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Description Required for Non-Specific Procedure Codes, HIPAA Version 5010

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Monday, January 2, 2012

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Description Required for Non-Specific Procedure Codes,

HIPAA Version 5010

 

Although the Office of E-Health Standards and Services (OESS) has deferred enforcement of compliance with HIPAA Version 5010 until March 31, 2012, the official compliance date remains January 1, 2012. CMS encourages providers to implement use of the 5010 version as soon possible. MLN Matters Article SE1138 describes the HIPAA compliance requirement when reporting non-specific procedure codes. When a non-specific procedure code is reported on a 5010 institutional or professional claim, a corresponding description of the service is required. Detailed information regarding this new requirement can be found in the 837I and 837P implementation guides. Non-specific procedure codes are codes that include, in their descriptor, terms such as: “Not Otherwise Classified (NOC); Unlisted; Unspecified; Unclassified; Other; Miscellaneous; Prescription Drug Generic; or Prescription Drug, Brand Name”. These terms included in the descriptors are not sufficient to meet the HIPAA compliance requirements. For example, using a description of “not otherwise classified” will not pass editing and the claim will be rejected.

 

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.