Pulmonology Coding Alert

Question: How do insurers determine reimbursement when I report an unlisted-procedure code? Can our practice do anything to increase or improve our reimbursement chances when reporting these codes?


Georgia Subscriber


Answer: There's no standard fee for unlisted-procedure code 32999 (Unlisted procedure, lungs and pleura). Rather, insurers consider claims on a case-by-case basis. Therefore, the success of any unlisted-procedure claim depends largely on the documentation you submit with your claim.

You should submit full documentation with every unlisted-procedure claim. To improve your reimbursement chances, you should take three additional steps, whenever possible:

1. Include a cover letter with a concise explanation of the procedure, free of medical jargon and confusing terminology.

2. Compare the procedure to a procedure with an existing CPT code that requires similar work and resources. This allows the payer to make an informed payment decision.

3. Assign a charge to the unlisted-procedure code. Since unlisted-procedure codes do not have any associated payment, you must identify the amount of reimbursement you wish to be paid. Remember that the insurer may not reimburse 100 percent of your charge. 

For example: CPT does not include a code for pleurolysis (the infusion of an enzyme into an empyema to promote liquification of the empyema fluid so that it can be drained through a chest tube). To report this procedure, you would have to use code 32999 and provide a letter describing the procedure. A procedure that requires similar work would be 32005 (Chemical pleurodesis [e.g., for recurrent or persistent pneumothorax]).
 
Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta.