Oncology & Hematology Coding Alert

You need to know both 'what' and 'where' for success.

Denials are occurring left and right due to improper 5010 reporting of "not otherwise classified" codes. Here's how to prevent your claims from getting one of those denials.

The Problem: NOC Drug Codes Are Unsupported

Giving inadequate information for non-specific HCPCS codes has become one of the most common reasons for rejection of electronic Medicare claims in the 5010 format, stated Cahaba Government Benefit Administrators in an email to providers.

Affected codes include those categorized as miscellaneous or "not otherwise classified" (NOC). You can see the current list at www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp, where you'll see familiar codes including J3490 (Unclassified drugs) and J9999 (Not otherwise classified, antineoplastic drugs).

The Solution: Fill SV101-7, Not the NTE Segment

Any time your practice submits an electronic 5010 claim for a code on the list, not only must you provide a more detailed description, you must provide it in the proper place.

So when you report an NOC or other non-specific code in 2400/SV101-2, the description, including drug and dosage information, "should appear in the 2400 loop, in the SV101-7," Cahaba instructs. "Do not use special characters in the description such as asterisks or colons. Letters, numbers, and periods are acceptable."

In 4010 transactions, you could send the drug and dosage information in the line item note in the NTE segment, noted National Government Services (NGS) in its 5010 Buzz series. Version 5010 uses that line item for other reasons, and you should not describe the nonspecific code there.