December 19, 2011
The 5010 Requirement for Additional Information When the CPT Code Includes the Phrase “Not Otherwise Specified”
ASA representatives have held discussions with X12 and CMS in regard to the 5010 requirement that claims with CPT codes that include the "not otherwise specified" phrase in their descriptors include an additional narrative description. This phrase is much more common in the anesthesia codes than elsewhere in CPT and, as such, the requirement has had a significant impact on 5010 testing of claims for anesthesia care.
We continue to demonstrate that, in anesthesia coding, the phrase does not result in an unspecified code as might be the situation in other types of medical services. Code 01999 (Unlisted anesthesia procedure(s)) is the only true non-specific anesthesia code.
At this point, the relevant parties appear to have a better understanding of the issue and further discussions are scheduled. Until there is formal resolution, we suggest checking with local payers to confirm that populating the SV101-7 field with the CPT short descriptor would fulfill the requirement.