How To Use CPT Code 99080

CPT 99080 is a code used for special reports, such as insurance forms, that require more information than standard medical communications or reporting forms. This article will cover topics such as the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99080 procedures.

1. What is CPT 99080?

CPT 99080 is a code used to report the completion of special reports or forms that require more information than what is typically conveyed in standard medical communications or reporting forms. These special reports may include insurance forms, Family and Medical Leave Act (FMLA) paperwork, or other non-standard documentation related to a patient’s medical condition and the necessity of rendered procedures.

2. 99080 CPT code description

The official description of CPT code 99080 is: “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form.”

3. Procedure

The 99080 procedure involves the following steps:

  1. Identifying the need for a special report or form that requires more information than standard medical communications or reporting forms.
  2. Obtaining the necessary information from the patient’s medical records, consultations with other healthcare providers, or additional examinations or tests.
  3. Completing the special report or form with the required information, ensuring accuracy and thoroughness.
  4. Submitting the completed special report or form to the appropriate party, such as an insurance company or employer.
  5. Retaining a copy of the completed special report or form in the patient’s medical records for future reference and potential audits.

4. Qualifying circumstances

Healthcare providers are eligible to bill for CPT code 99080 services when they complete special reports or forms that require more information than standard medical communications or reporting forms. These special reports may be related to insurance claims, FMLA paperwork, or other non-standard documentation that supports the medical necessity of rendered procedures. Providers must ensure that the completion of these special reports or forms is not already included in the descriptors of other billed services, such as work-related or medical disability evaluation services.

5. When to use CPT code 99080

It is appropriate to bill the 99080 CPT code when a healthcare provider completes a special report or form that requires more information than standard medical communications or reporting forms. Examples of when to use CPT code 99080 include:

  • Completing insurance forms that require detailed information about a patient’s medical condition and the necessity of rendered procedures.
  • Preparing FMLA paperwork that documents a patient’s medical condition and the need for time off work.
  • Completing non-standard documentation related to a patient’s medical condition for legal or regulatory purposes.

Do not use CPT code 99080 for the completion of routine forms, such as hospital discharge summaries, or in conjunction with work-related or medical disability evaluation services.

6. Documentation requirements

To support a claim for CPT 99080, healthcare providers must document the following information:

  • The specific special report or form that was completed, including its purpose and the party to whom it was submitted.
  • The additional information required for the special report or form that goes beyond standard medical communications or reporting forms.
  • The sources of the additional information, such as medical records, consultations, or additional examinations or tests.
  • A copy of the completed special report or form, retained in the patient’s medical records.

7. Billing guidelines

When billing for CPT code 99080, healthcare providers should follow these guidelines:

  • Ensure that the completion of the special report or form is not already included in the descriptors of other billed services, such as work-related or medical disability evaluation services.
  • Document the necessary information to support the claim, as outlined in the documentation requirements section.
  • Submit the claim with the appropriate modifiers, if applicable, to indicate any special circumstances related to the completion of the special report or form.

8. Historical information

CPT 99080 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 99080

Five similar codes to CPT 99080 and how they differentiate from CPT 99080 are:

  1. CPT 99070: This code is used for the provision of materials and supplies by the physician or other qualified healthcare professional over and above those usually included in the office visit or other services rendered.
  2. CPT 99075: This code is used for medical testimony provided by a healthcare provider, which is different from completing special reports or forms.
  3. CPT 99078: This code is used for group health education provided by a healthcare provider, not for completing special reports or forms.
  4. CPT 99090: This code is used for the analysis of clinical data stored in computers, not for completing special reports or forms.
  5. CPT 99091: This code is used for the collection and interpretation of physiologic data, not for completing special reports or forms.

10. Examples

Here are 10 detailed examples of CPT code 99080 procedures:

  1. A healthcare provider completes a detailed insurance form for a patient undergoing a complex surgical procedure, documenting the medical necessity of the surgery and the patient’s medical history.
  2. A healthcare provider prepares FMLA paperwork for a patient with a chronic medical condition, detailing the patient’s need for intermittent leave due to their condition.
  3. A healthcare provider completes a non-standard report for a patient involved in a legal case, providing detailed information about the patient’s injuries and treatment.
  4. A healthcare provider fills out a comprehensive insurance form for a patient receiving ongoing physical therapy, documenting the patient’s progress and the continued need for therapy.
  5. A healthcare provider prepares a detailed report for a patient’s employer, outlining the medical necessity of workplace accommodations due to the patient’s disability.
  6. A healthcare provider completes a complex insurance form for a patient receiving experimental treatment, providing information about the treatment’s potential benefits and risks.
  7. A healthcare provider prepares a non-standard report for a patient participating in a clinical trial, documenting the patient’s medical history and eligibility for the trial.
  8. A healthcare provider fills out a detailed insurance form for a patient receiving home health care services, documenting the patient’s medical condition and the need for ongoing care.
  9. A healthcare provider completes a comprehensive report for a patient’s school, outlining the medical necessity of special education services due to the patient’s medical condition.
  10. A healthcare provider prepares a detailed report for a patient’s insurance company, documenting the medical necessity of a costly diagnostic test not typically covered by insurance.

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