Home Health ICD-9/ICD-10 Alert

Question: My coders frequently use various "unspecified" codes, and I'm concerned that we're overusing them. When is it OK to use these codes? To what extent must we try to gather information that could lead us to a more specific code?

Answer: Not otherwise specified (NOS) codes indicate that the coder lacks information to code more specifically. In some cases, using these codes raises a red flag with your intermediary because some unspecific codes can send a message that says, "I don't have the documentation to back up this code so please call for my chart."

On the other hand, some NOS codes are fine to use. For example, the code 727.82 for calcium deposits in tendon and bursa includes calcification of tendon, NOS. In many cases, this may be the only information available from the physician, making this code perfectly acceptable.

Another example would be if you learned from the physician that a patient has arthritis, but the doctor gives you no specifics about the type of arthritis. In this case, you'd use code 716.9x, which is the code for arthritis, NOS. Conversely, 716.8x would indicate that the patient has another type of arthritis that is not described in the other codes - an unlikely scenario.

Bad idea: Stay away from codes like 707.9, which indicates the patient has an ulcer but you don't know where it is. This lack of essential detail obviously paints the agency in a poor light. Your coders must be able to distinguish between codes that include "other site" and those that indicate unspecified site.

Look to the 707.0 sub-category, for example. The code 707.00 (Site unspecified) would not be acceptable because you need to specify the site of the decubitus, so your intermediary will reject claims that include 707.00. However, 707.09 would be a valid code to use to indicate that the decubitus is at a different location (e.g., the edge of the ear) than those locations described by the other codes in the subcategory.

Look out: The number "9" or "0" as the fourth digit should alert your coders that they need to take a second look at the code and see if they can get additional, specific information.