del-mult birth, all live 

Del-mult brth, some live 

Del-mult birth, all sb 

Outcome of delivery NOS 

Screening-chromosom anom 

Screen-alphafetoprotein 

Screen by amniocent NEC 

Scr fetl malfrm-ultrasnd 

Screen-fetal retardation 

Screen-isoimmunization 

Antenatal screen strep b 

Scrn fetal anatmc survey 

Scrn risk preterm labor 

Antenatal screening NEC 

Antenatal screening NOS 

Prsc ntrutr cntrcptv dvc 

Asympt postmeno status 

Prphylct orgn rmvl ovary 

Fit/adj breast pros/impl 

Egg donor NEC 

Egg donor age


V5974 

V616 

V617 

V6701 

V7231 

V7232 

V7240 

V7241 

V7242 

V7611 

V762 

V7646 

V7647 

V824 

V8402 

V8404 

V8801 

V8802 

V8803 

V8901 

V8902 

V8903 

V8904 

V8905 

V8909 

Egg donor age 35+ desig 

Illegitimate pregnancy 

Unwanted pregnancy NEC 

Follow-up vag pap smear 

Routine gyn examination 

Pap smear confirmation 

Pregnancy test unconfirm 

Pregnancy test negative 

Pregnancy test-positive 

Screen mammogram hi risk 

Screen mal neop-cervix 

Screen malig neop-ovary 

Screen malig neop-vagina 

Mat pstntl scr-chrm anom 

Genetc sus mal neo ovary 

Genetc susc mal neo endo 

Acq absnce cervix/uterus 

Acq ab ut remn cerv stmp 

Acq absnc cerv/remain ut 

Sus amntc cav/mem nt fnd 

Sus placentl prob nt fnd 

Sus fetal anomaly nt fnd 

Sus fetal growth not fnd 

Sus cervcl shortn nt fnd 

Oth sus mat/ftl nt fnd 

October 2009 


Procedures allowed for females only 

6501 Laparoscopic oophorotomy 

6509 Other oophorotomy 

6511 Ovarian aspirat biopsy 

6512 Ovarian biopsy NEC 

6513 Lap biopsy of ovary 

6514 Oth lap dx proc ovaries 

6519 Ovarian dx procedure NEC 

6521 Ovarian cyst marsupializ 

6522 Ovarian wedge resection 

6523 Lap marsup ovarian cyst 

6524 Lap wedge resect ovary 

6525 Oth lap loc exc dest ova 

6529 Local destr ova les NEC 

6531 Lap unilat oophorectomy 

6539 Oth unilat oophorectomy 

6541 Lap uni salpingo-oophor 

6549 Oth uni salpingo-oophor 

6551 Oth remove both ovaries 

6552 Oth remove remain ovary 

6553 Lap remove both ovaries 

6554 Lap remove remain ovary 

6561 Oth remove ovaries/tubes 

6562 Oth remove rem ova/tube 

6563 Lap remove ovaries/tubes 

6564 Lap remove rem ova/tube 

6571 Oth simple suture ovary 

6572 Oth reimplant of ovary 

6573 Oth salpingo-oophoroplas 

6574 Lap simple suture ovary 

6575 Lap reimplant of ovary 

6576 Lap salpingo-oophoroplas 

6579 Repair of ovary NEC 

6581 Lap adhesiolys ova/tube 

6589 Adhesiolysis ovary/tube 

6591 Aspiration of ovary 

6592 Transplantation of ovary 

6593 Manual rupt ovarian cyst 

6594 Ovarian denervation 

6595 Ovarian torsion release 

6599 Ovarian operation NEC 

6601 Salpingotomy 

6602 Salpingostomy 

6611 Fallopian tube biopsy 

6619 Fallop tube dx proc NEC 

6621 Bilat endosc crush tube 

6622 Bilat endosc divis tube 

6629 Bilat endos occ tube NEC 

6631 Bilat tubal crushing NEC 

6632 Bilat tubal division NEC 

6639 Bilat tubal destruct NEC 

664 Total unilat salpingect 

6651 Remove both fallop tubes 

6652 Remove solitary fal tube 

6661 Destroy fallop tube les 

6662 Remov tube & ectop preg 

6663 Bilat part salpingec NOS 

6669 Partial salpingectom NEC 

6671 Simpl suture fallop tube 

6672 Salpingo-oophorostomy 

6673 Salpingo-salpingostomy 

6674 Salpingo-uterostomy 

6679 Fallop tube repair NEC 

668 Fallopian tube insufflat 

6691 Fallopian tube aspirat 

6692 Unilat fallop tube destr 

6693 Impl fallop tube prosth 

6694 Remov fallop tube prosth 

6695 Blow therapeut into tube 

6696 Fallopian tube dilation 

6697 Bury fimbriae in uterus 

6699 Fallopian tube op NEC 

670 Cervical canal dilation 

6711 Endocervical biopsy 

6712 Cervical biopsy NEC 

6719 Cervical dx procedur NEC 

672 Conization of cervix 

6731 Cervical cyst marsupial 

6732 Cervical les cauterizat 

6733 Cervical les cryotherapy 

6739 Cervical les destruc NEC 

674 Amputation of cervix 

6751 Transab cerclage cervix 

6759 Oth rep int cervical os 

6761 Suture cervical lacerat 

6762 Cervical fistula repair 

6769 Cervical repair NEC 

680 Hysterotomy 

6811 Digital exam of uterus 

6812 Hysteroscopy 

6813 Open uterine biopsy 

6814 Open uterine ligament bx 

6815 Clos uterine ligament bx 

6816 Closed uterine biopsy 

6819 Uterus/adnex dx proc NEC 

6821 Endomet synechiae divis 

6822 Incision uterine septum 

6823 Endometrial ablation 

6829 Uterine les destruct NEC 

6831 Lap scervic hysterectomy 

6839 Subtotl abd hyst NEC/NOS 

6841 Lap total abdominal hyst 

6849 Total abd hyst NEC/NOS 

6851 Lap ast vag hysterectomy 

6859 Vag hysterectomy NEC/NOS 

6861 Lap radical abdomnl hyst 

6869 Radical abd hyst NEC/NOS 

6871 Lap radical vaginal hyst 

6879 Radical vag hyst NEC/NOS 

688 Pelvic evisceration 

689 Hysterectomy NEC/NOS 

6901 D & C for preg terminat 

6902 D & C post delivery 

6909 D & C NEC 

6919 Destruc uter support NEC 

6921 Interposit op uterin lig 

6922 Uterine suspension NEC 

6923 Vag repair invers uterus 

6929 Uterus/adnexa repair NEC 

693 Paracerv uterine denerv 

6941 Suture uterine lacerat 

6942 Closure uterine fistula 

6949 Uterine repair NEC 

6951 Aspirat curet-preg termi 

6952 Aspirat curet-post deliv 

6959 Aspir curett uterus NEC 

696 Menstrual extraction 

697 Insertion of iud 

6991 Insert uterine device 

6992 Artificial insemination 

6993 Insertion of laminaria 



6994 Man replace invert uter 

6995 Incision of cervix 

6996 Remove cervical cerclage 

6997 Remove penetrat cerv FB 

6998 Uterine support op NEC 

6999 Uterine operation NEC 

700 Culdocentesis 

7011 Hymenotomy 

7012 Culdotomy 

7013 Intralum vag adhesiolys 

7014 Vaginotomy NEC 

7021 Vaginoscopy 

7022 Culdoscopy 

7023 Cul-de-sac biopsy 

7024 Vaginal biopsy 

7029 Vagin/cul-de-sac dx NEC 

7031 Hymenectomy 

7032 Excis cul-de-sac lesion 

7033 Excision vaginal lesion 

704 Vaginal obliteration 

7050 Cystocel/rectocel repair 

7051 Cystocele repair 

7052 Rectocele repair 

7053 Cysto & recto w grf/pros 

7054 Rep cystocel w grft/pros 

7055 Rep rectocele w grf/pros 

7061 Vaginal construction 

7062 Vaginal reconstruction 

7071 Suture vagina laceration 

7072 Repair colovagin fistula 

7073 Repair rectovag fistula 

7074 Rep vaginoent fistul NEC 

7075 Repair vag fistula NEC 

7076 Hymenorrhaphy 

7077 Vaginal suspens & fixat 

7078 Vag susp/fix w grft/pros 

7079 Vaginal repair NEC 

708 Vaginal vault obliterat 

7091 Vaginal operation NEC 

7092 Cul-de-sac operation NEC 

7093 Cul-de-sac grf/pros NEC 

7094 Insert biological graft 

7095 Insert synth graft/prost 

7101 Vulvar adhesiolysis 

7109 Incis vulva/perineum NEC 

7111 Vulvar biopsy 

7119 Vulvar diagnos proc NEC 

7121 Percutan bartholin aspir 

7122 Incise bartholin's gland 

7123 Bartholin gland marsup 

7124 Destruc bartholin gland 

7129 Bartholin's gland op NEC 

713 Local vulvar excis NEC 

714 Operations on clitoris 

715 Radical vulvectomy 

7161 Unilateral vulvectomy 

7162 Bilateral vulvectomy 

7171 Suture vulvar laceration 

7172 Repair vulvar fistula 

7179 Vulvar/perin repair NEC 

718 Other vulvar operations 

719 Other female genital ops 

720 Low forceps operation 

721 Low forceps w episiotomy 

7221 Mid forceps w episiotomy 

7229 Mid forceps op NEC 

7231 High forceps w episiot 

7239 High forceps op NEC 

724 Forceps rotat fetal head 

7251 Part brch extrac w forcp 

7252 Part breech extract NEC 

7253 Tot brch extrac w forcep 

7254 Tot breech extrac NEC 

726 Forceps-aftercoming head 

7271 Vacuum ext del w episiot 

7279 Vacuum extract del NEC 

728 Instrument delivery NEC 

729 Instrument delivery NOS 

7301 Induct labor-rupt memb 

7309 Artif rupt membranes NEC 

731 Surg induct labor NEC 

7321 Int/comb version no extr 

7322 Int/comb version w extr 

733 Failed forceps 

734 Medical induction labor 

7351 Manual rotat fetal head 

7359 Manual assist deliv NEC 

736 Episiotomy 

738 Fetal ops-facilitate del 

7391 Ext version-assist deliv 

7392 Replace prolapsed cord 

7393 Incis cx to assist deliv 

7394 Pubiotomy to assist del 

7399 Ops assisting deliv NEC 

740 Classical c-section 

741 Low cervical c-section 

742 Extraperitoneal c-sect 

743 Rem extratub ectop preg 

744 Cesarean section NEC 

7491 Hysterotomy to termin pg 

7499 Cesarean section NOS 

750 Intra-amnion inj for ab 

751 Diagnostic amniocentesis 

752 Intrauterine transfusion 

7531 Amnioscopy 

7532 Fetal ekg 

7533 Fetal blood sample/bx 

7534 Other fetal monitoring 

7535 Dx proc fetus/amnion NEC 

7536 Correction fetal defect 

7537 Amnioinfusion 

7538 Fetal pulse oximetry 

754 Manual removal-placenta 

7550 Repair ob lac uterus NOS 

7551 Repair ob lacerat cervix 

7552 Repair ob lac corp uteri 

7561 Repair ob lac blad/ureth 

7562 Repair ob lac rect/anus 

7569 Repair ob laceration NEC 

757 Manual explor uterus p/p 

758 Ob tamponade uterus/vag 

7591 Evac ob inc hemat perin 

7592 Evac ob hemat vulva/vag 

7593 Surg corr invert uterus 

7594 Man replac invert uterus 

7599 Obstetric operation NEC 

8781 X-ray of gravid uterus 

8782 Gas hysterosalpingogram 

8783 Dye hysterosalpingogram 

8784 Percutaneous hysterogram 

8785 Tube & uterus x-ray NEC 

8789 Female genital x-ray NEC 

8846 Contrast placentogram 

8878 Dx ultrasound-grav uter 

8926 Gynecologic examination 

9141 Bact smear-female genit 

October 2009 



9142 Culture-female genital 

9143 C & s-female genital 

9144 Parasitology-female gen 

9145 Toxicology-female genit 

9146 Cell blk/pap-female gen 

9149 Micro exam-femal gen NEC 

9217 Placental scan 

9614 Vaginal packing 

9615 Vaginal mold insertion 

9616 Other vaginal dilation 

9617 Vag diaphragm insertion 

9618 Oth vagin pessary insert 

9644 Vaginal douche 

9724 Replace vag diaphragm 

9725 Replace vaginal pessary 

9726 Replace vag/vulv packing 

9771 Removal iud 

9772 Remov intrauterine pack 

9773 Remov vaginal diaphragm 

9774 Removal oth vag pessary 

9775 Remov vag/vulv packing 

9816 Remov intralum uter FB 

9817 Remov intralum vag FB 

9823 Removal vulvar FB 

9998 Milk extraction 


Diagnoses allowed for males only 

