How To Use CPT Code 76999

CPT 76999 describes an unlisted ultrasound procedure that is used when there is no specific code available to report a diagnostic or interventional ultrasound procedure. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 76999?

CPT 76999 is an unlisted ultrasound procedure code that is used when there is no specific code available to report a diagnostic or interventional ultrasound procedure. This code is used to describe ultrasound procedures that are not represented by any of the standard and active CPT codes.

2. Official Description

The official description of CPT code 76999 is: ‘Unlisted ultrasound procedure (eg, diagnostic, interventional).’ This code is used when there is no specific code available to report a diagnostic or interventional ultrasound procedure.

3. Procedure

1. When performing an ultrasound procedure that does not have a specific code, the provider should use CPT code 76999.
2. This code is used for both diagnostic and interventional ultrasound procedures.
3. The provider uses high-frequency sound waves to view tissues and diagnose or manage conditions.
4. The ultrasound procedure may be used to diagnose a condition or to treat a condition through an interventional procedure.
5. Proper documentation should be done before billing for an unlisted procedure, and a cover letter explaining the reason for choosing the unlisted code should be included.
6. Similar codes should be compared to justify the claim amount being billed, and relevant documentation should be provided to support the claim.

4. Qualifying circumstances

CPT 76999 is used when there is no specific code available to report a diagnostic or interventional ultrasound procedure. It is important to ensure that proper documentation has been done before billing for an unlisted procedure. The ultrasound procedure may be performed to diagnose a condition or to treat a condition through an interventional procedure. The provider should consult the patient, if possible, to ensure that the appropriate code is used.

5. When to use CPT code 76999

CPT code 76999 should be used when there is no specific code available to report a diagnostic or interventional ultrasound procedure. It is important to follow CPT guidelines and not choose a code that merely approximates the service provided. If no specific procedure or service code exists, the appropriate unlisted procedure code should be used.

6. Documentation requirements

To support a claim for CPT 76999, proper documentation is essential. A cover letter explaining the reason for choosing the unlisted code should be included, along with one or more similar codes to justify the claim amount being billed. Operative notes or other relevant documentation should also be provided to strengthen the claim and avoid a possible denial.

7. Billing guidelines

When reporting a procedure with CPT code 76999, it is important to submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The provider should compare the service to similar codes and include the operative notes or other relevant documentation to support the claim. 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 76999 was added to the Current Procedural Terminology system on January 1, 1990, as an unlisted ultrasound procedure. There have been no updates to the code since its addition.

9. Examples

1. A provider performs an ultrasound procedure to diagnose a rare condition that does not have a specific code available. CPT code 76999 is used to report this unlisted ultrasound procedure.
2. An interventional radiologist performs an ultrasound-guided procedure to treat a complex condition. CPT code 76999 is used to report this unlisted interventional ultrasound procedure.
3. A physician uses ultrasound imaging to guide a needle biopsy of a suspicious mass. CPT code 76999 is used to report this unlisted ultrasound-guided biopsy procedure.
4. A surgeon performs an ultrasound examination during a complex surgical procedure. CPT code 76999 is used to report this unlisted intraoperative ultrasound procedure.
5. A provider uses ultrasound imaging to guide the placement of a central venous catheter. CPT code 76999 is used to report this unlisted ultrasound-guided catheter placement procedure.