Question

11. When can an unlisted code be used? When an unlisted code is used , a special report must be sent with the insurance claim explain .

12 . What are modified and how many digits are there?

13. Name and describe the four most commonly used modified.

Answer 1

11. What are unlisted codes? CPT ( Current Procedural Terminology) codes describes a procedure or service whereas Unlisted codes refers to a code that may not be found in the Current procedural Terminology (CPT) book to define the procedure that has been performed.

It can be used a) when a new technique or device is being used during a medical procedure b) when a procedure that has been performed not meet the AMA's requirements.

DOCUMENTATION:

a) A clear description of the nature, extent and need for the procedure or service

b) The patient's diagnosis and complications or risk factors

c) How it has performed should be mentioned. Whether the procedure was performed independently from other services provided (or) if it was performed at the same surgical site or through the same surgical opening.

d) Time, effort and equipment needed to provide the service

e) Number of times the service provided

f) Details of what was found during the surgery

g) Details of any other related problems that the patient has and follo-up care will be provided

h) For unlisted service codes, a reasonably comparable service code should be provided as well as value in comparable percentage of a reasonably comparable CPT.

12. Modifiers give an accurate description of the services and has 10 digits. For instance, Anesthesia - 00100-01999

13. a) MODIFIER -22 ( INCREASED PROCEDURAL SERVICE) When the work required to provide a service is substantially greater than required is identified by using this modifier.

b) MODIFIER - 51 ( MULTIPLE PROCEDURE) When multiple procedures are performed at the same session by the same individual may be identified by using this modifier

c) MODIFIER- 53 (DISCONTINUED PROCEDURE) In some cases, if the health professionals may elect to terminate a surgical or diagnostic procedure this modifier is used.

d) MODIFIER - 57 ( SURGICAL DECISION) An evaluation and management service that resulted in the initial decision to perform the surgery may identify by this modifier.