How are unlisted procedure codes presented in the CPT?
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
97039 Unlisted modality (specify type and time if
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. ]
There are no new answers.