01640 TB epididymis-unspec 

01641 TB epididymis-no exam 

01642 TB epididymis-exam unkn 

01643 TB epididymis-micro dx 

01644 TB epididymis-cult dx 

01645 TB epididymis-histo dx 

01646 TB epididymis-oth test 

01650 TB male genit NEC-unspec 

01651 TB male gen NEC-no exam 

01652 TB male gen NEC-ex unkn 

01653 TB male gen NEC-micro dx 

01654 TB male gen NEC-cult dx 

01655 TB male gen NEC-histo dx 

01656 TB male gen NEC-oth test 

05413 Herpetic infect of penis 

0720 Mumps orchitis 

09812 Gc prostatitis (acute) 

09813 Gc orchitis (acute) 

09814 Gc sem vesiculit (acute) 

09832 Gc prostatitis, chronic 

09833 Gc orchitis, chronic 

09834 Gc sem vesiculitis, chr 

13103 Trichomonal prostatitis 

1750 Mal neo male nipple 

1759 Mal neo male breast NEC 

185 Malign neopl prostate 

1860 Mal neo undescend testis 

1869 Malig neo testis NEC 

1871 Malign neopl prepuce 

1872 Malig neo glans penis 

1873 Malig neo penis body 

1874 Malig neo penis NOS 

1875 Malig neo epididymis 

1876 Mal neo spermatic cord 

1877 Malign neopl scrotum 

1878 Mal neo male genital NEC 

1879 Mal neo male genital NOS 

2144 Lipoma spermatic cord 

2220 Benign neoplasm testis 

2221 Benign neoplasm penis 

2222 Benign neoplasm prostate 

2223 Benign neo epididymis 

2224 Benign neoplasm scrotum 

2228 Ben neo male genital NEC 

2229 Ben neo male genital NOS 

2334 Ca in situ prostate 

2335 Ca in situ penis 

2336 Ca in situ male gen NEC 

2364 Unc behav neo testis 

2365 Unc behav neo prostate 

2366 Unc behav neo male NEC 

2570 Testicular hyperfunction 

2571 Postablat testic hypofun 

2579 Testicular dysfunct NOS 

30274 Male orgasmic disorder 

30275 Premature ejaculation 

4564 Scrotal varices 

60000 BPH w/o urinary obs/LUTS 

60001 BPH w urinary obs/LUTS 

60010 Nod prostate w/o ur obst 

60011 Nod prostate w ur obst 

60020 BPH loc w/o ur obs/LUTS 

60021 BPH loc w urin obs/LUTS 

6003 Cyst of prostate 

60090 BPH NOS w/o ur obs/LUTS 

60091 BPH NOS w ur obs/LUTS 

6010 Acute prostatitis 

6011 Chronic prostatitis 

6012 Abscess of prostate 

6013 Prostatocystitis 


6018 Prostatic inflam dis NEC 

6019 Prostatitis NOS 

6020 Calculus of prostate 

6021 Prostatic congest/hemorr 

6022 Atrophy of prostate 

6023 Dysplasia of prostate 

6028 Prostatic disorders NEC 

6029 Prostatic disorder NOS 

6030 Encysted hydrocele 

6031 Infected hydrocele 

6038 Hydrocele NEC 

6039 Hydrocele NOS 

6040 Orchitis with abscess 

60490 Orchitis/epididymit NOS 

60491 Orchitis in oth disease 

60499 Orchitis/epididymit NEC 

605 Redun prepuce & phimosis 

6060 Azoospermia 

6061 Oligospermia 

6068 Male infertility NEC 

6069 Male infertility NOS 

6070 Leukoplakia of penis 

6071 Balanoposthitis 

6072 Inflam dis, penis NEC 

6073 Priapism 

60781 Balanitis xerotica oblit 

60782 Vascular disorder, penis 

60783 Edema of penis 

60784 Impotence, organic orign 

60785 Peyronie's disease 

60789 Disorder of penis NEC 

6079 Disorder of penis NOS 

6080 Seminal vesiculitis 

6081 Spermatocele 

60820 Torsion of testis NOS 

60821 Extravag tors sperm cord 

60822 Intravag tors sperm cord 

60823 Torsion appendix testis 

60824 Torsion appy epididymis 

6083 Atrophy of testis 

6084 Male gen inflam dis NEC 

60881 Male gen dis in oth dis 

60882 Hematospermia 

60883 Male gen vascul dis NEC 

60884 Chylocele, tunic vaginal 

60885 Stricture, male gen orgn 

60886 Edema, male genital orgn 

60887 Retrograde ejaculation 

60889 Male genital dis NEC 

6089 Male genital dis NOS 

75251 Undescended testis 

75252 Retractile testis 

75261 Hypospadias 

75262 Epispadias 

75263 Congenital chordee 

75264 Micropenis 

75265 Hidden penis 

75269 Penile anomalies NEC 

75281 Scrotal transposition 

October 2009 


Diagnoses allowed for males only 

7587 Klinefelter's syndrome 

78832 Stress incontinence male 


7922 Abn findings-semen 

8780 Open wound of penis 

8781 Open wound penis-compl 

8782 Opn wound scrotum/testes 

8783 Opn wnd scrot/test-compl 

9393 Foreign body penis 

95913 Fx corpus cavrnosm penis 

V1045 Hx-male genit malig NOS 

V1046 Hx-prostatic malignancy 

V1047 Hx-testicular malignancy 

V1048 Hx-epididymis malignancy 

V1049 Hx-male genit malig NEC 

V1361 Hx-hypospadius 

V2634 Male genetc test dis car 

V2635 Test male part hab abort 

V2639 Male genetic test NEC 

V2652 Vasectomy status 

V502 Routine circumcision 

V7644 Scrn malig neop-prostate 

V7645 Screen malig neop-testis 

V8403 Genetc sus mal neo prost 


Procedures allowed for males only 

600 Incision of prostate 

6011 Closed prostatic biopsy 

6012 Open prostatic biopsy 

6013 Clos seminal vesicles bx 

6014 Open seminal vesicles bx 

6015 Periprostatic biopsy 

6018 Prostatic dx proced NEC 

6019 Semin ves dx proced NEC 

6021 Transureth prostatectomy 

6029 Oth transureth prostatec 

603 Suprapubic prostatectomy 

604 Retropubic prostatectomy 

605 Radical prostatectomy 

6061 Los excis prostatic les 

6062 Perineal prostatectomy 

6069 Prostatectomy NEC 

6071 Percut semin ves aspirat 

6072 Seminal vesicle incision 

6073 Seminal vesicle excision 

6079 Seminal vesicle op NEC 

6081 Periprostatic incision 

6082 Periprostatic excision 

6091 Percut prostatic aspirat 

6092 Injection into prostate 

6093 Repair of prostate 

6094 Control prostate hemorr 

6095 Trans bal dil pros ureth 

6096 Tu destr prostate by mt 

6097 Oth tu destr pros - rt 

6099 Prostatic operation NEC 

610 Scrotum & tunica i & d 

6111 Scrotum & tunica biopsy 

6119 Scrot/tunica dx proc NEC 

612 Excision of hydrocele 

613 Scrotal les destruction 

6141 Suture scrotal lacerat 

6142 Scrotal fistula repair 

6149 Scrotum/tunic repair NEC 

6191 Percut tunica aspiration 

6192 Excision tunica les NEC 

6199 Scrotum & tunica op NEC 

620 Incision of testes 

6211 Closed testicular biopsy 

6212 Open testicular biopsy 

6219 Testes dx procedure NEC 

622 Testicular les destruct 

623 Unilateral orchiectomy 

6241 Remove both testes 

6242 Remove solitary testis 

625 Orchiopexy 

6261 Suture testicular lacer 

6269 Testicular repair NEC 

627 Insert testicular prosth 

6291 Aspiration of testes 

6292 Injection into testes 

6299 Testicular operation NEC 

6301 Spermatic cord/vas biops 

6309 Spermat cord/vas dx NEC 

631 Exc spermatic varicocele 

632 Excise epididymis cyst 

633 Excise cord/epid les NEC 

634 Epididymectomy 

6351 Suture cord & epid lacer 

6352 Reduction torsion testes 

6353 Transplant spermat cord 

6359 Cord & epidid repair NEC 

636 Vasotomy 

6370 Male sterilization NOS 

6371 Ligation of vas deferens 

6372 Spermatic cord ligation 

6373 Vasectomy 

6381 Suture vas & epidid lac 

6382 Postop vas reconstruct 

6383 Epididymovasostomy 

6384 Removal vas ligature 

6385 Remov vas deferens valve 

6389 Vas & epididy repair NEC 

6391 Spermatocele aspiration 

6392 Epididymotomy 

6393 Spermatic cord incision 

6394 Sperm cord adhesiolysis 

6395 Insert valve in vas def 

6399 Cord/epid/vas ops NEC 

640 Circumcision 

6411 Penile biopsy 

6419 Penile diagnost proc NEC 

642 Local excis penile les 

643 Amputation of penis 

6441 Suture penile laceration 

6442 Release of chordee 

6443 Construction of penis 

6444 Reconstruction of penis 

6445 Replantation of penis 

6449 Penile repair NEC 

645 Sex transformat op NEC 

6491 Dorsal/lat slit prepuce 

6492 Incision of penis 

6493 Division of penile adhes 

6494 Fit ext penile prosthes 

6495 Ins noninfl penis prosth 

6496 Remove int penile prosth 

6497 Ins inflate penis prosth 

6498 Penile operation NEC 

6499 Male genital op NEC 

8791 Contr semin vesiculogram 

8792 Prostat/sem ves xray NEC 

8793 Contrast epididymogram 

8794 Contrast vasogram 

8795 Epididymis/vas x-ray NEC 

8799 Male genital x-ray NEC 

9824 Removal scrotal/penis FB 

9994 Prostatic massage 

9995 Stretching of foreskin 

9996 Sperm collection 

October 2009 


6. Manifestation 

6. Manifestation 

code as principal 

code 

diagnosis 

as 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-9-CM diagnoses with corresponding 

English descriptions identified as manifestation codes. 

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 Enceph/myelitis-oth inf 

32342 Myelitis d/t oth infect 

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 

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 


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-ankle 

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 

October 2009 



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 

78552 Septic shock 


7. 7. Non-specific principal principal 

diagnosis Effective 10/01/07, the non-specific principal diagnosis edit was discontinued 

and will appear for claims processed using MCE version 

diagnosis 

2.0-23.0 only. 

8. Questionable admission Some diagnoses are not usually sufficient justification for admission 

to an acute care hospital. For example, if a patient is given code 4011 

for benign hypertension, then the patient would have a questionable 

admission, since benign hypertension is not normally sufficient justification 

for admission to a hospital. 

Questionable admissions - principal diagnosis only 

25000 DMII wo cmp nt st uncntr 

27800 Obesity NOS 

3804 Impacted cerumen 

4011 Benign hypertension 

4262 Left bb hemiblock 

4263 Left bb block NEC 

4264 Rt bundle branch block 


7962 Elev bl pres w/o hypertn 

9999 Complic med care NEC/NOS 

V08 Asymp hiv infectn status 

V5331 Ftng cardiac pacemaker 

V5332 Ftng autmtc dfibrillator 

V5339 Ftng oth cardiac device 

The following list contains diagnosis codes with corresponding 

English descriptions identified as questionable admission when used 

as a principal diagnosis. 

October 2009 


9. Unacceptable principal principal diagnosis There are selected codes that describe a circumstance which influences 

an individual’s health status but not a current illness or injury, or 

diagnosis 

codes that are not specific manifestations but may be due to an underlying 

cause. These codes are considered unacceptable as a principal 

diagnosis. 

