How To Use CPT Code 99505

CPT 99505 describes the home visit services provided by a healthcare provider for stoma care and maintenance, specifically for patients with colostomy and cystostomy. 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 99505?

CPT 99505 can be used to describe the home visit services provided by a healthcare provider to evaluate a patient’s stoma and assess their ability, or that of their caregiver, to perform routine home stoma care and maintenance. This code is specifically used for patients with colostomy and cystostomy, which are surgical procedures that create passages from the large intestine or bladder to the external surface of the abdomen, respectively.

2. Official Description

The official description of CPT code 99505 is: ‘Home visit for stoma care and maintenance including colostomy and cystostomy.’

3. Procedure

1. A healthcare provider makes a home visit to a patient with a stoma, which is an artificial opening in the abdomen for the passage of stool or urine.
2. The provider evaluates the patient’s stoma and assesses their ability, or that of their caregiver, to perform routine home stoma care and maintenance.
3. During the visit, the provider may provide instructions on how to properly care for and maintain the stoma, including cleaning techniques, changing the stoma bag, and managing any complications or issues that may arise.
4. The provider may also assess the patient’s overall well-being and address any concerns or questions they may have regarding their stoma.
5. Additional visits may be scheduled as needed to ensure the patient’s stoma is properly cared for and maintained.

4. Qualifying circumstances

CPT 99505 is used for patients who have undergone colostomy or cystostomy procedures and require home stoma care and maintenance. Colostomy is a surgical procedure that creates a passage from the large intestine to the external surface of the abdomen, diverting waste through a stoma into a bag worn externally. Cystostomy, on the other hand, creates a passage from the bladder to the external surface of the abdomen, diverting urine through a stoma into a bag worn externally. The home visit is conducted by a healthcare provider to evaluate the patient’s stoma and assess their ability, or that of their caregiver, to perform routine stoma care and maintenance.

5. When to use CPT code 99505

CPT code 99505 should be used when a healthcare provider makes a home visit to a patient with a stoma, specifically for colostomy and cystostomy care and maintenance. This code is appropriate when the provider evaluates the patient’s stoma and assesses their ability, or that of their caregiver, to perform routine home stoma care and maintenance. It is important to note that this code is specific to home visits and should not be used for other types of visits or procedures.

6. Documentation requirements

To support a claim for CPT 99505, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the presence of a colostomy or cystostomy
• Evaluation of the patient’s stoma and assessment of their ability, or that of their caregiver, to perform routine home stoma care and maintenance
• Date and duration of the home visit
• Details of the stoma care and maintenance instructions provided
• Any complications or issues addressed during the visit
• Signature of the healthcare provider conducting the home visit

7. Billing guidelines

When billing for CPT 99505, ensure that the service provided is a home visit for stoma care and maintenance, specifically for patients with colostomy and cystostomy. It is important to accurately document the details of the visit and the services provided. CPT code 99505 should not be reported with other codes unless there are separate and distinct services performed during the same visit. It is also important to follow any specific billing guidelines provided by the payer or insurance company.

8. Historical information

CPT 99505 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider makes a home visit to a patient with a colostomy to evaluate the stoma and assess the patient’s ability to perform routine stoma care and maintenance.
2. A nurse visits a patient with a cystostomy in their home to provide instructions on how to properly care for and maintain the stoma.
3. A healthcare provider conducts a home visit to a patient with a colostomy to address any complications or issues related to the stoma.
4. A caregiver accompanies a healthcare provider during a home visit to learn how to perform routine stoma care and maintenance for a patient with a colostomy.
5. A nurse makes a home visit to a patient with a cystostomy to assess their overall well-being and provide support and guidance regarding stoma care.
6. A healthcare provider conducts a home visit to a patient with a colostomy to schedule additional visits for ongoing stoma care and maintenance.
7. A nurse visits a patient with a cystostomy in their home to demonstrate proper techniques for changing the stoma bag.
8. A healthcare provider makes a home visit to a patient with a colostomy to provide instructions on managing and preventing stoma-related infections.
9. A caregiver accompanies a healthcare provider during a home visit to learn how to troubleshoot common issues with a patient’s cystostomy.