Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims

The 5010 versions of the institutional and professional claim implementation guides mandate that when claims use non-specific procedure codes a corresponding description of the service is now required. The HIPAA Version 5010 implementation guide describes Non-Specific Procedure Codes as codes that may include, in their descriptor, terms such as: “Not Otherwise Classified (NOC); Unlisted; Unspecified; Unclassified; Other; Miscellaneous. If a procedure code containing any of these descriptor terms is billed, a corresponding description of that procedure is required; otherwise, the claim is not HIPAA compliant and will be front-end rejected. Note that there is no crosswalk of non-specified procedure codes with corresponding descriptions. A complete listing of Not Otherwise Classified (NOC) Code Set is available at https://www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp on the CMS website.