Wiki Comparable codes for unlisted codes

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AN2114

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I'm a new medical coder and have not had much experience with unlisted codes. From my understanding when you have an unlisted code you also need to submit a comparable code and a letter. For figuring out the comparable code, do you find a code comparable in price or something that is similar to the procedure? Any tips on writing the letter? Do I have to ask the doctor what comparable code to use and what to write or something I can just research myself and do on my own?
 
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I would contact the payer and find out what documentation they want with a claim that has an unlisted code. Some payers don't recognize unlisted codes AT ALL (Medicare contractors and our state Medicaid, for instance.) Some want a copy of the operative note. Some want a letter with a copy of the op note.
After you find out what they want, you can go from there. I have never had a payer ask for a comparable code but maybe some do. But you will need to find a comparable cpt, regardless, to figure out a comparable charge for the unlisted code you're using. You can ask the doctor for a cpt code that would be comparable, work and skill-wise.
Hope this helps.
 
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I agree with nsteinhauser, Unlisted Codes are usually payer specific driven, meaning you need to ask the payer on how to best process them and what they want.
 
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