Wiki Unlisted code appropriateness

[lmpitt80]

Hello,

I have questions and concerns in the numerous unlisted codes being reported on surgery claims coming through my department. The encounters are being coded by an outside company.
I've had almost 4 years of coding experience in just about every specialty and I have rarely used the unlisted codes. The amount unlisted codes being applied seem to be for things that are included in the surgical procedures listed. The procedures are not exactly new or out of the ordinary.

If there is any additional information that can be provided on reporting unlisted codes. Specifically in addition to other procedures being performed. My concern is that we may not be getting paid exactly what we should also possibly missing additional charges because frequent use of unlisted code.

Any feedback is much appreciated.

 

[Amy Pritchett]

In my personal auditing experience, when there are an exuberant amount of unlisted procedure codes, it seems that they are just coding the unlisted procedure codes to get their quota completed. I have also found that some coders are just uneducated and if the description does not say "everything" in the description, they will choose an unlisted CPT code. It would seem to me that they need a really good education on when to use unlisted codes. Unfortunately, you are correct! When using unlisted codes, you will not receive the amount of money that you should expect to be reimbursed simply because there is no money attached to an unlisted code until the insurance adjuster reads the reports. The other issue that you will run into is the "red flag" issue that comes from submitting too many unlisted procedure codes.

Hope this helps and good luck

 

[lmpitt80]

Thank you so much.