medicare and unlisted codes

eutsler

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Does anyone know what CMS and Noridian mean when they say 'concise description? Do they have something specific in mind like a cpt short descriptor, or is it okay to say "compare 37799 to 37765-RT, 4 stab incisions made"? (just an example)

Also, do you find that it's necessary to send the report even if your concise description fits in box 19?

the relevant citations:

Medicare Claims Processing Manual Chapter 26, 10.4 says “Enter a concise description of an "unlisted procedure code" or a NOC code if one can be given within the confines of this box. Otherwise an attachment shall be submitted with the claim.”

Noridian says “An unlisted procedure code or NOC must have a concise description of the services rendered in Item 19 on the CMS-1500 claim form or electronic equivalent. The electronic equivalent for Item 19 on EMC submissions will hold up to 80 characters for the concise statement and should be enough space to describe the unlisted procedure code. If the description does not fit in Item 19, providers who submit paper claims should include an attachment to describe the services. PWK segment is provided. See PWK article titled "Submitting Paperwork (PWK) Electronically."”

ETA: I've emailed Noridian, but they can take up to 45 days to respond.
 
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