[As per CPT Instructions
for use of the CPT Codebook, select the name of the procedure or service that
accurately identifies the service performed. Do not select a CPT code that
merely approximates the service provided. If no such specific code exists, then
report the service using the appropriate unlisted procedure or service code.
Any service or procedure must be adequately documented in the medical record].
Unlisted codes provide the
means of reporting and tracking services and procedures until a more specific
code is established.
Unlisted CPT codes are mostly ending with 9 or 99 CPT codes found
at the end of each section or subsection of the CPT book.
While
filling unlisted CPT codes, we must to include the following documents since
the unlisted CPT codes are not describing the specific procedure.
1. Description of the service or procedure (Nature,
Extent and necessity)
2. The number of times the service or procedure was
performed.
3. Performed along with other procedures on the same day
or same site.
4. Any complication related to the service or procedure.
5. Equipment, time and effort utilized to perform the
service or procedure.
When submitting supporting documentation, designate
the portion of the report that identifies the test or procedure associated with
the unlisted procedure code. Required information must be legible and clearly
marked.
Coding/Billing Guidelines:
• Unlisted CPT
codes must be submitted as paper claims.
• Unlisted CPT
codes and without supporting documentation would be denied.
• If any
appropriate CPT or HCPCS codes are available in the CPT book then an unlisted
procedure code would be denied.
• No additional
reimbursement would be provided for special techniques/equipment submitted
with an unlisted procedure code.
• Don’t use any modifier with unlisted procedure codes. (Exception: Unlisted codes for DME, orthotics and prosthetics require appropriate NU, RR or MS modifier.)
• For two or
more procedures that require the use of the same unlisted CPT code, the
unlisted CPT code should be reported once.