January 30, 2012
Medicare FFS Version 5010 Requirement Changes for Non-Specific Procedure Codes
Medicare Fee-for-Service (FFS) has amended the Not-Otherwise-Classified (NOC) code set listing effective Mon Jan 16, 2012. Thus, it has been determined that anesthesia codes that include the phrase “not otherwise specified” in their code descriptors (procedure codes 00100 through 01996) do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements. Anesthesia procedure code 01999, “Unlisted anesthesia procedure(s)” meets the requirements of a non-specified code and continues to require additional information to be supplied in the SV101-7 data element.
Additionally, various pathology and laboratory codes identified in procedure code section 8800 and a variety of other NOC codes have been removed. These codes do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.
The majority of procedure codes impacted and removed from the NOC code list are anesthesia codes, laboratory/pathology codes, and Physicians Quality Reporting System codes.
Medicare FFS’s complete listing of the NOC codes can be found at http://www.CMS.gov/ElectronicBillingEDITrans/40_FFSEditing.asp. Medicare will be updating the code set, at minimum, on a quarterly basis (January, April, July, and October) as the NOC list is refined and the parent code sets are updated. Please check back to the website frequently for the most updated list.
For more information on Version 5010 and D.0, please visit http://www.CMS.gov/Versions5010andD0.
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