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Know when to report an unspecified code

HIM-HIPAA Insider, February 24, 2014

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To report an unspecified code or to query, that is the question. And like so many coding questions, the answer is, it depends.

ICD-9-CM is full of not otherwise specified (NOS) codes. Think of those as not otherwise satisfied, says Andrea Clark, RHIA, CCS, CPC-H, CEO and founder of Health Revenue Assurance Associates (HRAA) in Plantation, Fla. “An NOS code really means nothing.”

Coders often default to the unspecified code because physicians don’t give them enough information, Clark says. For example, if the physician documents diabetes, coders just assign 250.00 (diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled).

Facilities need to review how often their coders assign NOS codes overall and by physician, Clark says. “That will get you to the physicians you need to train.” It can also tell facilities whether the coders need training as well. The physician may be documenting the information, but the coder doesn’t pick up on it.

One physician may account for a large number of NOS codes. In that case, the facility can focus on training that particular physician on what is lacking in his or her documentation.

Continue reading "Know when to report an unspecified code" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategies have free access to this article in the February issue. The article is available for purchase for non-subscribers.

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