How To Use CPT Code 99199

CPT 99199 is an unlisted special service, procedure, or report code used when no specific code is available for a medicine service or procedure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 99199 procedures.

1. What is CPT 99199?

CPT 99199 is an unlisted special service, procedure, or report code that is used when there is no specific code available for a medicine service or procedure. Medical coders and billers use this code to report other medicine services or procedures that are not represented by any of the standard and active CPT codes available. It is essential to consult the provider, if possible, to ensure that proper documentation has been done before billing for an unlisted procedure.

2. 99199 CPT code description

The official description of CPT code 99199 is: “Unlisted special service, procedure or report.”

3. Procedure

As CPT 99199 is an unlisted code, there is no specific step-by-step procedure associated with it. Instead, it is used to report a wide range of medicine services or procedures that do not have a specific CPT code. The provider must document the service or procedure performed in detail, including the steps involved, to support the claim for CPT 99199.

4. Qualifying circumstances

Eligibility for CPT code 99199 services depends on the specific medicine service or procedure performed. The provider must ensure that the service or procedure is medically necessary and not represented by any of the standard and active CPT codes available. Additionally, the provider should consult with the payer to determine if the service or procedure is covered under the patient’s insurance plan.

5. When to use CPT code 99199

CPT code 99199 should be used when the provider performs a medicine service or procedure that is not represented by any of the standard and active CPT codes available. It is essential to ensure that proper documentation has been done before billing for an unlisted procedure. CPT guidelines instruct that you should not choose a code that merely approximates the service provided. You should report the service using only the appropriate unlisted procedure code if no such specific procedure or service code exists.

6. Documentation requirements

When reporting a procedure with CPT 99199, it is crucial to 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 your service to those codes to justify the claim amount you are billing. Also, include the operative notes and/or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case-by-case basis, and they will determine payment based on the documentation you provide.

7. Billing guidelines

When billing for CPT code 99199, follow these guidelines:

• Do not choose a code that merely approximates the service provided.
• Report the service using only the appropriate unlisted procedure code if no specific procedure or service code exists.
• Report a Category III code when available in place of an unlisted procedure code.
• 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 your service to those codes to justify the claim amount you are billing.
• Include the operative notes and/or other relevant documentation to strengthen the claim and to avoid a possible denial.

8. Historical information

CPT 99199 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 99199

While there are no exact matches to CPT 99199, the following codes are similar in that they are also unlisted codes for various services and procedures:

1. CPT 99429: Unlisted preventive medicine service
2. CPT 99499: Unlisted evaluation and management service
3. CPT 96999: Unlisted special dermatological service or procedure
4. CPT 93799: Unlisted cardiovascular service or procedure
5. CPT 94799: Unlisted pulmonary service or procedure

10. Examples

Here are ten detailed examples of CPT code 99199 procedures:

1. A provider performs a specialized diagnostic test for a rare disease that does not have a specific CPT code.
2. A physician administers an experimental treatment for a chronic condition that is not represented by any of the standard and active CPT codes available.
3. A specialist conducts a unique procedure to remove a foreign body from a patient’s airway that is not covered by any existing CPT codes.
4. A provider performs a complex wound care procedure that involves multiple steps and techniques not represented by a single CPT code.
5. A physician administers a novel therapy for a neurological disorder that does not have a specific CPT code.
6. A specialist performs a unique diagnostic procedure to evaluate a patient’s cardiovascular function that is not represented by any of the standard and active CPT codes available.
7. A provider conducts a specialized genetic test for a rare inherited disorder that does not have a specific CPT code.
8. A physician performs a complex procedure to repair a congenital defect that is not covered by any existing CPT codes.
9. A specialist administers a novel treatment for a rare autoimmune disorder that does not have a specific CPT code.
10. A provider performs a unique procedure to treat a patient’s chronic pain that is not represented by any of the standard and active CPT codes available.