What is an unlisted CPT code? That is the question “Spotlight on CPT” will address this month.
Unlisted CPT codes are those that are meant to be assigned when the procedure performed by a provider is not found in the CPT code set. It could be a brand-new procedure, or one that is not fully explained by an existing CPT code.
Unlisted CPT codes are sprinkled throughout the CPT manual and each one relates to a specific section of the manual. Unlisted codes are noted in the guidelines which precede each section of the code book. For example, in the Anesthesia section guidelines code 01999 is identified as the only unlisted anesthesia code, whereas, in the Pathology and Laboratory guidelines, there are sixteen unlisted codes for use depending on which type of path/lab test it is (chemistry, immunology, microbiology, etc.).
Most unlisted CPT codes end in 99. Of course, there are some exceptions with unlisted codes ending in 00, 01, 29, 38, 39, 49, 59, 78, 79, 86, 96, 97, or 98.
When coding unlisted procedures, it is often necessary to supply a special report that can provide specific information about the procedure so that reimbursement can be determined. Details that should be included in the report include how much time and effort the procedure took, what equipment was needed, and a complete description of the procedure along with the medical necessity for it.
Remember, that when assigning CPT procedure codes, it is not acceptable to use a code that is “close” to the procedure that was actually performed. If there is not a specific CPT code for the procedure/service that was performed, an unlisted code should be assigned instead.
Now, light has been shed on unlisted CPT codes.
Dianna Foley, RHIA, CHPS, CCS is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
