How To Use CPT Code 95999

CPT 95999 describes a specific type of neurological or neuromuscular diagnostic 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 95999?

CPT 95999 can be used to report neurological or neuromuscular diagnostic procedures that do not have a specific code. This code is used when the provider performs a diagnostic procedure that is not represented by any of the standard and active CPT codes available. It is important to note that CPT guidelines instruct against choosing a code that only approximates the service provided. Instead, the appropriate unlisted procedure code should be used if no specific procedure or service code exists.

2. Official Description

The official description of CPT code 95999 is: ‘Unlisted neurological or neuromuscular diagnostic procedure.’

3. Procedure

1. When performing a neurological or neuromuscular diagnostic procedure that does not have a specific code, the provider should use CPT code 95999.
2. It is important to document the procedure in detail, including the specific steps taken and any relevant findings.
3. Submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes and compare the service to those codes to justify the claim amount being billed.
4. Include the operative notes or other relevant documentation to strengthen the claim and avoid a possible denial.

4. Qualifying circumstances

CPT 95999 can be used when the provider performs a neurological or neuromuscular diagnostic 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 code that accurately describes the procedure being performed.

5. When to use CPT code 95999

CPT code 95999 should be used when there is no specific code available to accurately describe a neurological or neuromuscular diagnostic procedure. It is important to follow CPT guidelines and not choose a code that only approximates the service provided. Instead, the appropriate unlisted procedure code should be used.

6. Documentation requirements

To support a claim for CPT 95999, the provider must document the following information:

• A detailed description of the neurological or neuromuscular diagnostic procedure performed
• Explanation of why there is no specific code available to accurately describe the procedure
• Comparison to one or more similar codes to justify the claim amount being billed
• Inclusion of operative notes or other relevant documentation to strengthen the claim

7. Billing guidelines

When billing for CPT 95999, it is important to follow the appropriate billing guidelines. Submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes and compare the service to those codes to justify the claim amount being billed. Additionally, include the 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 95999 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 unique neurological diagnostic procedure to assess a patient’s nerve function.
2. A provider conducts a specialized neuromuscular diagnostic procedure to evaluate muscle strength and coordination in a patient.
3. A provider performs a complex neurological diagnostic procedure to assess a patient’s brain activity and function.
4. A provider conducts an innovative neuromuscular diagnostic procedure to evaluate nerve conduction in a patient.
5. A provider performs an advanced neurological diagnostic procedure to assess a patient’s spinal cord function.
6. A provider conducts a cutting-edge neuromuscular diagnostic procedure to evaluate muscle response to stimulation in a patient.
7. A provider performs a sophisticated neurological diagnostic procedure to assess a patient’s sensory perception and processing.
8. A provider conducts an intricate neuromuscular diagnostic procedure to evaluate muscle tone and reflexes in a patient.
9. A provider performs a specialized neurological diagnostic procedure to assess a patient’s autonomic nervous system function.
10. A provider conducts an innovative neuromuscular diagnostic procedure to evaluate muscle biopsy samples in a patient.