VALIDITY
EDITS
|
1-300-01V
|
IF FILING DATE
PRIOR TO 10/01/2004
|
|
THEN VALUE IN
POSITIONS 1-7 MUST BE A VALID ICD DIAGNOSIS CODE, EXCLUDING E000.0-E999.1
(ICD-9-CM).
|
1-300-02V
|
IF FILING DATE
ON OR AFTER 10/01/2004
|
|
THEN VALUE IN
POSITIONS 1-7 MUST BE A VALID ICD DIAGNOSIS CODE, EXCLUDING E000.0-E999.1
(ICD-9-CM) AND V00-Y99.9 (ICD-10-CM).
|
|
AND BEGIN DATE
OF CARE MUST BE ON OR AFTER THE DIAGNOSIS EFFECTIVE DATE AND NOT
LATER THAN THE DIAGNOSIS TERMINATION DATE ON THE ICD DIAGNOSIS REFERENCE
TABLE
|
|
OR END DATE OF
CARE MUST BE ON OR AFTER THE DIAGNOSIS EFFECTIVE DATE AND NOT LATER
THAN THE DIAGNOSIS TERMINATION DATE ON THE ICD DIAGNOSIS REFERENCE
TABLE
|
1-300-03V
|
POA INDICATOR (POSITION 8 OF
THE PRINCIPAL DIAGNOSIS/POA INDICATOR) MUST BE A VALID VALUE.
|
Relational
Edits
|
1-300-01R
|
IF PRINCIPAL TREATMENT DIAGNOSIS/POA INDICATOR
(POSITIONS 1-7) =
|
799.9
|
ICD-9-CM OR
|
|
|
R69
|
ICD-10-CM OR
|
|
|
R99
|
ICD-10-CM
|
|
THEN AMOUNT ALLOWED
(TOTAL) MUST = ZERO
|
|
OR ANY OCCURRENCE
OF SPECIAL PROCESSING CODE =
|
1
|
MEDICAID
|
1-300-02R
|
IF PRINCIPAL TREATMENT DIAGNOSIS/POA
INDICATOR (POSITIONS 1-7) IS FOR FEMALE
|
|
AND PERSON SEX
(PATIENT) = MALE
|
|
THEN AT LEAST
ONE OVERRIDE CODE MUST =
|
G
|
DIAGNOSIS/PROCEDURE CODE FOR
FEMALE: SEX INDICATES MALE
|
1-300-03R
|
IF PRINCIPAL TREATMENT DIAGNOSIS/POA
INDICATOR (POSITIONS 1-7) IS FOR MALE
|
|
AND PERSON SEX
(PATIENT) = FEMALE
|
|
THEN AT LEAST
ONE OVERRIDE CODE MUST =
|
H
|
DIAGNOSIS/PROCEDURE CODE FOR
MALE: SEX INDICATES FEMALE
|
1-300-05R
|
IF OP/NSP CODE IS CESAREAN
SECTION OR REMOVAL OF FETUS (74.0-74.2, 74.4-74.99, 10D00Z0, 10D00Z1, 10D00Z2,
10D07Z3, 10D07Z4, 10D07Z5, 10D07Z6, 10D07Z7, 10D07Z8, 10A00ZZ, 10A03ZZ, 10A04ZZ, 10A08ZZ,
10A07Z6, 10A07ZW, 10A07ZX, OR 10A07ZZ)
|
|
THEN PRINCIPAL
TREATMENT DIAGNOSIS/POA INDICATOR (POSITIONS 1-7) MUST BE 640-676 OR O09.00-O77.9,
O82, OR O85-O9A.53.
|
1-300-06R
|
IF OP/NSP CODE IS ECTOPIC PREGNANCY
(74.3, 10D27ZZ, 10D28ZZ, 10T20ZZ, 10T23ZZ, OR 10T24ZZ)
|
|
THEN PRINCIPAL TREATMENT
DIAGNOSIS/POA INDICATOR (POSITIONS 1-7) MUST BE 633.0-633.9 OR O00.0-O00.92.
|
1-300-07R
|
IF TYPE OF INSTITUTION =
|
72
|
RTC
|
|
AND AMOUNT ALLOWED
(TOTAL) > 0
|
|
THEN PRINCIPAL
TREATMENT DIAGNOSIS/POA INDICATOR (POSITIONS 1-7) MUST =
|
290-316 (MENTAL HEALTH, ICD-9-CM) OR
|
|
|
F01- F99 (MENTAL HEALTH, ICD-10-CM)
|
1-300-09R
|
IF TYPE OF INSTITUTION =
|
72
|
RTC
|
|
AND AMOUNT ALLOWED
(TOTAL) > 0
|
|
THEN PATIENT AGE1 MUST
BE < 21
|
|
|
|
UNLESS ENROLLMENT/HEALTH
PLAN
CODE =
|
SR
|
SHCP-MTF REFERRED CARE
|