There are a few usually unacceptable principal diagnosis codes that 

are considered “acceptable” when a secondary diagnosis is also coded 

on the record. If no secondary diagnosis is present for this subset of 

codes, 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 

1992 Malig neopl-transp organ 

23877 Post tp lymphprolif dis 

27950 Graft-versus-host NOS 

27951 Ac graft-versus-host dis 

27952 Chronc graft-vs-host dis 

27953 Ac on chrn grft-vs-host 

3051 Tobacco use disorder 

3533 Thoracic root lesion NEC 

3708 Keratitis NEC 

4142 Chr tot occlus cor artry 

4143 Cor ath d/t lpd rch plaq 

41512 Septic pulmonary embolsm 

4233 Cardiac tamponade 

4404 Chr tot occl art extrem 

449 Septic arterial embolism 

6113 Fat necrosis of breast 

69550 Exfol d/t eryth =90% bdy 

78951 Malignant ascites 

7981 Instantaneous death 

7982 Death within 24 hr sympt 

7989 Unattended death 

V010 Cholera contact 

V011 Tuberculosis contact 

V012 Poliomyelitis contact 

V013 Smallpox contact 

V014 Rubella contact 

V015 Rabies contact 

V016 Venereal dis contact 

V0181 Contact/exposure-anthrax 

V0189 Communic dis contact NEC 

V019 Communic dis contact NOS 

V020 Cholera carrier 

V021 Typhoid carrier 

V022 Amebiasis carrier 

V023 GI pathogen carrier NEC 

V024 Diphtheria carrier 

V0251 Group b streptoc carrier 

V0252 Streptococus carrier NEC 

V0253 Meth susc Staph carrier 

V0254 Meth resis Staph carrier 

V0259 Bacteria dis carrier NEC 

V0260 Viral hep carrier NOS 

V0261 Hepatitis B carrier 

V0262 Hepatitis C carrier 

V0269 Viral hep carrier NEC 

V027 Gonorrhea carrier 

V028 Venereal dis carrier NEC 

V029 Carrier NEC 

V030 Vaccin for cholera 

V031 Vacc-typhoid-paratyphoid 

V032 Vaccin for tuberculosis 

V033 Vaccin for plague 

V034 Vaccin for tularemia 

V035 Vaccin for diphtheria 

V036 Vaccin for pertussis 

V037 Tetanus toxoid inoculat 

V0381 

V0382 

V0389 

V039 

V040 

V041 

V042 

V043 

V044 

V045 

V046 

V047 

V0481 

V0482 

V0489 

V050 

V051 

V052 

V053 

V054 

V058 

V059 

V060 

V061 

V062 

V063 

V064 

V065 

V066 

V068 

V069 

V071 

V072 

V0731 

V074 

V0751 

V0752 

V0759 

V079 

V090 

V091 

V092 

V093 

V094 

V0950 

V0951 

V096 

V0970 

V0971 

V0980 

V0981 

V0990 

V0991 

V1000 

V1001 

V1002 

V1003 

V1004 

V1005 

V1006 

V1007 

V1009 

V1011 

V1012 

V1020 

V1021 

V1022 

V1029 

Nd vac hmophlus inflnz b 

Nd vac strptcs pneumni b 

Nd other specf vacnation 

Vaccin for bact dis NOS 

Vaccin for poliomyelitis 

Vaccin for smallpox 

Vaccin for measles 

Vaccin for rubella 

Vaccin for yellow fever 

Vaccin for rabies 

Vaccin for mumps 

Vaccin for common cold 

Vaccin for influenza 

Vaccination for RSV 

Vaccn/inoc viral dis NEC 

Arbovirus enceph vaccin 

Vacc arboviral dis NEC 

Vaccin for leishmaniasis 

Need prphyl vc vrl hepat 

Need prphyl vc varicella 

Vaccin for disease NEC 

Vaccin for singl dis NOS 

Vaccin for cholera + tab 

Vaccination for DTP-DTaP 

Vaccin for dtp + tab 

Vaccin for dtp + polio 

Vac-measle-mumps-rubella 

Vaccination for Td-DT 

Nd vac strp pnumn/inflnz 

Vac-dis combinations NEC 

Vac-dis combinations NOS 

Desensitiza to allergens 

Prophylact immunotherapy 

Prophylac fluoride admin 

Hormone replace postmeno 

Prophylactic use SERMs 

Prophylact use aromatase 

Prphyl ot agnt af estrgn 

Prophylactic measure NOS 

Inf mcrg rstn pncllins 

Inf mcrg rstn b-lactam 

Inf mcrg rstn macrolides 

Inf mcrg rstn ttrcycln 

Inf mcrg rstn amnglcsds 

Inf mcr rst qn flr nt ml 

Inf mcrg rstn qn flrq ml 

Inf mcrg rstn sulfnmides 

Inf mcr rst oth ag nt ml 

Inf mcrg rstn oth ag mlt 

Inf mcr rst ot drg nt ml 

Inf mcrg rstn oth drg ml 

Infc mcrg drgrst nt mult 

Infc mcrg drgrst mult 

Hx of GI malignancy NOS 

Hx of tongue malignancy 

Hx-oral/pharynx malg NEC 

Hx-esophageal malignancy 

Hx of gastric malignancy 

Hx of colonic malignancy 

Hx-rectal & anal malign 

Hx of liver malignancy 

Hx of GI malignancy NEC 

Hx-bronchogenic malignan 

Hx-tracheal malignancy 

Hx-resp org malignan NOS 

Hx-laryngeal malignancy 

Hx-nose/ear/sinus malig 

Hx-intrathoracic mal NEC 

October 2009 



V103 

V1040 

V1041 

V1042 

V1043 

V1044 

V1045 

V1046 

V1047 

V1048 

V1049 

V1050 

V1051 

V1052 

V1053 

V1059 

V1060 

V1061 

V1062 

V1063 

V1069 

V1071 

V1072 

V1079 

V1081 

V1082 

V1083 

V1084 

V1085 

V1086 

V1087 

V1088 

V1089 

V1090 

V1091 

V110 

V111 

V112 

V113 

V118 

V119 

V1200 

V1201 

V1202 

V1203 

V1204 

V1209 

V121 

V122 

V123 

V1240 

V1241 

V1242 

V1249 

V1250 

V1251 

V1252 

V1253 

V1254 

V1259 

V1260 

V1261 

V1269 

V1270 

V1271 

V1272 

V1279 

V1300 

Hx of breast malignancy 

Hx-female genit malg NOS 

Hx-cervical malignancy 

Hx-uterus malignancy NEC 

Hx of ovarian malignancy 

Hx-female genit malg NEC 

Hx-male genit malig NOS 

Hx-prostatic malignancy 

Hx-testicular malignancy 

Hx-epididymis malignancy 

Hx-male genit malig NEC 

Hx-urinary malignan NOS 

Hx of bladder malignancy 

Hx of kidney malignancy 

Hx malig renal pelvis 

Hx-urinary malignan NEC 

Hx of leukemia NOS 

Hx of lymphoid leukemia 

Hx of myeloid leukemia 

Hx of monocytic leukemia 

Hx of leukemia NEC 

Hx-lymphosarcoma 

Hx-hodgkin's disease 

Hx-lymphatic malign NEC 

Hx of bone malignancy 

Hx-malig skin melanoma 

Hx-skin malignancy NEC 

Hx of eye malignancy 

Hx of brain malignancy 

Hx-malign nerve syst NEC 

Hx of thyroid malignancy 

Hx-endocrine malign NEC 

Hx of malignancy NEC 

Hx malig neoplasm NOS 

Hx malig neuroendo tumor 

Hx of schizophrenia 

Hx of affective disorder 

Hx of neurosis 

Hx of alcoholism 

Hx-mental disorder NEC 

Hx-mental disorder NOS 

Prsnl hst unsp nfct prst 

Prsnl hst tuberculosis 

Prsnl hst poliomyelitis 

Personal histry malaria 

Hx Methicln resist Staph 

Prsnl hst oth nfct parst 

Hx-nutrition deficiency 

Hx-endocr/meta/immun dis 

Hx-blood diseases 

Hx nerv sys/snse org NOS 

Hx benign neoplasm brain 

Personl hx infection CNS 

Hx nerv sys/snse org NEC 

Hx-circulatory dis NOS 

Hx-ven thrombosis/embols 

Hx-thrombophlebitis 

Hx sudden cardiac arrest 

Hx TIA/stroke w/o resid 

Hx-circulatory dis NEC 

Hx resp system dis NOS 

Prsnl hx recur pneumonia 

Hx resp system dis NEC 

Prsnl hst unspc dgstv ds 

Prsnl hst peptic ulcr ds 

Prsnl hst colonic polyps 

Prsnl hst ot spf dgst ds 

Prsnl hst urnr dsrd unsp 

V1301 

V1302 

V1303 

V1309 

V131 

V1321 

V1322 

V1329 

V133 

V134 

V1351 

V1352 

V1359 

V1361 

V1369 

V137 

V138 

V139 

V140 

V141 

V142 

V143 

V144 

V145 

V146 

V147 

V148 

V149 

V1501 

V1502 

V1503 

V1504 

V1505 

V1506 

V1507 

V1508 

V1509 

V151 

V1521 

V1522 

V1529 

V153 

V1541 

V1542 

V1549 

V1551 

V1552 

V1559 

V156 

V157 

V1580 

V1581 

V1582 

V1583 

V1584 

V1585 

V1586 

V1587 

V1588 

V1589 

V159 

V160 

V161 

V162 

V163 

V1640 

V1641 

V1642 

Prsnl hst urnr dsrd calc 

Personal history UTI 

Personl hx nephrotic syn 

Prsn hst ot spf urn dsrd 

Hx-trophoblastic disease 

History-pre-term labor 

Hx of cervical dysplasia 

Hx-genital/obs dis NEC 

Hx-skin/subcutan tis dis 

Hx of arthritis 

