How To Use CPT Code 97799
CPT 97799 is an unlisted physical medicine/rehabilitation service or procedure code used when no specific code exists for the service provided. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97799 procedures.
1. What is CPT 97799?
CPT 97799 is an unlisted code used to report procedures related to physical medicine or rehabilitation services that do not have a specific code. Medical coders and billers use this code when the provider performs physical medicine or rehabilitation services that are not represented by any of the standard and active CPT codes available.
2. 97799 CPT code description
The official description of CPT code 97799 is: “Unlisted physical medicine/rehabilitation service or procedure.”
The 97799 CPT code procedure involves the following steps:
- Identify the physical medicine or rehabilitation service that does not have a specific CPT code.
- Review the available CPT codes to ensure that no appropriate code exists for the service provided.
- Document the service provided, including a detailed description of the procedure, the patient’s condition, and the reason for the service.
- Submit the claim using CPT 97799, along with the required documentation and a cover letter explaining the choice of the unlisted code.
4. Qualifying circumstances
Eligibility for CPT code 97799 services depends on the following factors:
- The service provided is related to physical medicine or rehabilitation.
- No specific CPT code exists for the service provided.
- The service is medically necessary and supported by appropriate documentation.
- The provider has submitted a cover letter and relevant documentation to justify the use of the unlisted code.
5. When to use CPT code 97799
It is appropriate to bill the 97799 CPT code when the provider performs a physical medicine or rehabilitation service that is not represented by any of the standard and active CPT codes available. The service must be medically necessary and supported by appropriate documentation. Additionally, a cover letter explaining the choice of the unlisted code should be submitted along with the claim.
6. Documentation requirements
To support a claim for CPT 97799, the following information needs to be documented:
- A detailed description of the service provided, including the procedure, the patient’s condition, and the reason for the service.
- Relevant medical records, such as operative notes or other documentation, to support the medical necessity of the service.
- A cover letter explaining the choice of the unlisted code, including a comparison to similar codes and justification for the billed amount.
7. Billing guidelines
When billing for CPT code 97799, follow these guidelines:
- Do not choose a code that merely approximates the service provided. Use the unlisted code only if no specific code exists for the service.
- Report a Category III code when available in place of an unlisted procedure code.
- Submit a cover letter explaining the choice of the unlisted code, along with relevant documentation to support the claim.
- Be prepared for payers to consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.
8. Historical information
CPT 97799 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.
9. Similar codes to CPT 97799
Five similar codes to CPT 97799 and how they differentiate from CPT 97799 are:
- CPT 97110: Therapeutic exercises to develop strength, endurance, range of motion, and flexibility.
- CPT 97112: Neuromuscular reeducation of movement, balance, coordination, and posture.
- CPT 97116: Gait training to improve walking skills and mobility.
- CPT 97140: Manual therapy techniques to treat soft tissue and joint structures.
- CPT 97530: Therapeutic activities to improve functional performance.
Here are 10 detailed examples of CPT code 97799 procedures:
- A new rehabilitation technique for stroke patients that is not yet represented by a specific CPT code.
- An experimental physical therapy procedure for spinal cord injury patients that does not have a designated code.
- A unique combination of manual therapy techniques tailored to a patient’s specific needs that cannot be accurately coded using existing codes.
- A specialized aquatic therapy program for patients with multiple sclerosis that is not covered by a standard CPT code.
- An innovative balance training program for patients with Parkinson’s disease that does not have a corresponding code.
- A custom-designed exercise program for patients with rare neuromuscular disorders that cannot be accurately represented by existing codes.
- A novel pain management technique for patients with chronic pain that is not yet assigned a specific CPT code.
- An advanced prosthetic training program for amputee patients that does not have a designated code.
- A cutting-edge virtual reality-based rehabilitation program for patients with traumatic brain injuries that is not covered by a standard CPT code.
- A unique cognitive rehabilitation program for patients with dementia that cannot be accurately coded using existing codes.