Gastroenterology Coding Alert

Reader Questions:

Crack the 'NOS' Vs. 'NEC' Code

Question: What do -NEC- and -NOS- mean in diagnosis coding? How should I choose between them?

Florida Subscriber Answer: ICD-9 uses the abbreviations NEC and NOS to denote diagnoses -not elsewhere classified- and -not otherwise specified.- NEC is equivalent to using an -other- code selection, and NOS is equivalent to using an -unspecified- code selection.
 
Think of NEC as a lack of specificity in ICD-9. Your gastroenterologist provides specific findings, but ICD-9 does not list a specific code that describes the diagnosis. On the other hand, consider NOS the fault of insufficient documentation, which does not provide enough information to assign a more specific diagnosis code.
 
An example of when you would use an NEC code: Your gastroenterologist specifies -Atony colon disorder.- You look in the 564 category, Functional digestive disorders, not elsewhere classified, for the appropriate code. Codes 564.0-564.7 do not list the manifestation that the physician indicated, so you should report 564.89 (Other functional disorders of intestine), which includes -Atony of colon.-
 
But suppose the gastroenterologist notes simply, -gastric ulcer.- The physician doesn't specify acute or chronic, so you should report 531.9x, which includes -unspecified as acute or chronic, without mention of hemorrhage or perforation.-
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Gastroenterology Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.