Be Wary of Using Unlisted CPT® Codes
Question: I’m an auditor and found a claim with 99499 billed and denied. Is there a situation in which it would be appropriate to report 99499 — and is it ever paid? Florida Subscriber Answer: CPT® code 99499 (Unlisted evaluation and management service) exists because it is sometimes appropriate to use. However, there are so many CPT® codes for so many situations that reporting an unlisted code, which offers little or no information regarding the service provided, is almost sure to raise eyebrows: Payers may be skeptical that there isn’t a code that specifically describes the situation or encounter you’re trying to report. That being said, there are situations where reporting 99499 can be appropriate, but you need to make sure you’re providing a lot of evidence to support the selection of such a code. This may include the time spent on the procedure, the complexity, and an explanation of why a more specific CPT® code isn’t applicable or appropriate. It’s also important to check with the respective payer, as some payers have policies that include paying for unlisted services as long as medical necessity and documentation are supportive. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC 
