How To Use CPT Code 88399

CPT 88399 describes a surgical pathology procedure that does not have a specific code. 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 88399?

CPT 88399 can be used to report surgical pathology procedures that do not have a specific code. This code is used when the provider performs a surgical pathology procedure that is not represented by any of the standard and active CPT codes available.

2. Official Description

The official description of CPT code 88399 is: ‘Unlisted surgical pathology procedure.’

3. Procedure

1. The provider performs a surgical pathology procedure that does not have a specific code available.
2. The procedure is not represented by any of the standard and active CPT codes.
3. CPT code 88399 is used to report the unlisted surgical pathology procedure.

4. Qualifying circumstances

CPT 88399 is used when there is no specific code available to accurately describe the surgical pathology procedure performed by the provider. It is important to note that CPT guidelines instruct against choosing a code that merely approximates the service provided. Instead, the appropriate unlisted procedure code should be reported if no specific procedure or service code exists.

5. When to use CPT code 88399

CPT code 88399 should be used when the provider performs a surgical pathology procedure that does not have a specific code available. It is important to ensure that there is no other code that accurately describes the procedure before reporting CPT 88399. If a Category III code is available for the procedure, it should be reported instead of an unlisted procedure code.

6. Documentation requirements

To support a claim for CPT 88399, it is crucial to provide thorough documentation. This should include a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Additionally, include one or more similar codes and compare the service to those codes to justify the claim amount being billed. Operative notes or other relevant documentation should also be included to strengthen the claim and avoid possible denial. Payers will consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.

7. Billing guidelines

When billing for CPT 88399, it is important to ensure that there is no specific code available to accurately describe the surgical pathology procedure performed. Use the appropriate unlisted procedure code if no specific code exists. Include a cover letter explaining the reason for choosing the unlisted code and provide thorough documentation to support the claim. It is also important to compare the service to similar codes to justify the claim amount being billed.

8. Historical information

CPT 88399 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 provider performs a surgical pathology procedure that involves the examination of a tissue sample that does not have a specific code available.
2. A surgeon performs a complex surgical pathology procedure that requires extensive examination and analysis of the tissue sample.
3. A pathologist performs a specialized surgical pathology procedure that involves the use of advanced techniques to analyze the tissue sample.
4. A provider performs a surgical pathology procedure on a rare and unique case that does not have a specific code available.
5. A pathologist performs a surgical pathology procedure that requires additional testing and analysis beyond the standard procedures.
6. A surgeon performs a surgical pathology procedure that involves the examination of multiple tissue samples from different areas of the body.
7. A provider performs a surgical pathology procedure on a complex case that requires specialized expertise and knowledge.
8. A pathologist performs a surgical pathology procedure that involves the examination of a large and complex tissue sample.
9. A surgeon performs a surgical pathology procedure that requires the use of advanced imaging techniques to analyze the tissue sample.
10. A provider performs a surgical pathology procedure on a challenging case that requires extensive research and analysis.