Question

In CPT, unlisted codes are reported only if:

a. There is not a current CPT category I code available
b. There is not a current CPT category III code available
c. There is not a current CPT category II code available
d. There is not a HCPCS Level II code or a current CPT level III code

Answer 1

Unlisted codes are used in CPT reporting when no current CPT Category I code exists for a service or procedure. It's important to first look for a Category I or III code before using an unlisted code. The availability of CPT Category II or HCPCS Level II codes is not relevant to the decision to use an unlisted code.

Step-by-step explanation:

In CPT (Current Procedural Terminology), unlisted codes are reported only if there is not a current CPT Category I code available. Unlisted codes are a way to report services or procedures that do not have a specific CPT code assigned to them. It is essential to use the correct process for reporting unlisted codes, which includes providing a special report that describes the service or procedure in detail.

When determining whether or not to use an unlisted code, it is necessary to first search for an existing CPT Category I code that accurately represents the service provided. If such a code does not exist, the next step is to consider whether a CPT Category III code is available. CPT Category III codes represent temporary codes for emerging technologies, services, and procedures. If neither of these options is applicable, then the use of an unlisted code may be appropriate. However, it is not relevant whether a CPT Category II code (which is used for performance measurement) or a HCPCS Level II code is available, as these do not describe specific services or procedures.