Definitions of Medicare Code Edits

Definitions of Medicare code EditsDRAFT ICD-10 VERSIONS oftware version R1 PBL 031 September 2011 Manual updated March 2012ii Definitions of Medicare code EditsSeptember 2011 Document number PBL 031 September 2011 iiiSeptember 2011 About this documentTHE 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-10-CM and ICD-10-PCS code lists which were published in December 2010. The coding edit information in this manual is effective from 10/01/2010 to 09/30/2011.

1.4 Definitions of Medicare Code Edits September 2011 1. Invalid diagnosis or procedure code The Medicare Code Editor checks each diagnosis including the admit-ting diagnosis and each procedure against a table of valid ICD-10-CM and ICD-10-PCS codes. If an entered code does not agree with any code on the internal list, it is assumed to be invalid.

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