Hx pathological fracture 

Hx stress fracture 

Hx musculoskletl dis NEC 

Hx-hypospadius 

Hx-congenital malfor NEC 

Hx-perinatal problems 

Hx of diseases NEC 

Hx of disease NOS 

Hx-penicillin allergy 

Hx-antibiot allergy NEC 

Hx-sulfonamides allergy 

Hx-anti-infect allergy 

Hx-anesthetic allergy 

Hx-narcotic allergy 

Hx-analgesic allergy 

Hx-vaccine allergy 

Hx-drug allergy NEC 

Hx-drug allergy NOS 

Hx-peanut allergy 

Hx-milk prod allergy 

Hx-eggs allergy 

Hx-seafood allergy 

Hx-other food allergy 

Hx-allergy insct/arachnd 

Hx-latex allergy 

Hx-radiogrphc dye allrgy 

Hx-allergy NEC 

Hx-major cardiovasc surg 

Hx in utero proc in preg 

Hx in utero proc fetus 

Hx surgery to organs NEC 

Hx of irradiation 

Hx of physical abuse 

Hx of emotional abuse 

Psychological trauma NEC 

Hx traumatic fracture 

Hx traumatc brain injury 

Hx injury NEC 

Hx of poisoning 

Hx of contraception 

Hx failed mod sedation 

Hx of past noncompliance 

History of tobacco use 

Hx underimmunizn status 

Hx-contct/expos asbestos 

Hx-cont/exps haz bdy fld 

Hx-contact/exposure lead 

Hx of ECMO 

Personal history of fall 

Hx-health hazards NEC 

Hx-health hazard NOS 

Family hx-gi malignancy 

Fm hx-trach/bronchog mal 

Fam hx-intrathoracic mal 

Family hx-breast malig 

Fm hx genital malig NOS 

Fm hx ovary malignancy 

Fm hx prostate malig 



V1643 Fm hx testis malig 

V1649 Fm hx genital malig NEC 

V1651 Family hx-kidney malig 

V1652 Fam hx-bladder malig 

V1659 Fam hx-urinry malig NEC 

V166 Family hx-leukemia 

V167 Fam hx-lymph neoplas NEC 

V168 Family hx-malignancy NEC 

V169 Family hx-malignancy NOS 

V170 Fam hx-psychiatric cond 

V171 Family hx-stroke 

V172 Fam hx-neurolog dis NEC 

V173 Fam hx-ischem heart dis 

V1741 Fam hx sudden card death 

V1749 Fam hx-cardiovas dis NEC 

V175 Family hx-asthma 

V176 Fam hx-chr resp cond NEC 

V177 Family hx-arthritis 

V1781 Family hx osteoporosis 

V1789 Fam hx musculosk dis NEC 

V180 Fam hx-diabetes mellitus 

V1811 Fam hx MEN syndrome 

V1819 Fm hx endo/metab dis NEC 

V182 Family hx-anemia 

V183 Fam hx-blood disord NEC 

V184 Fam hx-mental retardat 

V1851 Family hx colonic polyps 

V1859 Fam hx digest disord NEC 

V1861 Fam hx-polycystic kidney 

V1869 Fam hx-kidney dis NEC 

V187 Family hx-gu disease NEC 

V188 Fm hx-infect/parasit dis 

V189 Fam hx genet dis carrier 

V190 Family hx-blindness 

V191 Family hx-eye disord NEC 

V192 Family hx-deafness 

V193 Family hx-ear disord NEC 

V194 Family hx-skin condition 

V195 Fam hx-congen anomalies 

V196 Family hx-allergic dis 

V197 Consanguinity 

V198 Family hx-condition NEC 

V201 Care of healthy chld NEC 

V202 Routin child health exam 

V2031 Health supvsn nb


V332 

V342 

V352 

V362 

V372 

V391 

V392 

V400 

V401 

V402 

V403 

V409 

V410 

V411 

V412 

V413 

V414 

V415 

V416 

V417 

V418 

V419 

V420 

V421 

V422 

V423 

V424 

V425 

V426 

V427 

V4281 

V4282 

V4283 

V4284 

V4289 

V429 

V430 

V431 

V4321 

V4322 

V433 

V434 

V435 

V4360 

V4361 

V4362 

V4363 

V4364 

V4365 

V4366 

V4369 

V437 

V4381 

V4382 

V4383 

V4389 

V440 

V441 

V442 

V443 

V444 

V4450 

V4451 

V4452 

V4459 

V446 

V447 

V448 

Twin NOS-nonhosp 

Oth multiple nb-nonhosp 

Oth multiple sb-nonhosp 

Multiple nb/sb-nonhosp 

Mult birth NOS-nonhosp 

Liveborn NOS-before adm 

Liveborn NOS-nonhosp 

Problems with learning 

Prob with communication 

Mental problems NEC 

Behavioral problems NEC 

Mental/behavior prob NOS 

Problems with sight 

Eye problems NEC 

Problems with hearing 

Ear problems NEC 

Voice production problem 

Smell and taste problem 

Problem w swallowing 

Sexual function problem 

Probl w special func NEC 

Probl w special func NOS 

Kidney transplant status 

Heart transplant status 

Heart valve transplant 

Skin transplant status 

Bone transplant status 

Cornea transplant status 

Lung transplant status 

Liver transplant status 

Trnspl status-bne marrow 

Trspl sts-perip stm cell 

Trnspl status-pancreas 

Trnspl status-intestines 

Trnspl status organ NEC 

Transplant status NOS 

Eye replacement NEC 

Lens replacement NEC 

Heart assist dev replace 

Artficial heart replace 

Heart valve replac NEC 

Blood vessel replac NEC 

Bladder replacement NEC 

Joint replaced unspcf 

Joint replaced shoulder 

Joint replaced elbow 

Joint replaced wrist 

Joint replaced hip 

Joint replaced knee 

Joint replaced ankle 

Oth spcf joint replaced 

Limb replacement NEC 

Larynx replacement 

Breast replacement 

Artific skin repl status 

Organ/tiss replacmnt NEC 

Tracheostomy status 

Gastrostomy status 

Ileostomy status 

Colostomy status 

Enterostomy status NEC 

Cystostomy status NOS 

Cutaneous-vesicos status 

Appendico-vesicos status 

Cystostomy status NEC 

Urinostomy status NEC 

Artificial vagina status 

Artif open status NEC 

V449 

V4500 

V4501 

V4502 

V4509 

V4511 

V4512 

V452 

V453 

V454 

V4551 

V4552 

V4559 

V4561 

V4569 

V4572 

V4573 

V4574 

V4575 

V4576 

V4577 

V4578 

V4579 

V4581 

V4582 

V4583 

V4584 

V4585 

V4586 

V4587 

V4588 

V4589 

V460 

V462 

V463 

V468 

V469 

V470 

V471 

V472 

V473 

V474 

V475 

V479 

V480 

V481 

V482 

V483 

V484 

V485 

V486 

V487 

V488 

V489 

V490 

V491 

V492 

V493 

V494 

V495 

V4960 

V4961 

V4962 

V4963 

V4964 

V4965 

V4966 

V4967 

Artif open status NOS 

Status cardc dvce unspcf 

Status cardiac pacemaker 

Status autm crd dfbrltr 

Status oth spcf crdc dvc 

Renal dialysis status 

Noncmplnt w renal dialys 

Ventricular shunt status 

Intestinal bypass status 

Arthrodesis status 

Prsc ntrutr cntrcptv dvc 

Prsc sbdrml cntrcp mplnt 

Prsc other cntrcptv dvc 

Cataract extract status 

Post-proc st eye/adn NEC 

Acquire absnce intestine 

Acquired absence kidney 

Acq absence urinary trct 

Acq absence of stomach 

Acq absence of lung 

Acq absnce genital organ 

Acquired absence of eye 

Acq absence of organ NEC 

Aortocoronary bypass 

Status-post ptca 

Breast impl remov status 

Dental restoratn status 

Insulin pump status 

Bariatric surgery status 

Trnsplnt orgn rem status 

TPA adm status 24 hr pta 

Post-proc states NEC 

Dependence on aspirator 

Depend-supplement oxygen 

Wheelchair dependence 

Machine dependence NEC 

Machine dependence NOS 

Intern organ deficiency 

Mech prob w internal org 

Cardiorespirat probl NEC 

Digestive problems NEC 

Urinary problems NEC 

Genital problems NEC 

Probl w internal org NOS 

Deficiencies of head 

Deficiencies neck/trunk 

Mechanical prob w head 

Mech prob w neck & trunk 

Sensory problem w head 

Sensor prob w neck/trunk 

Disfigurements of head 

Disfigurement neck/trunk 

Prob-head/neck/trunk NEC 

Prob-head/neck/trunk NOS 

Deficiencies of limbs 

Mechanical prob w limbs 

Motor problems w limbs 

Sensory problems w limbs 

Disfigurements of limbs 

Limb problems NEC 

Status amput up lmb NOS 

Status amput thumb 

Status amput oth fingers 

Status amput hand 

Status amput wrist 

Status amput below elbow 

Status amput above elbow 

Status amput shoulder 



V4970 Status amput lwr lmb NOS 

V4971 Status amput great toe 

V4972 Status amput othr toe(s) 

