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CMS Revises Requirement for Non-Specific Procedure Codes,

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Wednesday, February 1, 2012

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CMS has released a revised version of MLN Matters Article SE1138 . This transmittal explains that when a non-specific procedure code is reported on a 5010 institutional or professional claim, a corresponding description of the service is required. The original transmittal incorrectly stated that "simply using Not Otherwise Classified as the description does not pass editing and the claim will be rejected". The claim will not be rejected if “Not Otherwise Classified” is submitted as the description. If the corresponding non-specific procedure code description is not submitted, the transaction does not comply with the implementation guide and is not, therefore, HIPAA compliant.

The transmittal does not specific where on the claim the description should be entered but refers readers to the 837I and 837P implementation guides for detailed information regarding this new requirement.

A complete listing of Not Otherwise Classified (NOC) Code Set is available at http://www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp on the Centers for Medicare & Medicaid Services (CMS) website.

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This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.