NOC Billing
It is important that providers always use the most appropriate Current Procedural Terminology (CPT) code available that accurately describes the procedure performed when billing any service to Medicare. Upon medical review, providers billing services under NOC (Not Otherwise Classified) codes will have their services denied as billing errors if true codes describing the services rendered are available and have not been used. This determination will be made regardless of any supporting documentation accompanying the claim.
Almost any procedure that is well established in the medical field will have a true code. The purpose of an NOC code is to report services having absolutely no existing true codes. The reference aids available in the coding manuals should have been thoroughly utilized before any service is billed with an NOC code. A procedure's true code can often be found through cross-referencing the CPT index. The CPT has both indices and appendices that can be used to aid in selection of an appropriate code for billing purposes. Both procedures and body areas are included. If the true code for a procedure cannot be found in the index under the procedure name, it may often be found under the body area involved in the procedure.
Should the method described above not result in finding the true code for a particular procedure, a search of the index under related terms can be helpful. (For example, the provider coding transcatheter placement of an intravascular stent will find that in the CPT index there is no listing for that procedure under "Stent". However, the heading "Stent, Intravascular," although not listing procedure codes, does refer the reader to "See Transcatheter, Placement, Intravascular Stents." Under "Transcatheter," the reader will find "Placement Intravascular Stents" with a range of true procedure codes that can be found in the main body of the CPT in the cardiovascular surgery section.)
The CPT procedure description is also designed to assist in proper coding of procedures. Once the correct code has been established, a basic overview of additional coding information for that particular body area or procedure can be found in that section's main header. The additional information available in the beginning of each chapter of CPT should also be consulted and can be helpful in proper application of the code. If, after consulting CPT, additional assistance is needed to determine whether an NOC code should be used, that assistance can be obtained by contacting either the AMA coding hotline or using the WPS Website (http://www.wpsmedicare.com) "Search" function for a related article that may have been published.
Please remember that deliberate billing of inappropriate NOC codes for the purpose of maximizing payments or "unbundling" procedures could be considered to be fraudulent practice. Misrepresentation of non-covered or non-chargeable services with NOC codes in order to have them approved as covered services is also inappropriate, and may exemplify Medicare fraud.
Page Last Updated: Thursday, 18-Mar-2010 05:56:21 CDT
