Modifiers with Unlisted Codes

Modifiers with Unlisted Codes

February 1, 2024

Question:
Can I use modifiers on an unlisted code?

Answer:
In some circumstances, a modifier may be appropriately appended to an unlisted code.

For example,

  • CPT says, while uncommon, if multiple separately reportable unlisted codes are performed on the same patient on the same date by the same physician, multiple unlisted codes may be reported. If the two procedures are performed in the same anatomic region, then multiple units of the unlisted code may be reported with a modifier 59
  • Modifier 62 (two surgeons/co-surgery) may also be appended to an unlisted code such as 64999 if co-surgery is documented.
  • Modifier 58 for staged or more extensive procedures may also be appended to alert the payor to a second surgery during the global period,
  • During the global period, it may also be appropriate (and recommended) to append global period modifiers such as 78 or 79 to an unlisted code to fully describe the surgical scenario to a payor.

Do not append modifier 50 (bilateral procedure), modifier 51 or modifier 52 or 53 to an unlisted code. Your base, or comparison code, should reflect modifier 50 and the associated increase in fee. The same is true for modifier 22.

*This response is based on the best information available as of 2/1/24.

 

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