Wiki 99499 CPT code

[sarah_willham@yahoo.com]

Can someone give me their interpretation of this code? I am seeing it billed and then nothing in the record to indicate an unlisted E/M service…..

I then was asked about this code in regards to submitting it on a claim when the 12 dx codes are already filled to show additional codes were needed….. can someone provide me some clarification? The book doesn’t have any guidance……

 

[catherinetinkey@entmedicalservices.org]

Not sure what an "unlisted E/M' is used for, but any unlisted code you need to have a description and it would also have to have a documentation note for the visit. Most insurance will not reimburse for an unlisted code without a description.

 

[sarah_willham@yahoo.com]

They are saying it is used when you need to add additional codes to a claim…… I’m trying to find out where I can find the guidance that states that….. typically you can only add 12 dx codes to a claim…. I’ve never heard that 99499 is used to indicate more than 12 codes are needed on a claim…… there really isn’t any kind of guidance in the book for that code. I reached out to a colleague and she stated they use that code in surgery situations where the service provided, there is no code that matches so they use the 99499 and additionally a code that best represents the service provided along with additional documentation indicating why it was coded….. any help is greatly appreciated!

 

[TThivierge]

Hi
Any unlisted CPT code used will not be paid.Just passing this on....Lady T

 

[amyjph]

There is a very rare use for it.
Example: https://med.noridianmedicare.com/web/jeb/specialties/em/unlisted-em-service-cpt-code-99499 https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00100354

What you are talking about is when it is being used as a placeholder due to the diagnosis over 12 issue. There are times I have seen this. It is health plan specific and shouldn't be done unless they specifically tell you to do it.
Example: https://www.premera.com/documents/058270.pdf https://www.aetna.com/health-care-p...rt-and-the-importance-of-accurate-coding.html