Report the code that best represents the specific procedure

CPT procedure code versus unlisted procedure code: Procedural codes are a key component in the medical coding and billing industry. But where does unlisted procedure codes fit into the scheme of things?


When a procedure cannot be accurately described by a CPT code, you need to report unlisted procedure code rather than a code that is close. Using a listed code that does not match the procedure can bring in compliance risks.


When do you report unlisted procedure codes?


• You can use unlisted procedure codes for new procedures that are not yet represented in the CPT code set.

• You can also use these codes for procedures that do not involve new technology and are not performed at regular intervals.


When a physician carries out several procedures that are represented by the same unlisted procedure code, only one unit of the unlisted code should be reported. Also, you’ll do well to remember that you should not use modifiers on unlisted procedure codes as these codes do not have a standard description that can be changed.


More often than not, healthcare providers try to escape the use of unlisted procedures fearing that payment may elude them or might get delayed. Therefore, billing for unlisted procedure code is certainly more labor-intensive than billing for listed procedures. But this should not prevent you from reporting the code that best represents the specific procedure that was carried out.

Official Medical Code Descriptors and Guidelines, How-to articles, CMS references, Discussion forums

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