How To Use CPT Code 78399

CPT 78399 describes a musculoskeletal diagnostic nuclear medicine procedure that does not have a specific code. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78399?

CPT 78399 can be used to report a musculoskeletal diagnostic nuclear medicine procedure that does not have a specific code. This code is used when there is no other existing code that accurately represents the service provided by the healthcare professional.

2. Official Description

The official description of CPT code 78399 is: ‘Unlisted musculoskeletal procedure, diagnostic nuclear medicine.’

3. Procedure

1. The healthcare professional performs a musculoskeletal diagnostic nuclear medicine procedure that is not represented by any of the standard and active CPT codes available.
2. The procedure involves administering radiopharmaceuticals to the patient, which emit radiation that a scanner detects and produces an image to aid in the diagnosis, management, and treatment of musculoskeletal diseases.
3. The specific details of the procedure may vary depending on the patient’s condition and the healthcare professional’s judgment.

4. Qualifying circumstances

CPT 78399 is used when there is no specific code available to accurately describe the musculoskeletal diagnostic nuclear medicine procedure performed by the healthcare professional. This code should only be used when there is no other appropriate code that represents the service provided.

5. When to use CPT code 78399

CPT code 78399 should be used when there is no specific code available that accurately represents the musculoskeletal diagnostic nuclear medicine procedure performed by the healthcare professional. It is important to note that this code should only be used when there is no other appropriate code that can be used to report the service.

6. Documentation requirements

To support a claim for CPT 78399, the healthcare professional must provide the following documentation:

• A detailed description of the musculoskeletal diagnostic nuclear medicine procedure performed
• An explanation of why there is no specific code available to accurately represent the service
• Operative notes or other relevant documentation to support the claim

7. Billing guidelines

When billing for CPT 78399, it is important to provide 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. Additionally, include the operative notes or other relevant documentation to strengthen the claim and avoid a possible denial. 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 78399 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A healthcare professional performs a musculoskeletal diagnostic nuclear medicine procedure on a patient with an unexplained bone lesion.
2. A radiologist administers radiopharmaceuticals to a patient and uses nuclear medicine imaging to evaluate a suspected joint infection.
3. A nuclear medicine technologist performs a musculoskeletal diagnostic nuclear medicine procedure to assess the extent of bone metastasis in a cancer patient.
4. A physician uses nuclear medicine imaging to evaluate a patient with suspected osteomyelitis.
5. A healthcare professional performs a musculoskeletal diagnostic nuclear medicine procedure to assess the response to treatment in a patient with rheumatoid arthritis.
6. A radiologist uses nuclear medicine imaging to evaluate a patient with suspected bone tumor.
7. A nuclear medicine technologist performs a musculoskeletal diagnostic nuclear medicine procedure to assess the extent of joint inflammation in a patient with rheumatoid arthritis.
8. A physician uses nuclear medicine imaging to evaluate a patient with suspected stress fracture.
9. A healthcare professional performs a musculoskeletal diagnostic nuclear medicine procedure to assess the response to treatment in a patient with bone infection.
10. A radiologist administers radiopharmaceuticals to a patient and uses nuclear medicine imaging to evaluate a suspected bone tumor.