Advanced Clinical Editing For Providers

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26TC

The global procedure code <1> has been submitted in history on claim ID <2> without the modifiers
26 or TC.

ANE

Procedure XXXXX was billed by a provider not listed as an Anesthesiology provider.

ASD

An anesthesia service with an equal or higher base unit value than [XXXXX] was billed on
[mm/dd/yyyy] on claim ID [XYZ], Ext/Int Line ID [1/2]. Only the anesthesia code with the higher base
unit value should be billed per operative session.

BAG

Per LCD or NCD guidelines, procedure code G0102 has not met the associated Age relationship
criteria for CMS ID(s) 210.1.

BCC

Per LCD or NCD guidelines, procedure code G0247 has not met the associated Code-to-Code
relationship criteria for CMS ID(s) 70.2.1.

BDS

The beginning or ending Date of Service (DOS) is invalid or missing.

BFR

 Per LCD or NCD guidelines, procedure code G0445 has not met the associated Frequency
relationship criteria for CMS ID(s) 210.10.

BPO

Per LCD or NCD guidelines, procedure code G0445 has not met the associated Place of Service
relationship criteria for CMS ID(s) 210.10.

BPS

The place of service XX is missing or invalid.

BSP

Per LCD or NCD guidelines, procedure code G0445 has not met the associated Provider Specialty
relationship criteria for CMS ID(s) 210.10.

BSX

Per LCD or NCD guidelines, procedure code 77052 has not met the associated Gender relationship
criteria for CMS ID(s) L31856.

CAG

Procedure Code XXXXX is not typical for a patient whose age is XX. The typical age range for this
procedure is YY - ZZ.

CAG1

Procedure code 99100 is not typical for age of patient.

CDL

Procedure Code <1> has been deleted as of <2>.

CPO

Only one individual may report a single care plan oversight CPT code per patient in the same month.

CPO1

Procedure code 99091 cannot be reported within 30 days of the care plan oversight code reported on
claim ID <2>.

CPT

Ï Procedure code XXXXX is invalid.
Ï Procedure code XXXXX is disabled.

CSX

Procedure code <1> is not typically performed for a patient whose gender is <2>.

DLP

Procedure code <1> is a possible duplicate of the same procedure code found on Claim ID <2>, Line
ID <3> performed by the same provider on the same day.

DLPA

Procedure code <1> is a possible duplicate of the same procedure code found on Claim ID <2>
reported by the same provider using anatomic modifiers.

DLPB

Procedure code <1> is a possible duplicate of the same procedure code found on Claim ID <2>
reported by the same provider using LT or RT modifier.

DLPG

Procedure code <1> is a possible duplicate of the same procedure code found on Claim ID <2>
reported by the same provider using G modifiers.

DOB

Patients Date of Birth is missing or invalid.\

DTU

Discrepancy detected between the number of units XX on this claim line and the difference between
the Beginning DOS {mm/dd/yyyy) and the Ending DOS (mm/dd/yyyy) which is YY days.

ESR1

It is inappropriate to submit an ESRD related service code (4 or more face-to-face visits based on
patient's age) more than once per month.

ESR2

It is inappropriate to submit an ESRD related service code (2-3 face-to-face visits based on patient's
age) more than once per month.

ESR3

It is inappropriate to submit an ESRD related service code (1 face-to-face visit based on patient's age)
more than once per month.

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FCRP

Procedure code <1> found on claim ID <2> is a facility service code. This service is not to be reported
on a professional claim.

GFP

Procedure Code XXXXX is within the global period of 10 days of History Procedure Code XXXXX
performed on 01/30/2014 on Claim ID [1234], Ext/Int Line ID [1/1] by the same provider. Please review
documentation for appropriate modifier.

GFP1

Procedure Code <1> is within the global period of a surgical procedure code performed by the same
provider.

GSP

Procedure Code [XXXXX] is within the global period of XX days of History Procedure Code [YYYYY]
performed on mm/dd/yyyy on Claim ID [XYZ], Ext/Int Line ID [1/2] by the same provider. The
diagnosis indicates it is for the same condition. Please review documentation for an appropriate
modifier.

HBS

A hysterectomy must be reported by specialty General Surgeon (2), Obstetrics/Gynecology (16),
Urology (34), Surgical Oncology (91) or Gynecological Oncology (98).