V4973 Status amput foot 

V4974 Status amput ankle 

V4975 Status amput below knee 

V4976 Status amput above knee 

V4977 Status amput hip 

V4981 Asympt postmeno status 

V4982 Dental sealant status 

V4983 Await organ transplnt st 

V4984 Bed confinement status 

V4985 Dual sensory impairment 

V4989 Conditn influ health NEC 

V499 Probl influ health NOS 

V503 Ear piercing 

V508 Elective surgery NEC 

V509 Elective surgery NOS 

V529 Fitting prosthesis NOS 

V531 Fit contact lens/glasses 

V532 Adjustment hearing aid 

V534 Fit orthodontic device 

V5350 Fit/adjust intestinl dev 

V5351 Fit/adj gastric lap band 

V5359 Fit/adjust gi app-device 

V536 Fitting urinary devices 

V537 Fit orthopedic devices 

V538 Adjustment of wheelchair 

V5390 Fit/adjust device NOS 

V5391 Fit/adjust insulin pump 

V5399 Fit/adjust device NEC 

V549 Orthopedic aftercare NOS 

V559 Attn to artif open NOS 

V562 Fit/adj perit dial cath 

V5631 Hemodialysis testing 

V5632 Peritoneal dialysis test 

V570 Breathing exercises 

*V571 Physical therapy NEC 

*V5721 Encntr occupatnal thrpy 

*V5722 Encntr vocational thrpy 

*V573 Speech-language therapy 

V574 Orthoptic training 

V5781 Orthotic training 

*V5789 Rehabilitation proc NEC 

*V579 Rehabilitation proc NOS 

V582 Blood transfusion, no dx 

V5830 Attn rem nonsurg dressng 

V5831 Attn rem surg dressing 

V5832 Attn removal of sutures 

V5862 Long-term use antibiotic 

V5863 Lng use antiplte/thrmbtc 

V5864 Long-term anti-inflamtry 

V5865 Long-term use steroids 

V589 Aftercare NOS 

V5901 Blood donor-whole blood 

V5902 Blood donor-stem cells 

V5909 Blood donor NEC 

V5970 Egg donor NEC 

V5971 Egg donor age


V653 

V6540 

V6541 

V6542 

V6543 

V6544 

V6545 

V6546 

V6549 

V655 

V658 

V659 

V665 

V667 

V669 

V679 

V6801 

V6809 

V681 

V682 

V6881 

V6889 

V689 

V690 

V691 

V692 

V693 

V695 

V698 

V699 

V700 

V702 

V703 

V706 

V708 

V709 

V719 

V7211 

V7212 

V7219 

V722 

V725 

V7260 

V7261 

V7262 

V7263 

V7269 

V727 

V7284 

V7285 

V7286 

V729 

V730 

V731 

V732 

V733 

V734 

V735 

V736 

V7381 

V7388 

V7389 

V7398 

V7399 

V740 

V741 

V742 

V743 

Dietary surveil/counsel 

Counseling NOS 

Exercise counseling 

Counslng sbstn use abuse 

Counseling injry prevent 

Hiv counseling 

Consln ot sex trnsmt dis 

Insulin pump training 

Other specfd counseling 

Persn w feared complaint 

Reason for consult NEC 

Reason for consult NOS 

Convalescence NEC 

Encountr palliative care 

Convalescence NOS 

Follow-up exam NOS 

Disability examination 

Issue of med certif NEC 

Issue repeat prescript 

Request expert evidence 

Referral-no exam/treat 

Administrtve encount NEC 

Administrtve encount NOS 

Lack of physical exercse 

Inapprt diet eat habits 

High-risk sexual behavr 

Gambling and betting 

Behav insomnia-childhood 

Oth prblms rltd lfstyle 

Prblm rltd lfstyle NOS 

Routine medical exam 

Gen psychiatric exam NEC 

Med exam NEC-admin purp 

Health exam-pop survey 

General medical exam NEC 

General medical exam NOS 

Observ-suspect cond NOS 

Hearing exam-fail screen 

Hearing conservatn/trtmt 

Exam ears & hearing NEC 

Dental examination 

Radiological exam NEC 

Laboratory exam NOS 

Antibody response exam 

Routine physicl lab exam 

Pre-procedure lab exam 

Laboratory exam NEC 

Skin/sensitization tests 

Preop exam unspcf 

Oth specified exam 

Blood typing encounter 

Examination NOS 

Screening-poliomyelitis 

Screening for smallpox 

Screening for measles 

Screening for rubella 

Screening-yellow fever 

Screening-arbovirus dis 

Screening for trachoma 

Special screen exam HPV 

Scrn oth spcf chlmyd dis 

Scrn oth spcf viral dis 

Scrn unspcf chlmyd dis 

Scrn unspcf viral dis 

Screening for cholera 

Screening-pulmonary TB 

Screening for leprosy 

Screening for diphtheria 

V744 

V745 

V746 

V748 

V749 

V750 

V751 

V752 

V753 

V754 

V755 

V756 

V757 

V758 

V759 

V760 

V7610 

V7611 

V7612 

V7619 

V762 

V763 

V7641 

V7642 

V7643 

V7645 

V7646 

V7647 

V7649 

V7650 

V7651 

V7652 

V7681 

V7689 

V769 

V770 

V771 

V772 

V773 

V774 

V775 

V776 

V777 

V778 

V7791 

V7799 

V780 

V781 

V782 

V783 

V788 

V789 

V790 

V791 

V792 

V793 

V798 

V799 

V8001 

V8009 

V801 

V802 

V803 

V810 

V811 

V812 

V813 

V814 

Screen-bact conjunctivit 

Screen for veneral dis 

Screening for yaws 

Screen-bacterial dis NEC 

Screen-bacterial dis NOS 

Screen-rickettsial dis 

Screening for malaria 

Screen for leishmaniasis 

Screen-trypanosomiasis 

Screen-mycotic infect 

Screen-schistosomiasis 

Screen for filariasis 

Screen for helminthiasis 

Screen-parasitic dis NEC 

Screen for infec dis NOS 

Screen mal neop-resp org 

Scrn mal neo breast NOS 

Screen mammogram hi risk 

Screen mammogram NEC 

Scrn mal neo breast NEC 

Screen mal neop-cervix 

Screen mal neop-bladder 

Screen mal neop-rectum 

Screen mal neop-oral cav 

Screen mal neop-skin 

Screen malig neop-testis 

Screen malig neop-ovary 

Screen malig neop-vagina 

Screen mal neop oth site 

Scrn malig neo-intes NOS 

Screen malig neop-colon 

Scrn mal neo-small intes 

Screen neop-nervous syst 

Screen neoplasm NEC 

Screen-neoplasm NOS 

Screen-thyroid disorder 

Screen-diabetes mellitus 

Screen for malnutrition 

Screen-phenylketonuria 

Screen for galactosemia 

Screening for gout 

Screen-cystic fibrosis 

Screen-inborn err metab 

Screening for obesity 

Screen lipoid disorders 

Screen-endoc/nut/met NEC 

Screen-iron defic anemia 

Screen-defic anemia NEC 

Screen-sickle cell dis 

Scrn-hemoglobinopath NEC 

Screen-blood dis NEC 

Screen-blood dis NOS 

Screening for depression 

Screening for alcoholism 

Screen-mental retardat 

Screen-development prob 

Screen-mental dis NEC 

Screen-mental dis NOS 

Screen-traumtc brain inj 

Screen-neuro condition 

Screening for glaucoma 

Screening-eye cond NEC 

Screening for ear dis 

Scrn-ischemic heart dis 

Screen for hypertension 

Screen-cardiovasc NEC 

Screen-bronch/emphysema 

Screen-respir cond NEC 



V815 

V816 

V820 

V821 

V822 

V823 

V824 

V825 

V826 

V8271 

V8279 

V8281 

V8289 

V829 

V8301 

V8302 

V8381 

V8389 

V8401 

V8402 

V8403 

V8404 

V8409 

V8481 

V8489 

V850 

V851 

V8521 

V8522 

V8523 

V8524 

V8525 

V8530 

V8531 

V8532 

V8533 

V8534 

V8535 

Screen for nephropathy 

Screen for gu cond NEC 

Screen for skin cond 

Screen-rheumatoid arthr 

Screen-rheumat dis NEC 

Screen-cong hip dislocat 

Mat pstntl scr-chrm anom 

Screen-contamination NEC 

Multiphasic screening 

Screen-gentc dis carrier 

Genetic screening NEC 

Screen - osteoporosis 

Screen for condition NEC 

Screen for condition NOS 

Asympt hemoph a carrier 

Sympt hemophil a carrier 

Cystic fibrosis gene car 

Genetic carrier stat NEC 

Genetc sus mal neo brest 

Genetc sus mal neo ovary 

Genetc sus mal neo prost 

Genetc susc mal neo endo 

Genetic susc mal neo NEC 

Genetc sus mult endo neo 

Genetic suscept dis NEC 

BMI less than 19,adult 

BMI between 19-24,adult 

BMI 25.0-25.9,adult 











V8536 BMI 36.0-36.9,adult 

V8537 BMI 37.0-37.9,adult 

V8538 BMI 38.0-38.9,adult 

V8539 BMI 39.0-39.9,adult 

V854 BMI 40 and over,adult 

V8551 BMI,pediatric

10. 10. Non-specific O.R. procedure O.R. Effective 10/01/07, the non-specific O.R. procedure edit was 

procedure discontinued and will appear for claims processed using MCE version 

2.0-23.0 only. 

11. Non-covered procedure 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. 


Non-covered procedures 

1. The following criteria are retroactive effective November 6, 2006. 

The procedure shown below is identified as a non-covered procedure except when combined with 

non-operating room procedure code 0065 (Perc ins intracran stent). 

