I guess in a sense when I play I have a lot of "known" things I could start from, but there are so many "known" things at this point that they can combine in an infinite number of ways, producing the illusion that I started from nothing. So, you have to start from somewhere and gradually build a vocabulary that can be combined in numerous ways. For me, I started with a harmonic minor scale and a couple of chords from that scale, say i, iv, V. I messed around with just pulsing chords, strumming chords, broken arpeggios like chopin, etc. and I made up really simple melodies in the right hand. At first these were totally synchronous with the left hand, but as you gain confidence you can start making it more asynchronous. But it is a good way to start. And, if you're already an experienced pianist you might experiment with playing melodies in the left hand at the same time as the right hand. If you start in the same scale it'll actually sound decent even if it is random. Another thing that I believe helped me start was recording these early attempts. you might play something you would have forgotten, or surprise yourself. This helps build confidence.