Wrong Procedure Performed ICD-10-PCS
The wrong procedure performed edit is a coverage check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 3 ICD-10-CM external cause codes listed below. These external cause codes report surgery on the wrong patient, the wrong body part, or the wrong procedure entirely. Medicare does not pay for the associated care, so the MCE flags any claim carrying one of them.
External Cause Codes in This Edit 3 codes · 1 category
Questions About This Code Edit
What is the wrong procedure performed Medicare code edit?
Certain external causes of morbidity codes indicate that the wrong procedure was performed. The following list contains the codes, with corresponding English descriptions, that indicate the wrong procedure was performed. The Medicare Code Editor flags any inpatient claim that triggers the check.
How many codes are on the wrong procedure performed list?
The FY 2027 list contains 3 codes, imported from the CMS Definitions of Medicare Code Edits v44.0.
What happens when a claim triggers this edit?
These external cause codes report surgery on the wrong patient, the wrong body part, or the wrong procedure entirely. Medicare does not pay for the associated care, so the MCE flags any claim carrying one of them.
Does this edit make the codes invalid?
No. Every code on this list is a valid code. The edit is about Medicare payment rules, not about whether the code exists or can be documented.
Other ICD-10-PCS Medicare Code Edits
Source: CMS Definitions of Medicare Code Edits v44.0, effective October 1, 2026 through September 30, 2027. Code lists are imported directly from the official manual. See also the ICD-10-CM diagnosis edits and the MS-DRG list.
