July 21, 2008
Billing Unlisted Codes
Recently, an increasing number of claims for unlisted codes have been filed with neither a description of the unlisted code on the claim or in the medical record documentation.
In the event that a physician performs a procedure that does not have a designated CPT code, the physician should bill the procedure using an unlisted code. A description of the procedure should be listed in Item 19 of the HCFA-1500 claim form or in the narrative of the EMC claim. This may facilitate processing by keeping the claim from being developed for further documentation. If the claim does have to be developed for additional documentation, the operative report should clearly indicate what the unlisted code is for by describing in detail the procedure performed. If the unlisted code being used is for a non-surgical procedure and no other instructions have been published pertaining to that procedure then the provider should submit supporting documentation with an explanation of what the unlisted code is for.
Other errors and tips to know when filing claims for unlisted codes include:
- Ensure first there is truly no listed code for the service done
- Ensure the unlisted service is not component to a comprehensive service also billed the same date and
- Providers may cite a comparable service/code in the narrative field if one exists
