Pediatric Coding Alert

Question: Can you explain to this coding newbie the difference between Not Elsewhere Classified (NEC) and Not Otherwise Specified (NOS) and when I should use either one?

Montana Subscriber

Answer: You can think of them this way: NEC implies a problem with the ICD-10 codes themselves, whereas NOS implies a problem with a provider’s documentation. Or, to put it another way, if your pediatrician has specific findings on a condition that cannot be found in ICD-10, those findings would be classified as NEC, whereas if your pediatrician does not have, or cannot provide, specific information on a condition, you would use NOS.

Here’s an example that might help. Supposing your pediatrician sees a child with pneumonia and orders labs. If the labs come back, and an infectious organism has been identified as the cause of the pneumonia but that infectious agent is not represented by a code listed in ICD-10, you would use a code from the J16 (Pneumonia due to other infectious organisms, not elsewhere classified) group, such as J16.8 (Pneumonia due to other specified infectious organism).

However, if your pediatrician documents that the patient has pneumonia but does not specify what the infectious agent is, you have to use a code from the J18.- (Pneumonia, unspecified organism) group, such as J18.9 (Pneumonia, unspecified organism).