How To Use CPT Code 79999

CPT 79999 describes a radiopharmaceutical therapy 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 79999?

CPT 79999 can be used to report a radiopharmaceutical therapy procedure that does not have a specific code. This code is used when there is no other available CPT code that accurately represents the service provided by the healthcare provider.

2. Official Description

The official description of CPT code 79999 is: ‘Radiopharmaceutical therapy, unlisted procedure.’

3. Procedure

1. The healthcare provider performs a radiopharmaceutical therapy procedure that does not have a specific code available.
2. The procedure may involve the use of radioactive substances to treat a specific condition or disease.
3. The healthcare provider follows established protocols and guidelines for the administration of the radiopharmaceutical therapy.
4. The procedure may require specialized equipment and monitoring to ensure the safe and effective delivery of the therapy.
5. The healthcare provider documents the details of the procedure, including the specific radiopharmaceutical used, the dosage administered, and any relevant patient information.

4. Qualifying circumstances

CPT 79999 is used when there is no other specific CPT code available to accurately describe the radiopharmaceutical therapy procedure performed by the healthcare provider. This may occur when the procedure is new or uncommon, or when there is no established code for a particular type of therapy.

5. When to use CPT code 79999

CPT code 79999 should be used when there is no other specific CPT code available to accurately represent the radiopharmaceutical therapy procedure performed by the healthcare provider. It is important to note that CPT guidelines instruct against choosing a code that only approximates the service provided. Therefore, if there is a specific code available that closely matches the procedure, it should be used instead of CPT 79999.

6. Documentation requirements

To support a claim for CPT 79999, the healthcare provider must document the following information:

• A detailed description of the radiopharmaceutical therapy procedure performed
• The reason for choosing CPT 79999 instead of a specific, established code
• Comparison to similar codes, if available, to justify the claim amount
• Operative notes or other relevant documentation to strengthen the claim and avoid possible denial

7. Billing guidelines

When billing for CPT 79999, it is important to provide a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The cover letter should include one or more similar codes and compare the service to those codes to justify the claim amount. Additionally, the healthcare provider should include the operative notes or other relevant documentation to support 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 79999 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition. It is important to stay updated on any changes or revisions to CPT codes to ensure accurate billing and coding practices.

9. Examples

1. A healthcare provider performs a radiopharmaceutical therapy procedure for the treatment of a rare form of cancer that does not have a specific code available.
2. A patient undergoes a radiopharmaceutical therapy procedure to alleviate severe bone pain caused by metastatic disease.
3. A healthcare provider administers a radiopharmaceutical therapy to target and treat liver cancer in a patient.
4. A patient receives a radiopharmaceutical therapy for the management of neuroendocrine tumors.
5. A healthcare provider performs a radiopharmaceutical therapy procedure to treat lymphoma in a patient.