Wiki O03.30 Age criteria

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PennyG23

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During our state onsite we were told we were out of compliance. The DX code O03.30 is applicable for female patients age 12 to 55 years but our source of truth is Optum Encoder which shows 9-64 years. Could someone provide me a SOT that reflects the correct age range of 12-55 please? I found this but dont know the source they are using. The image below shows what's in Optum which is incorrect.

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PennyG23 said:
During our state onsite we were told we were out of compliance. The DX code O03.30 is applicable for female patients age 12 to 55 years but our source of truth is Optum Encoder which shows 9-64 years. Could someone provide me a SOT that reflects the correct age range of 12-55 please? I found this but dont know the source they are using. The image below shows what's in Optum which is incorrect.

View attachment 6947

View attachment 6948
Click to expand...


My ICD-10-CM book shows 9-64 years.

CMS uses the 9-64 age range as well. Here's a link and an excerpt from Transmittal 11059 of the Medicare Claims Processing Manual:


Screenshot 2024-03-27 133601.png
 
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