HPS

A hysterectomy following surgical treatment of an ectopic pregnancy or a c/section delivery may not
be reported by any specialty other than Obstetrics/Gynecology (16).

IAG

Dx XXXYY is not typical for a patient whose age is (XX). The typical age range for this diagnosis is X-

  1.  

ICD

Ï The diagnosis XXXYY is invalid
Ï The diagnosis XXXYY is disabled

ICM

There is no Primary Diagnosis listed for this procedure.

IDCD

Diagnosis codes <1> identify mutually exclusive codes; two conditions that cannot be reported
together.

IDCI

Diagnosis codes <1> identify mutually exclusive codes; two conditions that cannot be reported
together.

IDL

Dx XXXYY has been deleted.

IDX

Dx XXXYY is a nonspecific diagnosis code and requires a fourth and/or fifth digit.

IMC

Modifier XX cannot be billed on the same claim line as modifier YY.

IMD

The diagnosis XXXX and modifier YY combination are inappropriate..

IMO

Modifier XX is invalid or disabled.

INJ

Separate reporting is allowed for the supply code of injectable materials provided in POS <1> when
injection procedure <2> is reported.

INJ1

Separate reporting is allowed for the injection procedure performed in POS <1> when supply code
<2> of injectable materials is reported.

ISX

Diagnosis code(s) <1> typically would not be reported for a patient whose gender is <2>.

LBI

Per LCD or NCD guidelines, procedure code XXXXX has not met the associated Diagnosis Code
relationship criteria for CMS ID(s) L31896

LBM

Per LCD or NCD guidelines, procedure code XXXXX has not met the associated Modifier Code
relationship criteria for CMS ID(s) 90.1.

LBP

Per LCD or NCD guidelines, procedure code XXXXX has not met the associated Primary Diagnosis
Code relationship criteria for CMS ID(s) 100.1.

LBS

Per LCD or NCD guidelines, procedure code XXXXX has not met the associated Secondary
Diagnosis Code relationship criteria for CMS ID(s) 100.1.

LBT

Per LCD or NCD guidelines, procedure code XXXXX, has not met the associated Tertiary Diagnosis
Code relationship criteria for CMS ID(s) 100.1.

LNM

Inappropriate use of a repeat modifier with a laboratory procedure.

LPR

Repeat lab procedure XXXXX may require a repeat modifier.

M26

Procedure Code XXXXX requires a modifier -26 when billing for the professional component in place
of service XX [description of the value of the submitted Place of Service found in 'Place of Service'
System List for 'the current line'].

                                                            

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M51

Procedure code XXXXX has been billed on the same DOS as another procedure without an
appropriate modifier. Typically, procedures or services with the lower relative value should be reported
with modifier 51.

M62

Modifier 62 is not present on procedure code <1> and is reported by a different provider on claim ID
<2>.

M62R

Procedure code requires modifier 62.

mAM

Per Medicare guidelines, HCPCS Code " + the adjusted procedure code of 'the current line' + " is
identified as an ambulance code and requires an ambulance modifier appended.

mAM

Per CMS guidelines, HCPCS Code <1> is identified as an ambulance code and requires an
ambulance modifier appended.

mANM

Anesthesia code on this line requires an appropriate modifier.

mAS

Medicare statutory payment restriction for assistants at surgery applies to the procedure XXXXX.

mAT

Per Medicare guidelines procedure code <1> requires modifier GP, GO, or GN.

mAWF

Per Medicare, this service is covered once in a lifetime.

mAWP

Service occurred within a year of an initial preventive physical exam.

mAWS

Service occurred within a year of last covered annual wellness visit.

mCO

Billing for co-surgeons is not permitted for the procedure XXXXX.

mDP

Procedure Code [XXXXX] is within the global period of ZZ days of History Procedure Code [YYYYY]
performed on mm/dd/yyyy on Claim ID [1234], Ext/Int Line ID [1/2] by the same provider. The
diagnosis indicates it is not for the same condition. Please review to determine if a modifier is
appropriate.

mDT

Per the Medicare Physician Fee Schedule, Procedure Code XXXXX describes a diagnostic procedure
that requires a professional component modifier in this POS YY.

mEM

Ï E/M code [XXXXX] is billed the same date of service as a minor procedure without an appropriate
modifier..
Ï E/M code [XXXXX] is billed without an appropriate modifier for the same date of service as a minor
procedure on History Claim ID XYZ on History Line ID 123.
Ï E/M code [XXXXX] is billed on the same date of service or one day prior to a major procedure
without an appropriate modifier..
Ï E/M code [XXXXX] is billed without an appropriate modifier for the same date of service or one day
prior as a major procedure on History Claim ID XYZ on History Line ID 123.

