Can you use modifier 59 with an unlisted CPT code?

is it appropriate to put modifier 59 on an unlisted code? Probably not, unless you’ve already received a bundling/inclusive denial. It’s difficult to say whether or not a service is ‘not ordinarily encountered or performed on the same day’ as another procedure, without knowing exactly what the 2 procedures are.

What is an unlisted code and when can you use an unlisted code?

In medical billing, an unlisted code is used to report a service or procedure that does not have a specific Current Procedural Terminology (CPT) code. Reimbursement for these services can be nuanced and complex, but can be navigated with some basic understanding.

What does unlisted Procedure Code mean in CPT?

CPT® includes so-called “unlisted procedure codes” to report procedures or services for which there is no more specific code. Here are three tips to apply these codes, correctly.

Where can I find list of unlisted procedures?

A full listing of unlisted procedures also appears in the ‘Surgery Guidelines’ portion of CPT before the 10000-series codes. Be sure while reporting the appropriate unlisted code for the category/type of procedure performed.

How to write an unlisted procedure cover letter?

You should adhere to the following steps in writing the cover letter: Choose a comparison code that is similar to the unlisted procedure performed. This code should represent surgery on the same body area.

How to report an unlisted procedure for reimbursement?

Hence, they should be reported the same way that unlisted codes are reported. When seeking reimbursement for a surgical procedure, it is important to select the Current Procedural Terminology (CPT)* code or Healthcare Common Procedure Coding System (HCPCS) Level II code that accurately and precisely describes the services provided.