AHA Coding Clinic® for HCPCS - 2009 Quarter 1; FOR your INFORMATION
The reporting of unlisted services or procedures
When a separately reportable service has been performed and there is no HCPCS Level I (CPT, including Category I and Category III) codes or HCPCS Level II code which describes the service or procedure, an unlisted code is generally reported. In the CPT codebook the unlisted service/ procedure codes can be found at the end of a section or subsection. The long descriptors for these codes start with the term “Unlisted”. Unlisted codes should be reported only if no other specific HCPCS codes adequately describe the procedure or service. Under the outpatient prospective payment system (OPPS), the Centers...
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Article Overview
This article reviews when an unlisted service or procedure code may be used, where these codes are located in CPT, and how reporting differs in outpatient prospective payment system and non-OPPS settings. It is aimed at coders, billing staff, and compliance professionals who need a high-level understanding of unlisted code reporting and the related CMS guidance sources.
Why This Topic Matters
Correct identification of unlisted services affects claim reporting, payment processing, and compliance when no specific HCPCS code adequately describes a service or procedure.
What You Will Learn
- How unlisted service and procedure reporting is generally handled when no specific code exists
- Where unlisted CPT codes are typically found in the codebook
- How reporting considerations differ between OPPS and non-OPPS settings
- Which CMS resource is referenced for locating current unlisted CPT listings
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle staff
- Compliance professionals
- Healthcare administrators
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