How To Use CPT Code 97139

CPT 97139 is an unlisted therapeutic procedure code used when no specific code exists for the service provided. This article will cover the description, procedure, qualifying circumstances, when to use, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97139.

1. What is CPT 97139?

CPT 97139 is an unlisted therapeutic procedure code that is used when there is no specific CPT code available for the service provided. This code is used to report therapeutic procedures that effect change through the application of clinical skills or services that attempt to improve function in one or more areas and require direct patient contact by a physician or therapist.

2. 97139 CPT code description

The official description of CPT code 97139 is: “Unlisted therapeutic procedure (specify)”.

3. Procedure

The 97139 procedure involves the following steps:

1. Identify the therapeutic procedure that is not represented by any of the standard and active CPT codes available.
2. Ensure that the procedure requires direct patient contact by a physician or therapist.
3. Document the specific therapeutic procedure performed, including the area(s) treated and the duration of the treatment.
4. Submit the claim using CPT code 97139, along with a cover letter and supporting documentation as required by the payer.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 97139 services are those who require a therapeutic procedure that is not represented by any of the standard and active CPT codes available. The procedure must be performed by a physician or therapist with direct patient contact and must aim to improve function in one or more areas.

5. When to use CPT code 97139

It is appropriate to bill the 97139 CPT code when a therapeutic procedure is performed that does not have a specific code in the CPT system. The procedure must require direct patient contact by a physician or therapist and aim to improve function in one or more areas. Additionally, a Category III code should be reported when available in place of an unlisted procedure code.

6. Documentation requirements

To support a claim for CPT 97139, the following information needs to be documented:

• A detailed description of the therapeutic procedure performed, including the area(s) treated and the duration of the treatment.
• A cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes and compare the service provided to those codes to justify the claim amount being billed.
• Operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial.

7. Billing guidelines

When billing for CPT code 97139, follow these guidelines:

• Do not choose a code that merely approximates the service provided. Use the appropriate unlisted procedure code if no specific procedure or service code exists.
• Report a Category III code when available in place of an unlisted procedure code.
• Submit a cover letter and supporting documentation as required by the payer to justify the claim amount being billed and to avoid a possible denial.
• Be aware that payers will consider claims with unlisted procedure codes on a case-by-case basis and will determine payment based on the documentation provided.

8. Historical information

CPT 97139 was added to the Current Procedural Terminology system on January 1, 1990. There have been changes to the descriptor of the code on January 1, 2001, and January 1, 2002.

9. Similar codes to CPT 97139

Five similar codes to CPT 97139 and how they differentiate from CPT 97139 are:

1. CPT 97110: This code is for therapeutic exercises, which are more specific than the unlisted therapeutic procedures covered by CPT 97139.
2. CPT 97112: This code is for neuromuscular reeducation, which is a specific type of therapeutic procedure not covered by CPT 97139.
3. CPT 97116: This code is for gait training, which is a specific therapeutic procedure not included in CPT 97139.
4. CPT 97124: This code is for massage therapy, which is a specific type of therapeutic procedure not covered by CPT 97139.
5. CPT 97140: This code is for manual therapy techniques, which are more specific than the unlisted therapeutic procedures covered by CPT 97139.

10. Examples

Here are 10 detailed examples of CPT code 97139 procedures:

1. A therapist performs a unique combination of manual therapy techniques and therapeutic exercises not covered by existing CPT codes.
2. A physician provides a specialized form of neuromuscular reeducation not represented by any standard CPT codes.
3. A therapist performs a novel aquatic therapy intervention not covered by existing CPT codes.
4. A physician provides a new form of biofeedback therapy not represented by any standard CPT codes.
5. A therapist performs a unique combination of gait training and balance exercises not covered by existing CPT codes.
6. A physician provides a specialized form of cognitive rehabilitation not represented by any standard CPT codes.
7. A therapist performs a novel form of vestibular rehabilitation not covered by existing CPT codes.
8. A physician provides a new form of lymphedema therapy not represented by any standard CPT codes.
9. A therapist performs a unique combination of joint mobilization and soft tissue mobilization not covered by existing CPT codes.
10. A physician provides a specialized form of electrotherapy not represented by any standard CPT codes.