Did you know that healthcare providers often spend 30 to 40% of their revenue on their billing process?
As a healthcare provider, you want to make sure that you are accurately billing for services rendered.
But with the ever-changing landscape of medical coding and billing, it can be difficult to keep up with all the codes and regulations. You don't want to risk underbilling or overbilling your patients, so what do you do when there isn't an exact code for a service?
Unlisted CPT codes provide a solution! Keep reading because, in this article, we'll explain everything you need to know about unlisted CPT codes so that you can ensure accurate billing practices in your practice.
What Are Unlisted CPT Codes?
Unlisted CPT codes are special codes used when there is no exact code that describes the service provided. They allow healthcare providers to bill for services rendered without having to use a code that doesn't accurately reflect the care given.
These codes can also be used if you're unusually performing a procedure and it requires documentation that isn't available in the existing code set.
What Are the Difference Between CPT and ICD Codes?
CPT or Current Procedural Terminology codes are used to describe the medical services and procedures provided. ICD or International Classification of Diseases codes, on the other hand, provides information about the diagnosis that corresponds to those services and procedures.
Unlisted CPT codes are always paired with an ICD code that accurately describes the medical condition or diagnosis.
Benefits of Unlisted CPT Codes
Now that you know what an unlisted CPT code is, let's discuss the benefits it can bring to your practice. They include:
1. Increased Accuracy of Coding and Billing
Through the use of unlisted codes, coding and billing accuracy can be greatly improved. This leads to more efficient reimbursements and fewer missed opportunities for supplemental payments. As such, medical coding specialists can provide better services to their patients and healthcare facilities by not only having more accurate documentation of services provided but also faster processing of claims.
2. Reduced Risk of Incorrect or Inappropriate Billing
Utilizing unlisted CPT codes gives providers an added layer of protection when submitting claims to payers. This ensures accuracy in billing and allows for additional documentation during the adjudication process, which minimizes risks of incorrect or inappropriate coding.
Using an unlisted CPT code allows the provider to accurately explain each service rendered and ensures the correct reimbursement for not only that particular service but the entire claim as a whole.
3. Streamlined Billing Process
Streamlined billing ensures that everyone's time is used efficiently. With unlisted CPT codes, this process is further simplified to make things even easier. Every practice has unique needs, and the convenience of having a streamlined billing system allows those needs to be met without taking away too much time and effort from their staff members or clients. This way, they can focus on providing the best quality of care with minimal hassle.
How to Use Unlisted CPT Codes
When using an unlisted CPT codes, it's important to provide as much detail as possible in your medical documentation and billing process. This can include descriptions of the procedure, any additional services provided, and a description of why you chose the unlisted code.
You should always include the name of the procedure or type of service provided in your documentation. This is important so that insurance companies and patient billing departments can accurately process and pay claims.
It is also important to remember that some procedures may have an existing CPT code, but you may choose to bill an unlisted code instead. This may be because the existing code doesn't accurately reflect the service provided or ensure compliance with coding regulations.
In any case, you should make sure to provide a detailed narrative describing why you are using an unlisted CPT code instead of an existing one for your patient's care so that everyone involved in the billing process can accurately assess the situation.
The CPT codes are updated on an annual basis by the American Medical Association. It's important to stay current on these changes so that your billing practices remain accurate and compliant with coding regulations.
What CPT Codes Require a QW Modifier?
When billing an unlisted CPT code, it is important to use the QW modifier. This modifier indicates that the service or procedure provided was not listed in the CPT code set and provides additional information about why an unlisted code was chosen.
Without this modifier, your claim may be rejected by insurance companies, leading to delays in reimbursement and potential denials.
While the use of an unlisted procedure code requires a special report or documentation to describe the service, correct coding demands that the code reported is appropriate for the service provided, and not a code that is similar but actually represents another service.
Unlisted or unspecified codes, don't have payment rates assigned to them as they don't describe a specific service or procedure. It is prudent to work with the payer to establish payment rates in advance of any procedure or service. Establishing the value of the procedure relative to another procedure is oftenly the best way to facilitate claim adjudication. Payers will manually price services based on the documentation provided.
What are the Documentation Requirements for Unlisted CPT Codes?
How is the Payment Determined for Unlisted CPT Codes?
Most payers are reviewing the documentation submitted by the provider as well as information on comparable procedures to establish payment for unlisted CPT codes. It will likely be necessary to provide the supporting documentation that provides a detailed description of the nature, extent, and need for the procedure or the service and all the other listed above.
Unlisted CPT codes are a useful tool for healthcare providers that allows them to accurately document services provided without having to use an existing code that doesn't precisely reflect their care.
Unlisted codes can also help you avoid common coding errors, streamline your billing process, and reduce the risk of incorrect or inappropriate billing.
We encourage providers to consult their own experts for advice regarding reimbursement, coding, and coverage issues related to the use of unlisted procedure codes, and to consult Upvio for everything telehealth related.