Medicare Compliance & Reimbursement

Sometimes it’s inevitable — your CPT® or ICD-9 manuals don’t include the right codes to reflect what’s in your physician’s documentation. In those instances, you have to turn to unlisted CPT® codes or NOC (not otherwise classified) diagnosis codes. However, payers have specific requirements for submitting these codes and one Part B MAC recently sent out a warning about what to include on the claims for them if you don’t want your payments denied.

“When billing NOC or unlisted codes, providers shall be prepared to explain the NOC or unlisted code,” said Part B payer National Government Services, Inc. (NGS) in a May 13 email to providers. NGS “will return claims as un-processable if a NOC or unlisted code(s) is indicated, but an accompanying narrative or documentation is not submitted.”

You should add your narrative description to item 19 of your claim form or electronic equivalent, but if you can’t keep it brief, attach a supporting document to your claim. “Claims submitted with unlisted procedure codes and without supporting documentation will be rejected as un-processable, and a new claim will need to be submitted with documentation to support the unlisted code(s),” NGS warns