The Centers for Medicare and Medicaid Services (CMS) has issued revised instructions on the reporting of “Not Otherwise Classified” (NOC) codes via the 837 5010 standard. As originally crafted, any code will be considered non-specific if its descriptor includes the phrase “Not Otherwise Specified,” which will trigger an edit requiring additional information. ASA worked with X12 and CMS to exclude anesthesia codes 00100 – 01996 from this edit as that text does not result in a non-specific anesthesia procedure. CMS representatives advised us that any data submitted in Loop 2400 SV101-7 would satisfy the edit for Medicare claims until revisions have been made.
CMS has revised MLN SE1138 to note that affected claims will not fail its edits if the additional information provided is “Not Otherwise Specified.” Furthermore, the CMS website now includes a listing of NOC codes. Anesthesia codes 00100 – 01996 are not included. Code 01999 (Unlisted anesthesia procedures(s) ) remains subject to the edits. Certain J codes used to report injected medications are on the list so please review the file available via the links that follow below. CMS will update this listing quarterly.
For further information, please visit:
CMS MLN Matters Article
CMS Medicare Fee-for-Service Editing Information Webpage
ASA and X12 Reach Agreement — 5010 Special Information Requirement for Non-Specific CPT ® Codes Only Applies to a Single Anesthesia Code, CPT 01999