How To Use CPT Code 21299

CPT code 21299 describes craniofacial and maxillofacial procedures that do not have a specific code. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21299?

CPT 21299 is used to report craniofacial and maxillofacial procedures that do not have a specific code. It is used when the provider performs a procedure on the cranium, skull, face, or upper jaw that is not represented by any of the standard and active CPT codes available.

2. Official Description

The official description of CPT code 21299 is: ‘Unlisted craniofacial and maxillofacial procedure.’

3. Procedure

When using CPT code 21299, the provider performs a craniofacial or maxillofacial procedure that does not have a specific code. This could include various surgical procedures on the cranium, skull, face, or upper jaw. The specific details of the procedure will vary depending on the patient’s condition and the provider’s approach. It is important to document the procedure in detail to support the use of the unlisted code.

4. Qualifying circumstances

CPT 21299 can be used when there is no specific code available to accurately describe the craniofacial or maxillofacial procedure performed by the provider. This may occur when the procedure is unique or innovative, or when there is no existing code that adequately captures the complexity or specificity of the procedure. It is important to document the reasons for choosing the unlisted code and provide supporting documentation to justify the claim.

5. When to use CPT code 21299

CPT code 21299 should be used when there is no specific code available to accurately describe the craniofacial or maxillofacial procedure performed by the provider. It is important to ensure that there is no other code that closely approximates the service provided before using the unlisted code. If a Category III code is available that better describes the procedure, it should be used instead of the unlisted code.

6. Documentation requirements

To support a claim for CPT 21299, the provider must document the following information:

• A detailed description of the craniofacial or maxillofacial procedure performed
• The reasons for choosing the unlisted code instead of a specific code
• A comparison to similar codes, if available, to justify the claim amount
• Operative notes or other relevant documentation to support the claim

7. Billing guidelines

When billing for CPT 21299, it is important to include a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The letter should also include one or more similar codes and compare the service to those codes to justify the claim amount. Payers will consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.

8. Historical information

CPT code 21299 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates to the code since its addition.

9. Similar codes to CPT 21299

While there are no specific similar codes to CPT 21299, it is important to review the existing codes related to craniofacial and maxillofacial procedures to ensure that there is no code that closely approximates the service provided. If a Category III code is available that better describes the procedure, it should be used instead of the unlisted code.

9. Examples

1. A provider performs a unique craniofacial reconstruction procedure that does not have a specific code.
2. A surgeon performs a complex maxillofacial surgery that does not have a specific code to accurately describe the procedure.
3. A dentist performs a specialized procedure on the upper jaw that is not represented by any existing codes.
4. A plastic surgeon performs an innovative craniofacial procedure that does not have a specific code.
5. An oral and maxillofacial surgeon performs a complex procedure on the face that does not have a specific code.
6. A provider performs a rare craniofacial procedure that is not captured by any existing codes.
7. A surgeon performs a cutting-edge maxillofacial surgery that does not have a specific code.
8. A dentist performs a unique procedure on the cranium that is not represented by any existing codes.
9. A plastic surgeon performs an innovative maxillofacial procedure that does not have a specific code.
10. An oral and maxillofacial surgeon performs a complex procedure on the upper jaw that is not captured by any existing codes.