Procedure 

0062 Perc angio intracran ves 

2. The following criteria are retroactive effective April 26, 2006. 

ICD-9-CM procedure codes 5280 (Pancreat transplant NOS) and 5282 (Pancreatic homotransplan) alone 

[without 5569 (Kidney transplant NEC)] are considered “Non-covered procedures” except for the following 

condition: 

When either 5280 or 5282 is combined with at least one principal or secondary diagnosis code from the 

following diagnoses list: 

Diagnoses list 

25001 DMI wo cmp nt st uncntrl 

25003 DMI wo cmp uncntrld 

25011 DMI keto nt st uncntrld 

25013 DMI ketoacd uncontrold 

25021 DMI hprsm nt st uncntrld 

25023 DMI hprosmlr uncontrold 

25031 DMI o cm nt st uncntrld 

25033 DMI oth coma uncontrold 

25041 DMI renl nt st uncntrld 

25043 DMI renal uncntrld 

25051 DMI ophth nt st uncntrld 

25053 DMI ophth uncntrld 

25061 DMI neuro nt st uncntrld 

25063 DMI neuro uncntrld 

25071 DMI circ nt st uncntrld 

25073 DMI circ uncntrld 

25081 DMI oth nt st uncntrld 

25083 DMI oth uncntrld 

25091 DMI unspf nt st uncntrld 

25093 DMI unspf uncntrld 

3. The following criteria are retroactive effective May 1, 2008. 

The procedure shown below is identified as a non-covered procedure except when combined with 

diagnosis code V707 (Examination of participant in clinical trial). 

Procedure 

3752 Implantation of total internal biventricular heart replacement system 

October 2009 


Non-covered procedures 

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

1171 Keratomileusis 

1172 Keratophakia 

1175 Radial keratotomy 

1176 Epikeratophakia 

3735 Partial ventriculectomy 

3753 Repl/rep thr unt tot hrt 

3754 Repl/rep oth tot hrt sys 

3928 Extracran-intracr bypass 

4493 Insert gastric bubble 

5051 Auxiliary liver transpl 

5283 Pancreatic heterotranspl 

5796 Implant bladder stimulat 

5797 Replace bladder stimulat 

6370 Male sterilization NOS 

6371 Ligation of vas deferens 

6372 Spermatic cord ligation 

6373 Vasectomy 

645 Sex transformat op NEC 

6621 Bilat endosc crush tube 

6622 Bilat endosc divis tube 

6629 Bilat endos occ tube NEC 

6631 Bilat tubal crushing NEC 

6632 Bilat tubal division NEC 

6639 Bilat tubal destruct NEC 

9852 Eswl gb/bile duct 

9859 Eswl other sites 

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 

4101 Auto bone mt w/o purg 

4104 Auto hem stem ct w/o pur 

4107 Auto hem stem ct w purg 

4109 Auto bone mt w purging 

Diagnoses 

20400 Ac lym leuk wo achv rmsn 

20500 Ac myl leuk wo achv rmsn 

20510 Ch myl leuk wo achv rmsn 

20511 Chr myl leuk w rmsion 

20600 Ac mono leu wo achv rmsn 

20700 Ac erth/erlk wo ach rmsn 

20800 Ac leu un cl wo ach rmsn 

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 

4102 Alo bone marrow trnsplnt 

4103 Allogrft bone marrow NOS 

4105 Allo hem stem ct w/o pur 

4108 Allo hem stem ct w purg 

Diagnoses 

20300 Mult mye w/o achv rmson 

20301 Mult myelm w remission 

The procedure shown below is identified as a “Non-covered procedure” when the 

benefciary is over age 60. 

Procedure 

8465 Ins totl disc pros lumb 


12. Open biopsy check Biopsies can be performed as open biopsies, percutaneously, or endoscopically. 

The DRG Definitions assign a patient to different DRGs 

depending on whether or not the biopsy was open. In general, for 

most organ systems, open biopsies are performed infrequently. There 

are explicit ICD-9-CM codes for open and non-open biopsies. Since 

the distinction made between the different biopsy codes is not applied 

uniformly, the Medicare Code Editor identifies all biopsies that are 

coded as open biopsies. 

The following list contains codes, with corresponding English 

descriptions, that are flagged for an open biopsy check. 

Open biopsy procedures 

Non-open biopsy procedures 

0112 Open cereb meninges bx 0111 Clos cereb meninges bx 

0114 Open brain biopsy 0113 Closed brain biopsy 

0412 Open periph nerve biopsy 0411 Clos periph nerve biopsy 

0612 Open thyroid gland bx 0611 Closed thyroid gland bx 

0712 Open adrenal gland bx 0711 Closed adrenal gland bx 

2212 Open biopsy nasal sinus 2211 Closed nasal sinus bx 

2502 Open biopsy of tongue 2501 Closed biopsy of tongue 

2612 Open bx saliv gland/duct 2611 Clos bx saliv gland/duct 

3145 Opn bx larynx or trachea 3143 Closed biopsy larynx 

or 

3144 Closed biopsy trachea 

3325 Open bronchial biopsy 3324 Closed bronchial biopsy 

3328 Open lung biopsy 3326 Closed lung biopsy 

3426 Open mediastinal biopsy 3425 Clos mediastinal biopsy 

4133 Open spleen biopsy 4132 Closed spleen biopsy 

4225 Open biopsy of esophagus 4224 Closed bx of esophagus 

4415 Open gastric biopsy 4414 Closed gastric biopsy 

4515 Open small bowel biopsy 4514 Clos small bowel biopsy 

4526 Open large bowel biopsy 4525 Clos large bowel biopsy 

4825 Open rectal biopsy 4824 Closed rectal biopsy 

5012 Open liver biopsy 5011 Closed liver biopsy 

5113 Open biliary tract bx 5112 Percu bx gb/bile duct 

5212 Open pancreatic biopsy 5211 Closed pancreatic biopsy 

5423 Peritoneal biopsy 5424 Closed intra-abd mass bx 

5524 Open renal biopsy 5523 Closed renal biopsy 

5634 Open ureteral biopsy 5632 Closed ureteral biopsy 

5734 Open bladder biopsy 5733 Clos transureth bladd bx 

6012 Open prostatic biopsy 6011 Closed prostatic biopsy 

6014 Open seminal vesicles bx 6013 Clos seminal vesicles bx 

6212 Open testicular biopsy 6211 Closed testicular biopsy 

6813 Open uterine biopsy 6816 Closed uterine biopsy 

6814 Open uterine ligament bx 6815 Clos uterine ligament bx 

8512 Open breast biopsy 8511 Closed breast biopsy 

October 2009 


13. Bilateral procedure Certain codes do not accurately reflect procedures performed in one 

admission on two or more different bilateral joints of the lower 

extremities. A combination of these codes shows a bilateral procedure 

when they could be procedures performed on a single joint (i.e., 

duplicate procedures). For example, if 8151 (Total hip replacement) 

and 8152 (Partial hip replacement) are both coded on the claim, the 

edit “bilateral procedure” will appear. 

This edit instructs the fiscal intermediary to ensure that these procedures 

were performed on two separate joints. However, if 8151 (Total 

hip replacement) is coded twice, the edit would not appear because 

this signifies a true bilateral procedure. 

The following list contains the joint replacement procedure codes 

with corresponding English descriptions identified as “bilateral procedure” 

whenever two or more different joint procedures are coded, 

and the principal diagnosis causes assignment to MDC 8. 

Bilateral procedure codes 

0070 Rev hip repl-acetab/fem 

0080 Rev knee replacemt-total 

0085 Resrf hip,total-acet/fem 

0086 Resrf hip,part-fem head 

0087 Resrf hip,part-acetablum 

8151 Total hip replacement 

8152 Partial hip replacement 

8154 Total knee replacement 

8156 Total ankle replacement 


14. Invalid age A patient’s 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. 

15. Invalid sex A patient’s sex (gender) may be necessary for appropriate DRG determination. 

The sex code reported must be either 1 (male) or 2 (female). 

16. Invalid discharge status A patient’s 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 

05 = Disch/trans to another type of facility (valid until 03/31/08) 

05 = Disch/trans to a designated cancer center or children’s 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 facility–Medicaid 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 (10/01/01–09/30/03 only) 

72 = Outpatient services-this facility (10/01/01–09/30/03 only) 

October 2009 


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. 

Limited coverage 

3222 Lung vol reduction surg 

3350 Lung transplant NOS 

3351 Unilat lung transplant 

3352 Bilat lung transplant 

336 Comb heart/lung transpla 

3751 Heart transplantation 

3766 Implantable hrt assist 

4697 Transplant of intestine 

5059 Liver transplant NEC 

5280 Pancreas transplant NOS 

5282 Pancreatic homotransplan 

5569 Kidney tansplant NEC 

The following criteria are retroactive effective May 1, 2008. 

The procedure shown below is identified as a limited 

coverage procedure when combined with diagnosis code V707 

(Examination of participant in clinical trial). 

Procedure 

3752 Imp tot int bi ht rp sys 



18. Wrong 18. Wrong procedure procedure 

performed Certain E-codes indicate that the wrong procedure was 

performed performed. 


The following list contains the codes, with corresponding English 

descriptions, that indicate the wrong procedure was performed. 

E8765 

E8766 

E8767 

Perfrm wrong op/right pt 

Proc-pt not sched surg 

Rt proc-wrong side/part 

October 2009 




Chapter 2 

2Code list changes


Contents Code list changes 2.3 

Changes to existing edits 2.3 

New edit 2.13 

2.2 Definitions of Medicare Code Edits 

October 2009


Chapter 2 

Code list changes 

THIS 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. 

