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Q: How are unlisted procedure codes presented in the CPT?
A: Not all medical services or procedures are assigned CPT codes. The book does not contain codes for infrequently used, new, or experimental procedures. Each code section contains codes set aside specifically for reporting unlisted procedures. [ Before choosing an unlisted procedure code, carefully review the CPT code list to ensure that a more specific code is not available. These codes are found
at the end of the section or subsection of codes and most often end in either “99” or simply “9.” For instance: 97039 Unlisted modality (specify type and time if constant attendance) 97139 Unlisted therapeutic procedure (specify) 97799 Unlisted physical medicine/rehabilitation service or procedure Also, check for HCPCS Level II codes if these are acceptable to the third-party payer. Whenever an unlisted code is reported, it is necessary to include a descriptive narrative of the procedure performed in item 19 of the CMS-1500 claim form, as long as it can be adequately explained in the space provided. It is advisable to check with payers as to coverage issues concerning unlisted procedures. ]
Expert answered|smp0784|Points 3760|
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Asked 8/2/2012 1:03:36 PM
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