How To Use CPT Code 93998

CPT 93998 describes a noninvasive vascular diagnostic study 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 93998?

CPT 93998 can be used to report noninvasive vascular diagnostic procedures or services that do not have a specific code. This code is used when a provider performs a new, rare, or unusual noninvasive vascular procedure or service that is not represented by any of the standard and active CPT codes available.

2. Official Description

The official description of CPT code 93998 is: ‘Unlisted noninvasive vascular diagnostic study.’

3. Procedure

  1. The provider performs a noninvasive vascular diagnostic procedure or service that does not have a specific code.
  2. This procedure or service may be new, rare, or unusual, and is not represented by any of the standard and active CPT codes available.
  3. The provider may use CPT code 93998 to report this noninvasive vascular diagnostic study.

4. Qualifying circumstances

CPT 93998 is used when a provider performs a noninvasive vascular diagnostic procedure or service that is not represented by any of the standard and active CPT codes available. This may occur when the procedure or service is new, rare, or unusual, and there is no specific code that accurately describes it. An example of when CPT 93998 may be used is when a provider performs a noninvasive vascular test without an ankle-brachial index (ABI), which is required for other specific codes such as CPT 93922, 93923, and 93924.

5. When to use CPT code 93998

CPT code 93998 should be used when there is no specific code available to accurately describe a noninvasive vascular diagnostic procedure or service. It is important to note that CPT guidelines instruct providers not to choose a code that merely approximates the service provided. If no specific procedure or service code exists, the appropriate course of action is to report the service using CPT code 93998.

6. Documentation requirements

To support a claim for CPT code 93998, providers must include the following documentation:

  • A cover letter explaining the reason for choosing the unlisted code instead of a defined, active code
  • One or more similar codes to compare the service to
  • Operative notes or other relevant documentation to strengthen the claim and avoid a possible denial

7. Billing guidelines

When billing for CPT code 93998, providers should submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. It is important to include one or more similar codes and compare the service to those codes to justify the claim amount being billed. Additionally, providers should include 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 code 93998 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

  1. A provider performs a noninvasive vascular diagnostic study that does not have a specific code, such as a rare or unusual procedure.
  2. A provider performs a noninvasive vascular test without an ankle-brachial index (ABI), which is required for other specific codes.
  3. A provider performs a new noninvasive vascular procedure or service that is not represented by any of the standard and active CPT codes available.
  4. A provider performs a noninvasive vascular diagnostic study that is not accurately described by any of the existing codes.
  5. A provider performs a noninvasive vascular procedure or service that is unique and does not have a specific code.
  6. A provider performs a noninvasive vascular test without the need for an ankle-brachial index (ABI), which is required for other specific codes.
  7. A provider performs a noninvasive vascular diagnostic study that is not adequately captured by any of the standard and active CPT codes available.
  8. A provider performs a noninvasive vascular procedure or service that is uncommon and does not have a specific code.
  9. A provider performs a noninvasive vascular test without an ankle-brachial index (ABI), which is necessary for other specific codes.
  10. A provider performs a noninvasive vascular diagnostic study that is not accurately represented by any of the existing codes.

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