Correct Service Descriptions When Billing Not Otherwise Classified Codes

Medical Billing

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Not Otherwise Classified (NOC) codes are used for services that do not have an existing CPT code that accurately identifies the service or procedure performed. Services billed under NOC codes will be denied as billing errors if codes describing the services are available. Wisconsin Physicians Service (WPS) Government Health Administrators (GHA) has recognized a reoccurring issue with NOC code descriptions. A large number of claims are being submitted with NOC codes, with missing or inadequate descriptions of the provided services.

NOC services, drugs, and biologicals can be correctly reimbursed by the WPS GHA only if providers indicate the following in the 2400/SV101-7 data element or Item 19 of the CMS 1500 form:

  • A complete description of services performed. The description must have enough information for the reviewer to adequately determine coverage and compare pricing for similar services.
  • The name of the drug/biologic, dosage, and method of administration.

Examples of good descriptions:

  • Stab Phlebectomy of Varicose Veins 1 Extremity 6 Stab Incisions
  • Arthroscopic Decompression of the Suprascapular Nerve
  • Injection, Factor VIII FC Fusion (Recombinant), per IU: 25,000 units

Examples of inadequate descriptions:

  • Not Otherwise Classified
  • Biologic Injection
  • Drug Administered

Providers should list one unit of service for the NOC code in the 2400/SV1-04 data element or in item 24G of the CMS 1500 form. NOC drugs and biologicals should not be quantity-billed, even if multiple units are provided. Narrative information is used to determine the payment for these codes. Documentation submitted with a claim must also support the described service. Claims without adequate descriptions and units of service may be rejected or denied.

Contact Yeo & Yeo Medical Billing & Consulting’s Certified Professional Coders for assistance with diagnostic or procedural coding.

Source:WPS Government Health Administrators


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