How to Code Other/NEC Codes vs. Unspecified/NOS Codes
The official coding guidelines state, “Codes titled ‘other’ or ‘other specified’ are for use when the information in the medical record provides detail for which a specific code does not exist.” Codes designated as ‘other’ codes can be identified it the alphabetical index by the abbreviation NEC after the term. NEC stands for not elsewhere classified. When a specific code is not available for a condition, consider using an ‘other’ code instead of the unspecified code.
Coding guidelines state, “Codes titled ‘unspecified’ are for use when the information in the medical record is insufficient to assign a more specific code.” In other words, you don’t have additional information. In both the alphabetical list and the tabular list, you will find the abbreviation NOS – Not otherwise specified to indicate these unspecified codes.
Let’s look at a group of codes and apply this logic. Sequelae of cerebral infarction code to the I69.3 category. Below are the category headings.
- I69.30 - Unspecified sequelae of cerebral infarction
- I69.31 - Cognitive deficits following cerebral infarction
- I69.32 - Speech and language deficits following cerebral infarction
- I69.33 - Monoplegia of upper limb following cerebral infarction
- I69.34 - Monoplegia of lower limb following cerebral infarction
- I69.35 - Hemiplegia and hemiparesis following cerebral infarction
- I69.36 - Other paralytic syndrome following cerebral infarction
- I69.39 - Other sequelae of cerebral infarction
You can see that I69.30 indicates that the patient has a sequela of a CVA, but you don’t know what that sequela is. As a side note, this code should never be used in home health. As the assessing clinician, you should know what the sequela is. This code is very different from the I69.39 code which indicates other sequelae of CVA. The I69.39 category is used when you know the specific sequela (dysphagia, ataxia, etc.) but it is something other than a cognitive deficit, speech & language deficit, monoplegia, hemiplegia or other paralytic syndrome.
Remember that “Other specified/NEC” means that you have the additional information, there just isn’t a specific code for it and “Unspecified/NOS” means that you do not have any additional documentation.