Wiki Unlisted surgery codes

[Chelsea050618]

Question... My physician has a habit of using the "unlisted" codes frequently and I would like to know if anyone has a round about number for what the reimbursement rates are for the 27299, 27599, and 29999 CPT codes. Thanks in advance!

 

[Orthocoderpgu]

Question... My physician has a habit of using the "unlisted" codes frequently and I would like to know if anyone has a round about number for what the reimbursement rates are for the 27299, 27599, and 29999 CPT codes. Thanks in advance!

That would depend on the "comparison" code that is submitted with it which shows, in general, the amount of work and effort that was done in order to complete the procedure. Insurance is not going to base a payment on an unlisted code which is why they need a comparison code and a copy of the op note.

 

[amyjph]

There is no reimbursement rate assigned to unlisted codes. It depends on what the code is being used for, how you valued the code (a comparison CPT, the work done, etc.), and how the payer reimburses them. If a provider has a carve out and/or something put into their contract regarding these also makes a difference.
If they are being used for hip scopes, or some other type of procedure which is not experimental and does not have it's own CPT.
Are the unlisted codes being billed correctly/appropriately would be my first question in this scenario.

Some info (may be an older date or items could be slightly outdated): https://www.facs.org/media/3pqhpnxk/2017_08_unlisted.pdf

https://www.aaos.org/aaosnow/2019/sep/managing/managing03/

CMS manuals and most MAC sites talk about this topic too.

 

[Chelsea050618]

That would depend on the "comparison" code that is submitted with it which shows, in general, the amount of work and effort that was done in order to complete the procedure. Insurance is not going to base a payment on an unlisted code which is why they need a comparison code and a copy of the op note.

The codes that were used are 27447 and 27599 (EXCISION OF LARGE OSGOOD LESION INVOLVING PATELLAR TEND). I'm honestly just looking to see if anyone has a reimbursement on the claims they send out that's similar to a sx like this.