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American Association of Oral and Maxillofacial Surgeons

Practice Management & Allied Staff News & Materials

HIPAA Version 5010 Non-specific Procedure Code Guidelines

January 31st, 2012

The HIPAA Version 5010 is a new set of standards to replace the current standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims and remittances. All HIPAA covered entities are required to comply. Failure to comply will result in interruptions with your business operations and rejected claims. The 5010 version has many requirements when filing a claim.

The HIPAA Version 5010 Implementation guide is now mandating that unlisted codes provide a description of the procedure in order to be HIPAA compliant. An unlisted code is one that contains terms in their descriptor such as, "Not otherwise classified (NOC), unlisted, unspecified, unclassified, other, miscellaneous, prescription drug generic, or prescription drug brand name." When a code containing one of these descriptions is reported on the Version 5010 form, a procedure description of "Not otherwise classified" is needed. If this description is not included on the 5010 form, the claim may not be rejected, but the claim may be delayed for review.

Along with the non-specific procedure code description, those filing a claim using the 5010 form must use a full address in the billing field (Not a PO Box), submit the full 9-digit zip code, and report anesthesia in minutes instead of units. The HIPAA Version 5010 was scheduled for a compliance date of January 1, 2012, but that date has been deferred until March 31, 2012.

For a full list of the "Not Otherwise Classified (NOC)" code set, visit the CMS website at http://www.cms.gov/ElectronicBillingEDITrans/40_FFSEditing.asp. Also, for more information pertaining to the implementation of the HIPAA Version 5010 guide, visit the CMS Website.