mEPG

Evaluative procedure code <1> requires the reporting of one or more functional G-codes, G8978-
G8999, G9186, G9158-G9176.

mEV

Procedure Code [XXXXX] was performed on the same day of History Procedure Code [YYYYY]
performed on Claim ID [1234], Ext/Int Line ID [1/2] by the same provider or provider in the same
specialty and group. The diagnosis indicates it is for the same condition

MF30

Procedure code <1> may not be reported more than once in a 30 day period.

MF90

Procedure code <1> may not be reported more than once in a 90 day period.

MFD

Procedure Code XXXXX with an allowed daily frequency of XX has been exceeded by YY for date of
service mm/dd/yyyy.

mFL

Per Medicare guidelines, a diagnosis code(s), which meets medical necessity for procedure code
[XXXXX], is missing or invalid.

mFP

Procedure Code [XXXXX] is within the global period of XY days of History Procedure Code [YYYYY]
performed on mm.dd.yyyy on Claim ID [XYZ], Ext/Int Line ID [1/2]. The diagnosis indicates it is for the
same condition.

MFX1

The maximum frequency for the procedure code has been exceeded. The allowable maximum
frequency for the procedure is 1 time per calendar month.

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mGT

Per the Medicare Physician Fee Schedule, procedure code XXXXX describes the global code of a
service or diagnostic test. Modifier <26 or TC> is not appropriate.

mHB

Per Medicare guidelines, the associated administration code for vaccine procedure code [XXXXX], is
missing or invalid.

mI10

Per CMS guidelines ICD9 codes and ICD10 codes cannot be billed on the same claim.

mI9

Per CMS guidelines ICD-9 codes cannot be billed with dates of service greater than September, 30,
2015.

mIC

Per Medicare guidelines, procedure code <1> is a service covered incident to a physician's service
and modifier 26 or TC is not appropriate.

mIM

Ï Modifier 26 is not appropriate for Procedure Code XXXXX, as per Medicare Fee Schedule.
Ï Modifier TC is not appropriate for Procedure Code XXXXX, as per Medicare Fee Schedule.
Ï A Co Surgeon Modifier 62 is not appropriate for Procedure Code XXXXX, as per Medicare Fee
Schedule.
Ï A Team Surgeon Modifier 66 is not appropriate for Procedure Code XXXXX, as per Medicare Fee
Schedule.
Ï An assistant surgeon modifier XX is not appropriate for Procedure Code XXXXX, as per Medicare
Fee Schedule.
Ï A Multiple Procedure Modifier 51 is not appropriate for Procedure Code XXXXX, as per Medicare
Fee Schedule.
Ï Modifier 22 is not appropriate for Procedure Code XXXXX, as per Medicare Fee Schedule.F99

mIM

Modifier is not appropriate for procedure code.

ML1

Modifier L1 is inappropriate to be reported on a professional claim. It is appropriate to report on a
facility claim.

mLP

Per the Medicare Physician Fee Schedule, Procedure XXXXX is inappropriate with Modifier -TC.
Performance of the test is paid under the lab fee schedule.

mM51

Procedure code XXXXX has been billed on the same DOS as another procedure without an
appropriate modifier. Typically, procedures or services with the lower relative value should be reported
with modifier 51.

mMEY

Per Medicare guidelines, all claim lines on the same claim must contain the modifier EY.

mMFL

Per CMS guidelines, the associated administration or drug code for vaccine code <1> is missing or
invalid.

mMFQ

A severity/complexity modifier, CH, CI, CJ, CK, CL, CM, CN is required to be appended to Medicare
nonpayable function-related G-Codes.

mMGK

Modifier GK cannot be submitted alone, another line with GA or GZ must be present on the same
claim.

mMHB

Per Medicare guidelines, the associated administration code for vaccine procedure code [XXXXX], is
missing or invalid.

mMPN

Per Medicare guidelines, the associated administration code for vaccine procedure code [XXXXX], is
missing or invalid.

mMSP

Per Medicare guidelines the diagnosis code(s) billed does not support the medical necessity of
G0101.

mMUE

Per Medicare's Medically Unlikely Edits, the units of service billed for procedure code XXXXX exceed
the allowed units of Y.

mMUE

Per Medicare's Medically Unlikely Edits, the units of service billed for procedure code <1> exceed the
allowed units.

mNG

A procedure code with a Medicare global follow up period could not be located in the last six months
of the patient's history. Use a separately billable E/M instead of 99024.

