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Back  RFI # 1467: Procedure Code Description

Formal vs. Informal Help Informal Formal

Submitter

Christine Doyle

Description

Anesthesia billers currently in 5010 testing are reporting up to 50% rejection rates attributed to SV101-7. The range of CPT codes describing anesthesia services (00100-01999) contains 52 codes that include the words "not otherwise specified" the code descriptors. These codes describe SPECIFIC ANESTHESIA SERVICES. It is the underlying surgical procedure that is not specifically described by these codes. These anesthesia codes were intentionally designed with a "one-to-many" relationship, based on similar body location, technical difficulty and risk associated with the anesthetic. Nothing in the Standard indicates that the phrase "not otherwise specified" automatically defines a code as non-specific. The standard states that a non-specific code MAY include that phrase or other such terms, but does not mean those words definitively make the code non-specific. Please clarify in explicit terms that anesthesia services including this phrase do not require additional information in Loop 2400 SV101-7.

Submitter Assigned Keywords

SV101-7, Procedure Code Description, Anesthesia

Response

When using the phrase “non-specific procedure code”, it was the intent of the developers of the implementation guide to require the description of the services rendered when the procedure code descriptor does not provide enough information about the services performed.

Based on that intent, anesthesia and other such procedure code descriptors that include “not otherwise specified” are not defined as “non-specific” procedure codes.

Conversely, based on that intent, for example CPT4 code 01999 “Unlisted anesthesia procedure(s)” or CPT4 code 20999 “Unlisted Procedure, Musculoskeletal System, General” would require that a procedure code description (SV101-7) be used.
Submission 12/8/2011
Status Date 2/17/2012
Status F - Final
Primary References
Document 005010X222
Section837
Loop2400
Segment IDSV1
Element Position01
Component Position7