What is An “Other Specified” Code?
Codes with “other specified” or “not elsewhere classified (NEC)” notated in the title are for use when the information in the medical record provides detail
for a code that does not exist in ICD-10
and the provider is left with choosing a more generalized code, or in other words, it is “as good as it gets.”
An unspecified code referred to often as “not otherwise specified (NOS),” is different than a ‘NEC’ code. An unspecified code is for use when the medical record is insufficient to assign a more specific code; the provider does not have enough information YET. If the provider were to choose an unspecified code, he/she is telling the payer they do not know enough about the patient’s condition to provide documentation to support a more specific diagnosis. This should be the exception rather than the rule. There may be situations in which the provider is waiting on imaging results and therefore will be forced to use an unspecified or ‘NOS’ diagnosis code, but once that information is obtained, a more specific diagnosis should be assigned.
: Codes titled “other specified” in the Tabular List usually (not always) have a number ‘8’ in the fourth or sixth character and/or a number ‘9’ in the fifth character. This lets the coder know that the code is more likely an NEC or “not elsewhere classified” code. Codes in the Tabular List with “unspecified” in the title usually have a number ‘9’ in the fourth or sixth character and/or a ‘0’ in the fifth character.
Q. Is it okay to code with unspecified diagnosis codes?
A. Providers have to report the most accurate diagnosis codes available at the time of the service. If a provider is not able to provide the most detailed level of specificity at the time the patient is seen, then an unspecified diagnosis code may be used. However, providers should be aware that unspecified diagnosis codes may be flagged during claim adjudication and require the provider to submit documentation in order to justify the unspecified code. Providers/coders/billers are strongly urged to contact the payer to determine their specific policy with regard to unspecified codes. It should also be noted that coding the symptoms the patient is experiencing (as opposed to the diagnosis) is also acceptable in some limited cases.