Changes to existing edits 

Diagnoses for Newborns 

The following codes were added: 

768.70 Hypoxic-ischemic encephalopathy, unspecified 

768.71 Mild hypoxic-ischemic encephalopathy 

768.72 Moderate hypoxic-ischemic encephalopathy 

768.73 Severe hypoxic-ischemic encephalopathy 

779.31 Feeding problems in newborn 

779.32 Bilious vomiting in newborn 

779.33 Other vomiting in newborn 

779.34 Failure to thrive in newborn 

V20.31 Health supervision for newborn under 8 days 

V20.32 Health supervision for newborn 8 to 28 days old 

The following codes were removed: 

768.7 Hypoxic-ischemic encephalopathy (HIE) 

779.3 Feeding problems in newborn 

October 2009 

Code list changes 2.3


Diagnoses for Pediatrics - (age 0-17) 


789.7 Colic 

799.82 Apparent life threatening event in infant 

Diagnoses for Maternity -age 12-55 years old 


670.10 Puerperal endometritis, unspecified as to episode of care 

or not applicable 

670.12 Puerperal endometritis, delivered, with mention of postpartum 

complication 

670.14 Puerperal endometritis, postpartum condition or 

complication 

670.20 Puerperal sepsis, unspecified as to episode of care or not 

applicable 

670.22 Puerperal sepsis, delivered, with mention of postpartum 

complication 

670.24 Puerperal sepsis, postpartum condition or complication 

670.30 Puerperal septic thrombophlebitis, unspecified as to episode 

of care or not applicable 

670.32 Puerperal septic thrombophlebitis, delivered, with mention 

of postpartum complication 

670.34 Puerperal septic thrombophlebitis, postpartum condition 

or complication 

670.80 Other major puerperal infection, unspecified as to episode 


670.82 Other major puerperal infection, delivered, with mention 


670.84 Other major puerperal infection, postpartum condition or 

complication 

The following code was removed: 

V65.11 Pediatric pre-birth visit for expectant parent(s) 

Diagnoses for Females Only 


621.34 Benign endometrial hyperplasia 

621.35 Endometrial intraepithelial neoplasia [EIN] 

670.10 Puerperal endometritis, unspecified as to episode of care 

or not applicable 

670.12 Puerperal endometritis, delivered, with mention of postpartum 

complication 

670.20 Puerperal sepsis, unspecified as to episode of care or not 

applicable 



670.22 Puerperal sepsis, delivered, with mention of 

postpartum complication 

670.24 Puerperal sepsis, postpartum condition or complication 

670.30 Puerperal septic thrombophlebitis, unspecified as to episode 


670.32 Puerperal septic thrombophlebitis, delivered, with mention 


670.34 Puerperal septic thrombophlebitis, postpartum condition 

or complication 

670.80 Other major puerperal infection, unspecified as to episode 


670.82 Other major puerperal infection, delivered, with mention 


670.84 Other major puerperal infection, postpartum condition or 

complication 

The following code was removed: 

V65.11 Pediatric pre-birth visit for expectant parent(s) 

Diagnoses for Males Only 


603.0 Encysted hydrocele 

603.1 Infected hydrocele 

603.8 Other hydrocele 

603.9 Hydrocele NOS 

Procedures Allowed for Females Only 


75.37 Amnioinfusion 

75.38 Fetal pulse oximetry 

Manifestations Not Allowed as Principal Diagnoses 


365.41 Glaucoma associated with chamber angle anomalies 

365.42 Glaucoma associated with anomalies of iris 

365.43 Glaucoma associated with other anterior segment 

anomalies 

October 2009 



Unacceptable Principal Diagnoses 


V10.90 Personal history of unspecified type of malignant 

neoplasm 

V10.91 Personal history of malignant neuroendocrine tumor 

V15.52 Personal history of traumatic brain injury 

V15.80 Personal history of failed moderate sedation 

V15.83 Personal history of underimmunization status 

V20.31 Health supervision for newborn under 8 days 

V20.32 Health supervision for newborn 8 to 28 days old 

V26.42 Encounter for fertility preservation counseling 

V26.82 Encounter for fertility preservation procedure 

V53.50 Fitting and adjustment of intestinal appliance and device 

V53.51 Fitting and adjustment of gastric lap band 

V53.59 Fitting and adjustment of other gastrointestinal 

appliance and device 

V60.81 Foster care (status) 

V60.89 Other specified housing or economic circumstances 

V61.07 Family disruption due to death of family member 

V61.08 Family disruption due to other extended absence of family 

member 

V61.23 Counseling for parent-biological child problem 

V61.24 Counseling for parent-adopted child problem 

V61.25 Counseling for parent (guardian)-foster child problem 

V61.42 Substance abuse in family 

V72.60 Laboratory examination, unspecified 

V72.61 Antibody response examination 

V72.62 Laboratory examination ordered as part of a routine general 

medical examination 

V72.63 Pre-procedural laboratory examination 

V72.69 Other laboratory examination 

V80.01 Special screening for traumatic brain injury 

V80.09 Special screening for other neurological conditions 

V87.32 Contact with and (suspected) exposure to algae bloom 

V87.43 Personal history of estrogen therapy 

V87.44 Personal history of inhaled steroid therapy 

V87.45 Personal history of systemic steroid therapy 

V87.46 Personal history of immunosuppressive therapy 


209.00 Malignant carcinoid tumor of the small intestine, unspecified 

portion 

209.01 Malignant carcinoid tumor of the duodenum 

209.02 Malignant carcinoid tumor of the jejunum 

209.03 Malignant carcinoid tumor of the ileum 

209.10 Malignant carcinoid tumor of the large intestine, unspecified 

portion 



209.11 Malignant carcinoid tumor of the appendix 

209.12 Malignant carcinoid tumor of the cecum 

209.13 Malignant carcinoid tumor of the ascending colon 

209.14 Malignant carcinoid tumor of the transverse colon 

209.15 Malignant carcinoid tumor of the descending colon 

209.16 Malignant carcinoid tumor of the sigmoid colon 

209.17 Malignant carcinoid tumor of the rectum 

209.20 Malignant carcinoid tumor of unknown primary site 

209.21 Malignant carcinoid tumor of the bronchus and lung 

209.22 Malignant carcinoid tumor of the thymus 

209.23 Malignant carcinoid tumor of the stomach 

209.24 Malignant carcinoid tumor of the kidney 

209.25 Malignant carcinoid tumor of foregut, not otherwise 

specified 

209.26 Malignant carcinoid tumor of midgut, not otherwise 

specified 

209.27 Malignant carcinoid tumor of hindgut, not otherwise 

specified 

209.29 Malignant carcinoid tumor of other sites 

209.30 Malignant poorly differentiated neuroendocrine carcinoma, 

any site 

209.40 Benign carcinoid tumor of the small intestine, unspecified 

portion 

209.41 Benign carcinoid tumor of the duodenum 

209.42 Benign carcinoid tumor of the jejunum 

209.43 Benign carcinoid tumor of the ileum 

209.50 Benign carcinoid tumor of the large intestine, unspecified 

portion 

209.51 Benign carcinoid tumor of the appendix 

209.52 Benign carcinoid tumor of the cecum 

209.53 Benign carcinoid tumor of the ascending colon 

209.54 Benign carcinoid tumor of the transverse colon 

209.55 Benign carcinoid tumor of the descending colon 

209.56 Benign carcinoid tumor of the sigmoid colon 

209.57 Benign carcinoid tumor of the rectum 

209.60 Benign carcinoid tumor of unknown primary site 

209.61 Benign carcinoid tumor of the bronchus and lung 

209.62 Benign carcinoid tumor of the thymus 

209.63 Benign carcinoid tumor of the stomach 

209.64 Benign carcinoid tumor of the kidney 

209.65 Benign carcinoid tumor of foregut, not otherwise 

specified 

209.66 Benign carcinoid tumor of midgut, not otherwise 

specified 

209.67 Benign carcinoid tumor of hindgut, not otherwise 

specified 

209.69 Benign carcinoid tumor of other sites 

October 2009 



V10.9 Unspecified personal history of malignant neoplasm 

V53.5 Fitting and adjustment of other intestinal appliance 

V60.8 Other specified housing or economic circumstances 

V72.6 Laboratory examination 

V80.0 Special screening for neurological conditions 

E-Code as PDX 


E000.0 Civilian activity done for income or pay 

E000.1 Military activity 

E000.8 Other external cause status 

E000.9 Unspecified external cause status 

E001.0 Activities involving walking, marching and hiking 

E001.1 Activities involving running 

E002.0 Activities involving swimming 

E002.1 Activities involving springboard and platform diving 

E002.2 Activities involving water polo 

E002.3 Activities involving water aerobics and water exercise 

E002.4 Activities involving underwater diving and snorkeling 

E002.5 Activities involving rowing, canoeing, kayaking, rafting 

and tubing 

E002.6 Activities involving water skiing and wake boarding 

E002.7 Activities involving surfing, windsurfing and boogie 

boarding 

E002.8 Activities involving water sliding 

E002.9 Other activity involving water and watercraft 

E003.0 Activities involving ice skating 

E003.1 Activities involving ice hockey 

E003.2 Activities involving snow (alpine) (downhill) skiing, 

snow boarding, sledding, tobogganing and snow tubing 

E003.3 Activities involving cross country skiing 

E003.9 Other activity involving ice and snow 

E004.0 Activities involving mountain climbing, rock climbing 

and wall climbing 

E004.1 Activities involving rappelling 

E004.2 Activities involving climbing BASE jumping 

E004.3 Activities involving climbing bungee jumping 

E004.4 Activities involving hang gliding 

E004.9 Other activity involving climbing, rappelling and jumping 

off 

E005.0 Activities involving dancing 

E005.1 Activities involving yoga 

E005.2 Activities involving gymnastics 

E005.3 Activities involving trampoline 

E005.4 Activities involving cheerleading 



E005.9 Other activity involving dancing and other rhythmic 

movements 

E006.0 Activities involving roller skating (inline) and 

skateboarding 

E006.1 Activities involving horseback riding 

E006.2 Activities involving golf 

E006.3 Activities involving bowling 

E006.4 Activities involving bike riding 

E006.5 Activities involving jump rope 

E006.6 Activities involving non-running track and field events 

E006.9 Other activity involving other sports and athletics played 

individually 

E007.0 Activities involving american tackle football 

E007.1 Activities involving american flag or touch football 

E007.2 Activities involving rugby 

E007.3 Activities involving baseball 

E007.4 Activities involving lacrosse and field hockey 

E007.5 Activities involving soccer 

E007.6 Activities involving basketball 

E007.7 Activities involving volleyball (beach) (court) 

