Wiki Unlisted surgery with other surgery codes

[hsmith67]

So, we have an unlisted code for a surgical procedure and other surgical procedures were done. The comparative CPT has a higher RVU than the other codes that have a CPT. Based on this, should the unlisted code be billed first and subsequent codes have the -51. Or, is there a rule that the unlisted code either has to go last or can never be listed first?

Thanks for any guidance with references!
Hunter Smith, CPC

 

[amyjph]

This does not make sense because an unlisted code doesn't have an RVU or description attached to it. The subsequent codes might have a lower RVU than the comparison code but the unlisted will be reported on the claim so the 51 would not be needed. You are not reporting the comparison CPT, you are reporting the unlisted CPT. It's the same idea as not appending a modifier to an unlisted code because modifiers are used to alter the meaning of a code description and unlisted don't have descriptions. (Some payers want modifiers on the unlisted though*). Individual payers may have reporting requirements to follow. I have not seen an exact guideline on the reporting order but I always put the unlisted last since it doesn't have an RVU by definition.

Many payers such as Medicare don't want the 51. Example: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144532