How to Bill for Unlisted Codes in Medical Billing

by Kurt Ullman •

“The hoops you have to get through vary by payer,” said Kim Pollock, RN, MBA, CPC, CMDP, a consultant with KarenZupko & Associates, Inc. in Chicago. “Some will routinely pay on an unlisted code that is used accurately. Others may not even recognize the unlisted code at all.”

Get Preauthorization When Possible

It is recommended that you approach the payer to get a preauthorization if possible. This speeds up a process that may be slow under the best of circumstances. Even with preauthorization expect delays, as most require human intervention.

“The Academy has a manual for addressing these issues,” said Dr. Manes. “It can be found on the members-only part of the website at entnet.org. This is a very good resource.”

Kurt Ullman is a freelance medical writer based in Indiana.

Unlisted Service or Procedure Codes

Some services or procedures are not listed in the most current CPT code. When submitting for reimbursement you will need to use an appropriate “unlisted procedure” code; these are organized by organ system or anatomic area.

17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue.
20999 Unlisted procedure, musculoskeletal system, general
21299 Unlisted procedure, craniofacial and maxillofacial
21499 Unlisted procedure, musculoskeletal procedure, head
21899 Unlisted procedure, neck or thorax
30999 Unlisted procedure, nose
31299 Unlisted procedure, accessory sinuses
31599 Unlisted procedure, larynx
31899 Unlisted procedure, trachea, bronchi
38999 Unlisted procedure, hemic or lymphatic system
40799 Unlisted procedure, lips
40899 Unlisted procedure, vestibule of mouth
41599 Unlisted procedure, tongue, floor of mouth
41899 Unlisted procedure, dentoalveolar structures
42299 Unlisted procedure, palate, uvula
42699 Unlisted procedure, salivary glands or ducts
42999 Unlisted procedure, pharynx, adenoids, or tonsils
60699 Unlisted procedure, endocrine system
64999 Unlisted procedure, nervous system
69399 Unlisted procedure, external ear
69799 Unlisted procedure, middle ear
69949 Unlisted procedure, inner ear
69979 Unlisted procedure, temporal bone, middle fossa approach

—Compiled by Kim Pollock, RN, MBA, CPC, CMDP at KarenZupko & Associates, Inc.