How To Use CPT Code 96999

CPT 96999 describes an unlisted special dermatological service or procedure that is not represented by any specific code in the integumentary system. 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 96999?

CPT 96999 is used to report procedures in the integumentary system that do not have a specific code. It is used when the provider performs a procedure that is not represented by any of the standard and active CPT codes available for dermatological services. 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 96999 is: ‘Unlisted special dermatological service or procedure.’

3. Procedure

1. The provider performs a procedure on the integumentary system that does not have a specific code available.
2. The procedure is not represented by any of the standard and active CPT codes for dermatological services.
3. CPT code 96999 is used to report the unlisted procedure or service.

4. Qualifying circumstances

CPT 96999 should only be used when there is no specific code available that accurately describes the procedure or service performed on the integumentary system. It is important to note that this code should not be chosen if there is a code that approximates the service provided. The provider must justify the use of CPT 96999 by explaining why there is no specific code available and how the service differs from any similar codes that may exist.

5. When to use CPT code 96999

CPT code 96999 should be used when there is no specific code available that accurately describes the procedure or service performed on the integumentary system. It should not be used if there is a code that approximates the service provided. It is important to thoroughly review the available codes and determine if there is a more specific code that can be used before resorting to CPT 96999.

6. Documentation requirements

To support a claim for CPT 96999, the provider must include a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The cover letter should include one or more similar codes and compare the service to those codes to justify the claim amount being billed. Additionally, the provider should 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.

7. Billing guidelines

When billing for CPT 96999, it is important to follow the specific guidelines set by the payer. The provider should ensure that there is no specific code available that accurately describes the procedure or service performed. If a Category III code is available, it should be reported instead of CPT 96999. The provider should include a cover letter explaining the reason for choosing the unlisted code and provide supporting documentation to justify the claim amount being billed.

8. Historical information

CPT 96999 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 specialized dermatological procedure on a patient’s scalp that does not have a specific code available.
2. A provider performs a unique dermatological service on a patient’s face that is not represented by any other specific code.
3. A provider performs a specialized procedure on a patient’s skin that is not accurately described by any other available code.
4. A provider performs a special dermatological service on a patient’s back that does not have a specific code available.
5. A provider performs a procedure on a patient’s skin that is not adequately represented by any other available code.
6. A provider performs a specialized dermatological service on a patient’s arm that does not have a specific code available.
7. A provider performs a unique procedure on a patient’s leg that is not accurately described by any other available code.
8. A provider performs a specialized dermatological service on a patient’s chest that does not have a specific code available.
9. A provider performs a specialized procedure on a patient’s neck that is not represented by any other specific code.
10. A provider performs a unique dermatological service on a patient’s hand that is not accurately described by any other available code.