What is the purpose of the special report required with an unlisted code?

The special report required with an unlisted code serves to clarify the necessity of the procedure. When an unlisted code is used, it indicates that there is no specific code that accurately describes the service or procedure performed. The special report must provide detailed information about the service, including what was done, why it was medically necessary, and any relevant clinical details. This documentation helps to ensure that payers can understand the context and rationale for the procedure performed, thus supporting the claim for reimbursement. It is essential for establishing the legitimacy of the claim, particularly when the usual codes do not apply.