Wiki Unlisted Code

Crik

New
Messages
6
Best answers
0
My doc did an unlisted procedure for a inpatient surgical procedure. I am trying to bill Co Medicaid and now they are asking for an invoice. There isn't an invoice so what do you do or how do I bill this?
 
This is from AAPC Coder:
"When reporting an "unlisted procedure code" to describe a procedure or service, it will be necessary to submit supporting documentation (e.g., the procedure report/OP notes) along with the claim to provide an adequate description of the nature, extent, need for the procedure, and the time, effort, and equipment necessary to provide the service. Also, submit a cover letter explaining why you have reported the unlisted code, instead of a definitive code.

Apart from reporting this unlisted code, mention one more code with similar type of service and bill the dollar amount associated with that code. The reason is that no fee is assigned to an unlisted code by the Medicare Physician Fee Schedule. But by comparing this unlisted procedure with another definitive CPT® code and its payment amount, you can explain to payers the reason for the amount that you have claimed. In your cover letter, explain the reasons for your billing the reimbursement amount. This can help a coder to avert a possible claim denial."
 
Has anyone had any luck in negotiating reimbursement for procedures reported with an unlisted code? In my 25-year career, I know that this is rare but possible. My particular interest is Endoscopic Gastrocnemius Release (EGR), reported with code 29999: Unlisted procedure, arthroscopy, but the process is the same for all unlisted codes if you are negotiating reimbursement; and a win is a win.

I've been assembling tools to help clinicians establish a fair price and negotiate payment with the carriers and posting them for free on the website: www.ioectr.com. Click on the "Other Procedures Tab" for the unlisted code documents. Any advice or feedback is welcome! I created a sample SS to calculate values based on a comparison code but what I really need is an "official" one from a professional medical association or from someone who has successfully contracted reimbursement.

In addition, this procedure could be performed in the office, or Office-Based Surgical Suite (OBSS), which is a separate issue. I also have information for managers and providers on how to set up an OBSS.

Jeffrey P. Restuccio, CPC
 
Top