How To Use CPT Code 92499

CPT 92499 describes an unlisted ophthalmological service or 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 92499?

CPT 92499 is used to report ophthalmological procedures that do not have a specific code. It is used when the provider performs an ophthalmological procedure that is not represented by any of the standard and active CPT codes available. This code allows for the reporting of services that do not have a specific code assigned to them.

2. Official Description

The official description of CPT code 92499 is: ‘Unlisted ophthalmological service or procedure.’

3. Procedure

1. When performing a procedure that does not have a specific code, the provider should use CPT code 92499.
2. The provider should document the details of the procedure, including the specific service or procedure performed.
3. A cover letter should be submitted with the claim, explaining the reason for choosing the unlisted code instead of a defined, active code.
4. The cover letter should include one or more similar codes and compare the service to those codes to justify the claim amount being billed.
5. Operative notes or other relevant documentation should be included to strengthen the claim and avoid a possible denial.

4. Qualifying circumstances

CPT 92499 can be used when there is no specific code available to accurately describe the ophthalmological service or procedure performed. It is important to note that this code should only be used when there is no other appropriate code available. The provider should ensure that the service or procedure performed is truly unlisted and cannot be accurately described by any other existing code.

5. When to use CPT code 92499

CPT code 92499 should be used when there is no specific code available to accurately describe the ophthalmological service or procedure performed. It should not be used as an approximation of a specific service or procedure. If a Category III code is available that accurately describes the service or procedure, it should be used instead of CPT code 92499.

6. Documentation requirements

To support a claim for CPT code 92499, the provider must include the following documentation:

• A detailed description of the ophthalmological service or procedure performed
• A cover letter explaining the reason for choosing the unlisted code and comparing the service to similar codes
• Operative notes or other relevant documentation to strengthen the claim

7. Billing guidelines

When billing for CPT code 92499, the provider should ensure that there is no other appropriate code available to accurately describe the service or procedure performed. A cover letter should be submitted with the claim, explaining the reason for choosing the unlisted code and comparing the service to similar codes. The payer will consider the claim on a case-by-case basis and determine payment based on the documentation provided.

8. Historical information

CPT code 92499 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 complex ophthalmological procedure that does not have a specific code assigned to it.
2. An ophthalmologist performs a unique surgical procedure on a patient’s eye that is not represented by any existing codes.
3. A provider performs a specialized diagnostic test on a patient’s eyes that is not described by any available codes.
4. An ophthalmologist performs a novel treatment procedure for a rare eye condition that does not have a specific code.
5. A provider performs a non-standard ophthalmological service that is not accurately described by any existing codes.
6. An ophthalmologist performs a cutting-edge surgical procedure on a patient’s eye that is not represented by any available codes.
7. A provider performs a unique therapeutic procedure for a complex eye condition that does not have a specific code assigned to it.
8. An ophthalmologist performs an innovative diagnostic test on a patient’s eyes that is not accurately described by any existing codes.
9. A provider performs a specialized surgical procedure on a patient’s eye that is not represented by any available codes.
10. An ophthalmologist performs a novel treatment procedure for a rare eye condition that does not have a specific code assigned to it.