tci ED Coding & Reimbursement Alert - 2024 Issue Q3

Reader Questions: Reevaluate the Relationship Between Unlisted Codes and Modifiers

Question: Can I append a modifier to an unlisted CPT® code? I’m having trouble getting paid when I use unlisted codes. Might a modifier help? Idaho Subscriber Answer: A modifier won’t likely help you get paid. This is because unlisted codes cannot be matched to a specific procedure and therefore there’s nothing specific to modify. For example, if you’re using an unlisted procedure code, you cannot append, say, modifier 22 (Increased procedural services), because doing so suggests that you know you did something of unusual complexity beyond the specific procedure code. When using an unlisted...

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