When both a "Not Otherwise Classified" (NOC) Code and a National Drug Code (NDC) are reported for a given Service Line in a v5010 837 transaction, is the Service Line Description (SV202-07 or SV101-07) required?
The SITUATIONAL RULE for the Service Line Description states, "Required when, in the judgment of the submitter, the Procedure Code does not definitively describe the service/product/supply and Loop ID-2410 is not used. OR Required when SV202-2 is a non-specific Procedure Code. Non-specific codes may include in their descriptors terms such as: Not Otherwise Classified (NOC); Unlisted; Unspecified; Unclassified; Other; Miscellaneous; Prescription Drug, Generic; or Prescription Drug, Brand Name.”
2 possible interpretations: 1) some Covered Entities assume that the Description is not allowed when the NDC is reported, regardless of whether the Procedure Code is NOC, or 2) others interpret that the Description is required when an NOC Code is reported, regardless of whether the NDC is also reported.
This is explicitly addressed in version 005010X222A1 and 005010X223A2 of the 837 professional and institutional TR3, the second part of the situational rule is satisfied when using a non-specific procedure code by sending SV101-7/SV202-7. The presence of the NDC code in the 2410 loop has no bearing on the usage requirements for SV101-7/SV202-7.
The workgroup will consider revising the wording of the situational rule in a future version of the TR3.
When a non-specific drug procedure code is billed in SV101-2/SV202-2 and the NDC is provided in loop 2410, the NDC code or a description must be submitted in the SV101-7/SV202-7.