How To Use CPT Code 90999

CPT 90999 describes an unlisted dialysis procedure, whether performed in an inpatient or outpatient setting. This article will provide an overview of CPT code 90999, including its official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes.

1. What is CPT Code 90999?

CPT 90999 is a code used to report dialysis services or procedures that do not have a specific code assigned to them. It is used when the provider performs a dialysis service or procedure that is not represented by any of the standard and active CPT codes available. This code should only be used when there is no specific procedure or service code that accurately describes the service provided.

2. Official Description

The official description of CPT code 90999 is an unlisted dialysis procedure, whether performed in an inpatient or outpatient setting. There are no additional notes or guidelines provided for this code.

3. Procedure

  1. When performing a dialysis procedure that does not have a specific code, the provider should use CPT code 90999.
  2. It is important to document the details of the procedure, including the specific steps taken and any unique aspects of the service provided.
  3. Submit a cover letter along with the claim, explaining the reason for choosing the unlisted code instead of a defined, active code.
  4. Include one or more similar codes and compare the service to those codes to justify the claim amount being billed.
  5. Attach any relevant documentation, such as operative notes, to support the claim and avoid possible denial.

4. Qualifying circumstances

CPT code 90999 can be used when the provider performs a dialysis service or procedure that does not have a specific code assigned to it. This may occur when the service provided is unique or does not fit into any existing code. It is important to ensure that there is no other specific code available before using CPT 90999.

5. When to use CPT code 90999

CPT code 90999 should be used when there is no specific code available to accurately describe the dialysis service or procedure performed. It is important to follow the CPT guidelines and not choose a code that merely approximates the service provided. If a Category III code is available for the procedure, it should be used instead of an unlisted procedure code.

6. Documentation requirements

To support a claim for CPT code 90999, the provider must ensure that the following documentation is included:

  • A cover letter explaining the reason for choosing the unlisted code instead of a defined, active code
  • Comparison to one or more similar codes to justify the claim amount being billed
  • Relevant documentation, such as operative notes or other supporting documents

7. Billing guidelines

When billing for CPT code 90999, it is important to follow the billing guidelines and ensure that the service provided meets the criteria for using this code. The provider should not report CPT 90999 if there is a specific code available that accurately describes the service. It is also recommended to include a cover letter and relevant documentation to support the claim and avoid possible denial.

8. Historical information

CPT code 90999 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.

9. Examples

  1. A provider performs a unique dialysis procedure that does not have a specific code assigned to it.
  2. A patient requires a specialized dialysis procedure that is not covered by any existing codes.
  3. A provider performs a dialysis procedure that is a combination of multiple existing codes, requiring the use of CPT 90999.
  4. A patient undergoes a dialysis procedure that is not accurately described by any available codes, necessitating the use of CPT 90999.
  5. A provider performs a dialysis procedure that is not represented by any of the standard and active CPT codes, requiring the use of CPT 90999.
  6. A patient requires a dialysis procedure that is unique and does not fit into any existing code categories.
  7. A provider performs a dialysis procedure that is not covered by any specific codes, necessitating the use of CPT 90999.
  8. A patient undergoes a dialysis procedure that is not accurately captured by any available codes, requiring the use of CPT 90999.
  9. A provider performs a dialysis procedure that is not adequately described by any existing codes, necessitating the use of CPT 90999.
  10. A patient requires a specialized dialysis procedure that is not represented by any specific codes, requiring the use of CPT 90999.

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