Medical Billing For An Unlisted Procedure

Medical Billing For An Unlisted Procedure

Have you ever heard of a jejunostomy in medical billing? Probably not, because this procedure is not listed under any current procedural terminology codes. The service is similar to a gastrostomy, but slightly different in nature. The question becomes: Should you use a gastrostomy CPT medical billing code when the service is actually for a jejunostomy?

A medical billing guideline would answer this question. It is not acceptable to choose the “next best” code when an exact code will not work for a service. Medical billing should be completely accurate. If there is not suitable code to describe the service, you should report the right unlisted procedure code.

In the case of the jejunostomy, the correct medical billing unlisted procedure code is 43999, not 43760. Whenever you provide an unlisted medical billing code, you must also present documentation describing what the procedure actually encompasses. You may document that the procedure is like a 43760 (change of gastrostomy tube), just don’t bill with that CPT code.

Many people would also use modifier 22 in medical billing. This means: Unusual procedural services. Just like the unlisted procedure code, when you use modifier 22 you must provide documentation as to why the procedure is unusual. Many times, when this modifier is used, the physician requires extra reimbursement because extra time and effort is exerted. Your medical billing should reflect that.

Medical billing is an exact science. You should never take an approximate approach when it comes to healthcare procedures. Current procedural terminology codes were designed and defined for a reason. The only time you would use a specific CPT is if that specific surgery is performed. Unlisted procedure codes are there to assist you in unsure medical billing times. These codes are the “catch-all” of the medical billing industry.

View all Articles by: Melissa Clark, CCS-P