E007.8 Activities involving physical games generally associated 

with school recess, summer camp and children 

E007.9 Other activity involving other sports and athletes played 

as a team or group 

E008.0 Activities involving boxing 

E008.1 Activities involving wrestling 

E008.2 Activities involving racquet and hand sports 

E008.3 Activities involving frisbee 

E008.4 Activities involving martial arts 

E008.9 Other specified sports and athletics activities 

E009.0 Activity involving exercise machines primarily for cardiorespiratory 

conditioning 

E009.1 Activity involving calisthenics 

E009.2 Activity involving aerobic and step exercise 

E009.3 Activity involving circuit training 

E009.4 Activity involving obstacle course 

E009.5 Activity involving grass drills 

E009.9 Other activity involving cardiorespiratory exercise 

E010.0 Activity involving exercise machines primarily for muscle 

strengthening 

E010.1 Activity involving push-ups, pull-ups, sit-ups 

E010.2 Activity involving free weights 

E010.3 Activity involving pilates 

E010.9 Other activity involving other muscle strengthening 

exercises 

E011.0 Activities involving computer keyboarding 

October 2009 



E011.1 Activities involving hand held interactive electronic 

device 

E011.9 Other activity involving computer technology and electronic 

devices 

E012.0 Activities involving knitting and crocheting 

E012.1 Activities involving sewing 

E012.2 Activities involving furniture building and finishing 

E012.9 Activity involving other arts and handcrafts 

E013.0 Activities involving personal bathing and showering 

E013.1 Activities involving laundry 

E013.2 Activities involving vacuuming 

E013.3 Activities involving ironing 

E013.4 Activities involving floor mopping and cleaning 

E013.5 Activities involving residential relocation 

E013.8 Other personal hygiene activity 

E013.9 Other household maintenance 

E014.0 Caregiving involving bathing 

E014.1 Caregiving involving lifting 

E014.9 Other activity involving person providing caregiving 

E015.0 Activities involving food preparation and clean up 

E015.1 Activities involving grilling and smoking food 

E015.2 Activities involving cooking and baking 

E015.9 Other activity involving cooking and grilling 

E016.0 Activities involving digging, shoveling and raking 

E016.1 Activities involving gardening and landscaping 

E016.2 Activities involving building and construction 

E016.9 Other activity involving property and land 

maintenance, building and construction 

E017.0 Activities involving roller coaster riding 

E017.9 Other activity involving external motion 

E018.0 Activities involving piano playing 

E018.1 Activities involving drum and other percussion instrument 

playing 

E018.2 Activities involving string instrument playing 

E018.3 Activities involving winds and brass instrument playing 

E019.0 Activities involving walking an animal 

E019.1 Activities involving milking an animal 

E019.2 Activities involving grooming and shearing an animal 

E019.9 Other activity involving animal care 

E029.0 Refereeing a sports activity 

E029.1 Spectator at an event 

E029.2 Rough housing and horseplay 

E029.9 Other activity 

E030 Unspecified activity 

E830.7 Accident to watercraft causing submersion, occupant of 

military watercraft, any type 



E831.7 Accident to watercraft causing other injury, occupant 

of military watercraft, any type 

E832.7 Other accidental submersion or drowning in water transport 

accident, occupant of military watercraft, any type 

E833.7 Fall on stairs or ladders in water transport, occupant of 


E834.7 Other fall from one level to another in water transport, 

occupant of military watercraft, any type 

E835.7 Other and unspecified fall in water transport, occupant of 


E836.7 Machinery accident in water transport, occupant of military 

watercraft, any type 

E837.7 Explosion, fire, or burning in watercraft, occupant of military 

watercraft, any type 

E838.7 Other and unspecified water transport accident, occupant 

of military watercraft, any type 

E876.6 Performance of operation (procedure) on patient not 

scheduled for surgery 

E876.7 Performance of correct operation (procedure) on wrong 

side/body part 

E928.7 Environmental and accidental causes, mechanism or 

component of firearm and air gun 

E990.1 Injury due to war operations from flamethrower 

E990.2 Injury due to war operations from incendiary bullet 

E990.3 Injury due to war operations from fire caused indirectly 

from conventional weapon 

E991.4 Injury due to war operations by fragments from 

munitions 

E991.5 Injury due to war operations by fragments from person-borne 

improvised explosive device 

E991.6 Injury due to war operations by fragments from 

vehicle-borne improvised explosive device (IED) 

E991.7 Injury due to war operations by fragments from other 

improvised explosive device (IED) 

E991.8 Injury due to war operations by fragments from weapons 

E992.0 Injury due to torpedo 

E992.1 Injury due to depth charge 

E992.2 Injury due to marine mines 

E992.3 Injury due to sea-based artillery shell 

E992.8 Injury due to war operations by other marine weapons 

E992.9 Injury due to war operations by unspecified marine 

weapon 

E993.0 Injury due to war operations by aerial bomb 

E993.1 Injury due to war operations by guided missile 

E993.2 Injury due to war operations by mortar 

E993.3 Injury due to war operations by person-borne improvised 

explosive device (IED) 

October 2009 



E993.4 Injury due to war operations by vehicle-borne improvised 

explosive device (IED) 

E993.5 Injury due to war operations by other improvised explosive 

device (IED) 

E993.6 Injury due to war operations by unintentional 

detonation of own munitions 

E993.7 Injury due to war operations by unintentional 

discharge of own munitions launch device 

E993.8 Injury due to war operations by other specified explosion 

E993.9 Injury due to war operations by unspecified explosion 

E994.0 Injury due to war operations by destruction of aircraft 

due to enemy fire or explosives 

E994.1 Injury due to war operations by unintentional destruction 

of aircraft due to own onboard explosives 


due to collision with other aircraft 


due to onboard fire 

E994.8 Injury due to war operations by other destruction of 

aircraft 

E994.9 Injury due to war operations by unspecified destruction 

of aircraft 

E995.0 Injury due to war operations by unarmed hand-to-hand 

combat 

E995.1 Injury due to war operations, struck by blunt object 

E995.2 Injury due to war operations by piercing object 

E995.3 Injury due to war operations by intentional restriction of 

air and airway 

E995.4 Injury due to war operations by unintentional drowning 

due to inability to surface or obtain air 

E995.8 Injury due to war operations by other forms of conventional 

warfare 

E995.9 Injury due to war operations by unspecified form of conventional 

warfare 

E996.0 Injury due to war operations by direct blast effect of 

nuclear weapon 

E996.1 Injury due to war operations by indirect blast effect of 


E996.2 Injury due to war operations by thermal radiation effect 

of nuclear weapon 

E996.3 Injury due war operations by nuclear radiation effects 

E996.8 Injury due to war operations by other effects of nuclear 

weapons 

E996.9 Injury due to war operations by unspecified effect of 


E997.3 Injury due to war operations by weapon of mass destruction 

(WMD), unspecified 



E998.0 Injury due to war operations but occurring after cessation 

of hostilities by explosion of mines 

E998.1 Injury due to war operations but occurring after cessation 

of hostilities by explosion of bombs 

E998.8 Injury due to other war operations but occurring after 

cessation of hostilities 

E998.9 Injury due to unspecified war operations but occurring 

after cessation of hostilities 

Bilateral Procedures 

The following codes from MDC 8 were added to the list of 

diagnosis codes used in evaluating for bilateral procedures: 

209.73 Secondary neuroendocrine tumor of bone 

274.00 Gouty arthropathy, unspecified 

274.01 Acute gouty arthropathy 

274.02 Chronic gouty arthropathy without mention of tophus 

(tophi) 

274.03 Chronic gouty arthropathy with tophus (tophi) 

279.41 Autoimmune lymphoproliferative syndrome 

279.49 Autoimmune disease, not elsewhere classified 

813.46 Torus fracture of ulna (alone) 

813.47 Torus fracture of radius and ulna 

832.2 Nursemaid's elbow 


274.0 Gouty arthropathy 

279.4 Autoimmune disease, not elsewhere classified 

New edit 

Wrong Procedure Performed 

Certain E-codes indicate that the wrong procedure was 

performed. 


E8765 Performance of wrong operation (procedure) on 

correct patient 

E8766 Performance of operation (procedure) on patient not 

scheduled for surgery 

E8767 Performance of correct operation (procedure) on wrong 

side/body part 

October 2009 





Index 

A 

Adult 

age categories, 1.4 


Age categories, 1.4 

adult, 1.4 

maternity, 1.4 

newborn, 1.4 

pediatric, 1.4 

Age conflict, 1.4 

adult diagnosis codes, 1.18 

maternity diagnosis codes, 1.9 

newborn diagnosis codes, 1.5 

pediatric diagnosis codes, 1.8 

B 

Bilateral procedure, 1.54 

C 

Code lists, 1.1 

Codes 

adult diagnoses, 1.18 

age conflict, 1.5, 1.8, 1.9, 1.18 

diagnoses allowed for females only, 1.20 

diagnoses allowed for males only, 1.35 

limited coverage, 1.56 

manifestations not allowed as principal dx, 1.38 

D 

maternity diagnoses, 1.9 

newborn diagnoses, 1.5 

non-covered procedure, 1.51 

non-open biopsy procedure, 1.53 

open biopsy procedure, 1.53 

pediatric diagnoses, 1.8 

procedures allowed for females only, 1.32 

procedures allowed for males only, 1.37 

questionable admission, 1.41 

unacceptable principal diagnosis, 1.43 

valid discharge status, 1.55 

Diagnoses allowed for females only codes, 1.20 

Diagnoses allowed for males only codes, 1.35 

Duplicate of PDX, 1.4 

example, 1.4 

E 

E-code as principal diagnosis, 1.4 

E-codes, 1.4 

Edit list, 1.3 

Edits 

age conflict, 1.4 

bilateral procedure, 1.54 

duplicate of PDX, 1.4 

E-code as principal diagnosis, 1.4 

invalid age, 1.55 

October 2009 

Index I.1


invalid discharge status, 1.55 

invalid sex, 1.55 

limited coverage, 1.56 

manifestation code as principal diagnosis, 1.38 

new edit, 2.13 

non-covered procedure, 1.50 

open biopsy check, 1.53 

questionable admission, 1.41 

requires secondary diagnosis, 1.42 

sex conflict, 1.19 

unacceptable principal diagnosis, 1.42 

wrong procedure performed, 1.57 

Example 

duplicate of PDX, 1.4 

P 

Pediatric 



Procedures allowed for females only codes, 1.32 

Procedures allowed for males only codes, 1.37 

Procedures, wrong procedure performed, 1.57, 2.13 

Q 

Questionable admission, 1.41 

codes, 1.41 

I 

Invalid age, 1.55 

Invalid discharge status, 1.55 

Invalid sex, 1.55 

L 

Limited coverage, 1.56 

codes, 1.56 

List of edits, 1.3 

M 

Manifestation code as principal diagnosis, 1.38 

Manifestations not allowed as principal dx codes, 1.38 

Maternity 



N 

Newborn 



Non-covered procedure, 1.50 

codes, 1.51 

Non-open biopsy procedure codes, 1.53 

R 

Requires secondary diagnosis, 1.42 

S 

Sex conflict, 1.19 

diagnoses allowed for females only codes, 1.20 

diagnoses allowed for males only codes, 1.35 

procedures allowed for females only codes, 1.32 

procedures allowed for males only codes, 1.37 

U 

UB-04 discharge status code list, 1.55 

Unacceptable principal diagnosis, 1.42 

codes, 1.43 

V 

Valid discharge status codes, 1.55 

W 

Wrong procedure performed, 1.57, 2.13 

O 

Open biopsy check, 1.53 

codes, 1.53 

I.2 Definitions of Medicare Code Edits 

October 2009

Medicare Code Editor Software

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?