tci Medicare Compliance & Reimbursement - 2015 Issue 11

Industry Notes: This MAC Warns Against Vague Unlisted, NOC Claims

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...

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