In Coding
May 5th, 2017
AMA’s Instructions for Use of the CPT® Codebook tell us, “do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using he appropriate unlisted procedure or service code.” The Instructions further note, “Each of these unlisted procedural code numbers (with the appropriate accompanying ...
In Billing
Dec 8th, 2014
You may claim unlisted procedure codes only if an existing CPT® Category I or Category III code does not describe the procedure you wish to report. Per Chapter 1 of the National Correct Coding Initiative Policy Manual for Medicare Services, “A physician should not report a CPT® code for a specific procedure if it does ...
Providers hear over and over again how important their documentation is to ensuring proper code selection and, ultimately, optimal compliant reimbursement. But the documentation stakes are even higher when there isn’t an appropriate code to describe the procedure or service performed.            You should never report a code that “almost” describes the procedure or service performed. ...
May 1st, 2013
ICD-10 is so specific that reporting unspecified codes will raise documentation red flags. By Shelly Cronin, CPC, CPMA, CPPM, CPC-I, CANPC, CGIC, CGSC Diagnosis coding is traditionally viewed as unessential to claims reimbursement; however, with ICD-10 that may change. Payers are going to great lengths to beef up their policies and to map their covered ...
In Billing
Nov 28th, 2012
When you report a CPT® “unlisted procedure” code, or one of the new technology (Category III) codes, you may be required to enclose a special report with your claim. Additionally, the CPT® codebook provides instruction regarding special reports in the Radiology Guidelines, which specify, “A service that is rarely provided, unusual, variable, or new may ...