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mNP

Procedure Code XXXXX does not typically require performance by a physician in Place of Service XX
[description of the value of the adjusted billing POS code found in 'Place of Service' System List for
'the current line'] per Medicare Guidelines.

MOD

Use of modifier XX (crosswalks to YY), is not typical for procedure XXXXX.

MOD57

An E/M code <1> reported with modifier 57 was provided on the same date as a minor surgical
procedure on Claim ID <2>. Please review documentation for appropriate modifier.

mOG

Proc [99024] is outside the Medicare global period of ZZ days for Hx Proc [XXXXX] performed on
mm/dd/yyyy on Claim ID [1234], Int/Ext Line ID [1/2]. The diagnosis indicates it is for the same
condition. Use a separately billable E/M instead of 99024.

mPC

Per the Medicare Physician Fee Schedule, procedure code XXXXX describes the physician work
portion of a diagnostic test. Modifier <26 or TC> is not appropriate.

mPDP

The PD modifier must be billed with the 26 modifier.

mPDT

The PD modifier may not be billed with the TC modifier.

mPI

Per the Medicare Physician Fee Schedule, procedure code XXXXX describes a physician
interpretation for service and is not appropriate in place of service ZZ.

mPN

Per Medicare guidelines, a diagnosis code(s), which meets medical necessity for procedure code
[XXXXX], is missing or invalid.

mPS

Per the Medicare Physician Fee Schedule, procedure code XXXXX describes the physician services.
Use of modifier <26 or TC> is not appropriate.

mPT

Procedure Code XXXXX is a physical therapy service. No payment is made if provided in Place of
Service XX [description of the value of the adjusted billing POS found in 'Place of Service' System List
for 'the current line'] per Medicare Guidelines.

mPT

Per Medicare guidelines, procedure code <1> is a physical therapy service. No payment is made if
provided in place of service <2>.

mSB

Add-on procedure code XXXXX has been submitted without an appropriate primary procedure.

mSP

Per Medicare guidelines procedure code XXXXX is within the global period of history procedure code
YYYYY performed on mm/dd/yyyy on Claim ID [XYZ], Ext/Int Line ID [1/2] by the same provider.

mTC

Per the Medicare Physician Fee Schedule, procedure code XXXXX describes only the technical
portion of a service or diagnostic test. Modifier <26 or TC> is not appropriate.

mTH

Per Medicare guidelines procedure code <1> requires modifier GT or GQ.

mTS

Team Surgery is not permitted for Procedure XXXXX.

mUM

Per Medicare Guidelines, Procedure Code XXXXX has an unbundle relationship with Procedure Code
YYYYY on Claim [1234], Ext/Int Line ID [1/2]. Review documentation to determine if a modifier is
appropriate.

mUN

Per CCI Guidelines, Procedure Code XXXXX has an unbundle relationship with history Procedure
Code YYYYY Ext/Int Line ID [1/2] on Claim [XYZ].

mUO

Per CCI Guidelines, Procedure Code XXXXX [PROCEDURE DESCPRITION] has an unbundle
relationship with Procedure Code YYYYY [PROCEDURE DESCRIPTION] on Claim [1234], Ext/Int
Line ID [1/2]. Review documentation to determine if a modifier is appropriate.

N51

Procedure code XXXXX has been billed with the modifier 51, either the procedure code has the
highest RVU on the claim or the use of modifier 51 is not appropriate with the procedure code.

NGP

A procedure code with a Global Follow-up period could not be located in the patient's history. Report a
separately billable E/M instead of 99024 if appropriate.

NPT

This patient received care by provider <1> on Claim ID <2> on Date of Service <3> and is within three
years of Procedure Code <4> on current line. An established patient E/M code should be used.

NPTh

A new patient E/M was reported on Claim ID <1> within the last three years. An established patient
E/M code should have been used.

                                                          

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OBA

Antepartum care code <1> cannot be submitted 280 days prior to global delivery codes 59400, 59510,
59610, 59618 by the same provider.

OGP

A procedure code with a Global Follow-up period could not be located in the patient's history. Report a
separately billable E/M instead of 99024 if appropriate.

