Oncology & Hematology Coding Alert

Reader Question :

Use This List for Unlisted Procedures

Question: What documentation must I have to report an unlisted-procedure code, such as 96549 (Unlisted chemotherapy procedure)?

Minnesota Subscriber

Answer: According to Cindy Parman, CPC, CPC-H, RCC, at Coding Strategies Inc., before you report this unlisted-procedure code, you must have the following:

  • a detailed description of the procedure performed
  • copies of articles in medical journals clinical trials, medical indications, etc.
  • documentation of the medical necessity of the procedure
  • time, effort and equipment required to perform the procedure
  • patient diagnosis, chief complaint (CC), presenting signs and symptoms
  • any concurrent problems requiring treatment or management
  • description of follow-up care and prognosis
  • cost savings from the procedure
  • comparison with existing procedure's reimbursement, including a comparison of time, effort, technical and professional work for both.