Home Health ICD-9/ICD-10 Alert

Question: I'm concerned that our agency is overusing unspecified codes. When is it OK to use these codes? To what extent should we try to gather more detailed information that could lead us to a more specific code?

Answer: Not otherwise specified (NOS) codes indicate that you are missing the information you need in order to choose a more specific code. In some cases, using these codes can send an unintended message -- "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 (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. The most common hypertension code is also an NOS code -- 401.9 (Hypertension, unspecified).

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 (Arthropathy, unspecified), which is the code for arthritis, NOS. Conversely, 716.8x (Other specified arthropathy) 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 (Chronic ulcer of unspecified site), 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. Learn 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 you're bound to see rejections on claims that include 707.00. However, 707.09 (Pressure ulcer; other site) would be a valid code to use to indicate that the decubitus is at a different location (such as the edge of the ear) than those locations described by the other codes in the subcategory.

Look out: The number "9" as the fourth digit in a code or "0" as the fifth digit in a code should alert you that you need to take a second look at the code and see if you can get additional, specific information that will help you to make a more specific choice.