ONL

Online code <1> cannot be reported for services related to an E/M provided in the previous 7 days.

PAT

The patient ID is missing.

PCM

Modifier -26 is not appropriate with Procedure Code XXXXX because that procedure is defined as
100% professional or 100% technical.

PDO

The ICD-10-CM code <1> may only be used as first-listed or primary diagnosis position.

POS

Procedure Code XXXXX is not typically performed by a physician at Place of Service XX [description
of the value of the submitted Place of Service found in 'Place of Service' System List for 'the current
line'].

PPGD

It is not appropriate to submit postpartum code 59430 within 49 days of an obstetrical package code
found on claim <1>.

PRE

Pre-Op E/M Service [XXXXX] performed one day before the History Surgical Procedure Code
[YYYYY] on Claim ID-Ext/Int Line ID [XYZ-1/2] is not allowed as part of the global surgical package.

PRS

Ï The Provider Specialty is missing.
Ï The Provider Specialty is invalid.

PRV

The Provider ID and/or Department ID are missing.

PSX

The Gender for this patient is either missing or invalid.

RDL

Repeat radiology procedure XXXXX may require a repeat procedure modifier.

RNM

Inappropriate use of a repeat modifier with a radiology procedure.

S51

Procedure code XXXXX is an add-on code. Modifier 51 (Multiple Procedures) is not appropriate with
add-on codes.

sAG

Per Medicaid guidelines, the patient's age does not meet policy requirements for the procedure code
and/or a diagnosis code.

SAM

There is more than one occurrence of Proc [XXXXX], on the same date of service, on Claim ID -
Ext/Int Line ID [XYZ - 1/2] with a surgical assistant modifier. Only one surgical assistant is allowed per
procedure.

sAM

Per Medicaid guidelines, HCPCS Code <1> is identified as an ambulance code and requires an
ambulance modifier appended.

sANM

Per Medicaid guidelines, anesthesia code <1> on claim line ID <2> requires an appropriate modifier.

SAS

Procedure Code XXXXX typically requires no surgical assistant.

sCC

Per Medicaid guidelines, an additional procedure code is needed to meet policy requirements.

sDP

Per Medicaid guidelines, this procedure code is within the global period of a procedure code found in
history submitted by the same provider. The diagnosis indicates it is not for the same condition.
Please review to determine if a modifier is appropriate.

sDSP

Per Medicaid guidelines, a primary diagnosis code, which meets medical necessity for the procedure
code is missing or invalid.

sDSS

Per Medicaid guidelines, a secondary diagnosis code, which meets medical necessity for the
procedure code is missing or invalid.

sDT

Per Medicaid guidelines, procedure code <1> describes a diagnostic procedure that requires a
professional component modifier in place of service <2>.

sEM

Per Medicaid guidelines, E/M code <1> billed on the same day of a minor procedure or the same day
or day before a major procedure requires an appropriate modifier.

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sEV

Per Medicaid guidelines, procedure code <1> was performed on the same day of procedure code <2>
found in history Claim ID <3> and was performed by the same provider. The diagnosis indicates it is
for the same condition.

sFP

Per Medicaid guidelines, E/M code <1> is within the global period of procedure code <2> found in
history on claim ID <3> and line ID <4> submitted by the same provider as the current line billing
provider. The diagnosis indicates it is for the same condition.

sFR

Per Medicaid guidelines, the frequency does not meet policy requirements for the procedure code.

sGT

Per Medicaid guidelines, modifier <1> is inappropriately appended to procedure code <2>.

sIM

Per Medicaid guidelines, modifier <1> is not appropriate for procedure code <2>.

sLP

Per Medicaid guidelines, procedure code <1> is inappropriate with Modifier TC. Performance of the
test is paid under the lab fee schedule.

sMEY

Per Medicaid guidelines, all claim lines on the same claim must contain the modifier EY.

sMGK

Per Medicaid guidelines, modifier GK cannot be submitted alone, another line with GA or GZ must be
present on the same claim.

sMN

Per Medicaid guidelines, a diagnosis code which meets medical necessity is missing or invalid.

sMPP

Per Medicaid guidelines, procedure code <1> cannot be billed without first billing procedure code <2>.

sMVC

Per Medicaid guidelines, the associated vaccine code for administration procedure code <1> is
missing or invalid.

