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ASA and X12 Reach Agreement — 5010 Special Information Requirement for Non-Specific CPT ® Codes Only Applies to a Single Anesthesia Code, CPT 01999

Thursday, December 22, 2011

We are pleased to report that upon further review and discussions with ASA, X12 (the body charged with developing and maintaining the standards used for electronic claims standards) has agreed that anesthesia codes that include the phrase "not otherwise specified" in their code descriptors do not meet the definition of a non-specific code, and the rule that requires additional information in the SV101-7 segment should not apply to CPT codes 00100 through 01996.  CPT code 01999 "Unlisted anesthesia procedure(s)" does meet the definition of a non-specific code and requires additional information in the SV101-7 segment.  X12 is working internally to draft final language to clarify the matter. 

CMS representatives advise us that any data submitted in SV101-7 will satisfy the edit for Medicare claims until edit revisions have been made. 

We will post updates as more information becomes available.  We thank X12 for its attention to this issue

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