Wiki Coding question

[2WOLVES]

When I was studying in class I was instructed not to use the unspecified codes in the ICD-9 Book. Then I started a job and I noticed that when I do use these codes that they come back denied from the insurance companies.
Are we to be using these codes or not? I do understand that the ICD-9 book says to use these codes when a more specific diagnosis can not be used. Even when I try to use these codes because I can not find another code to fit it comes back denied. So should you ever use these codes?

Thank-you
Lori

 

[cleanclaims]

Are you talking about NOS or NEC codes? Both of these types of ICD-9 codes serve a purpose, and are billable codes; however, you should always be coding to the greatest level of specificity so it sounds like you are using them more often then they are intended.

NEC: There is no separate code for the condition in ICD-9 even though the diagnostic statement may be very specific

NOS: Used only when neither the diagnostic statement nor the medical records provides information that permits classification to a more specific code

If you are finding that you are are using many NOS codes, I would talk to the physician and ask that they document to the highest level of specificity.