unlisted procedure

[turnerdc@gmail.com]

Can anyone give me information on how to bill an unlisted procedure (53899) and if we send anything with the billing and how the charge is determined for the unlisted code since there is not a fee schedule? Thanks

 

[Donna T]

Here are some general guidelines for you to follow when billing an unlisted procedure:

1 - Request a medical review
2 - Submit a letter of medical necessity
3 - Send OP note
4 - Request a specific amount for the procedure (remember unlisted codes aren't given a payment value so you need to request an amount
5 - If possible include a CPT code in your letter of medical necessity that most closely approximates the procedure that the physician performed

Hope this is helpful to you.