Neurosurgery Coding Alert

Question: If I want to report a certain procedure for which CPT does not include a specific code, and I choose what I feel is the closest or next-best code, am I at risk of running afoul of compliance guidelines?

Utah Subscriber

Answer: The AMA and most experts advise against choosing "the next-best" CPT code when reporting procedures without a distinct CPT code. Although you may contact individual carriers for instructions in some circumstances, generally if the service you provided is not included in CPT, the correct code choice is an unlisted-procedure code, e.g., 64999, Unlisted procedure, nervous system.

Be sure to provide detailed documentation, including a narrative description, outlining the procedure and the time involved. You may compare the procedure to the closest procedure listed in CPT for these purposes (it may speed payment to put this, along with the title of the operation, in box 19 of the CMS 1500 form).

The payer will use this information to determine payment. The AMA has a toll-free number (800-634-6922) to call if you have questions about CPT. AMA members receive four free inquiries annually.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.