sNBT

Per Medicaid guidelines, procedure code <1> and procedure code <2> on claim ID <3> cannot be
billed together.

sNP

Per Medicaid guidelines, procedure code <1> does not typically require performance by a physician in
place of service <2>.

sOG

Per Medicaid guidelines, procedure code 99024 is outside the global period of a related procedure
code found in history or could not be located in history. Use a separately billable E/M instead of
99024.

sPC

Per Medicaid guidelines, procedure code <1> describes the physician work portion of a diagnostic
test. Modifier 26 or TC on current line ID <2> is not appropriate.

sPEC

Per Medicaid guidelines, claim ID <1> is missing or has an invalid provider specialty ID.

sPI

Per Medicaid guidelines, procedure code <1> describes a physician interpretation for a service and is
not appropriate in place of service <2>.

sPOS

Per Medicaid guidelines, the place of service code is missing or invalid for procedure code <1>.

sPS

Per Medicaid guidelines, procedure code <1> describes the physician service. Use of modifier 26 or
TC is not appropriate.

sRM

Per Medicaid guidelines, the required modifier is missing or the modifier is inappropriate for the
procedure code.

sSB

Per Medicaid guidelines, add-on procedure code <1> has been submitted without an appropriate
primary procedure.

sSP

Per Medicaid guidelines, procedure code <1> is within the global period of procedure code <2> found
on history Claim ID <3> performed by the same provider. Review documentation to determine if a
modifier is appropriate.

sSX

Per Medicaid guidelines, the patient's gender does not meet policy requirements for the procedure
code and/or a diagnosis code.

sTC

Per Medicaid guidelines, procedure code <1> describes only the technical portion of a service or
diagnostic test. Modifier 26 or TC is not appropriate.

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SUBD

A definitive add-on procedure code <1> has been submitted without an appropriate primary procedure
code.

SUBI

An interpreted add-on code <1> has been submitted without an appropriate primary procedure code.

sUM

Per Medicaid guidelines, the current procedure code has an unbundled relationship with a procedure
code in history. Review documentation to determine if a modifier is appropriate.

sUN

Per Medicaid National Correct Coding Initiative edits, Procedure Code [XXXXX] has an unbundle
relationship with history Procedure Code [YYYYY], Ext/Int Line ID [1/2].

sUO

Per Medicaid National Correct Coding Initiative edits, Procedure Code [XXXXX] [description of
adjusted procedure code on 'the current line'] has an unbundle relationship with Procedure Code
[yyyyy] [description of adjusted procedure code on 'the history line' ] on Claim 1234, Ext/Int Line ID
[1/2]. Review documentation to determine if a modifier is appropriate.

sVP

Per Medicaid guidelines, this procedure code has been billed without a corresponding venipuncture
code.

TCM

<1> is included in transitional care management service, 99495-99496, when reported in the same 30
day period.

TCMh

A procedure code found in history on Claim ID <1> is included in transitional care management
service, 99495-99496, when reported in the same 30 day period.

TEL

Telephone code <1> cannot be reported for services related to an E/M provided in the previous 7
days.

UEX

Procedure Code XXXXX [PROCEDURE DESCRIPTION] has an Exclusive relationship with
Procedure Code YYYYY [PROCEDURE DESCRIPTION] on Claim XYZ, Ext/Int Line ID [1/2].

UNB25

Modifier 25 should only be reported on an E/M code <1> when another claim with the same provider
and same date of service is found in history requiring the use of this modifier.

UNB57

Modifier 57 may only be reported on E/M code <1> when another claim is found in history, for the
same provider and same date of service or 1 day prior, that requires the use of this modifier.

UNID

Report only remote services when an in person interrogation device evaluation is performed during the
same time period as the remote interrogation device evaluation.

UNSL

The ICD-10-CM code(s) reported define an unspecified ICD-10-CM diagnosis code which has an
equivalent code for laterality (right or left). Review documentation to verify whether or not a more
specific ICD-10-CM diagnosis code is appropriate.

UOV

Procedure Code XXXXX [PROCEDURE DESCRIPTION] has an Unbundle relationship with
Procedure Code YYYYY [PROCEDURE DESCRIPTION] on Claim XYZ, Ext/Int Line ID [1/2]. Review
documentation to determine if a modifier is appropriate.

VEN

Procedure code <1> has been reported on <2> without a corresponding venipuncture code. Add a
venipuncture code, if appropriate.

 

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