Lori
Well-known member
Good Morning Coders!
What are you coding today?
CPT codes 99429 (unlisted preventive medicine service) and 99499 (unlisted evaluation and management service) sometimes require an approved Treatment Authorization Request (TAR) in order for these codes to be reimbursed depending on the payer.
99499 (unlisted service) must be used only in the rare circumstance where the visit does not reflect even the lowest level of E/M service in an applicable code family yet still evidences medical necessity. Supporting documentation must be provided to help a payer determine a payment amount.
When you report a CPT® “unlisted procedure” code, or one of the new technology (Category III) codes, you may be required to enclose a special report with your claim.
The CPT® codebook provides instruction regarding special reports in the Radiology Guidelines, which specify, “A service that is rarely provided, unusual, variable, or new may require a special report. Pertinent information should include an adequate definition or description of the nature extent, and need for the procedure; and the time effort, and equipment necessary to provide the service.”
What is included in a special report?
Pertinent information should include an adequate definition or description of the nature extent, and need for the procedure; and the time effort, and equipment necessary to provide the service.” The special report should also provide information about the time, effort, and equipment necessary to provide the service.
Additional information that may be helpful to the carrier includes: The complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures performed, concurrent problems, and planned follow-up care. This data gives the payer a better understanding of what the procedure is, what was required to perform it, and how it should be reimbursed.
What are you coding today?
CPT codes 99429 (unlisted preventive medicine service) and 99499 (unlisted evaluation and management service) sometimes require an approved Treatment Authorization Request (TAR) in order for these codes to be reimbursed depending on the payer.
99499 (unlisted service) must be used only in the rare circumstance where the visit does not reflect even the lowest level of E/M service in an applicable code family yet still evidences medical necessity. Supporting documentation must be provided to help a payer determine a payment amount.
When you report a CPT® “unlisted procedure” code, or one of the new technology (Category III) codes, you may be required to enclose a special report with your claim.
The CPT® codebook provides instruction regarding special reports in the Radiology Guidelines, which specify, “A service that is rarely provided, unusual, variable, or new may require a special report. Pertinent information should include an adequate definition or description of the nature extent, and need for the procedure; and the time effort, and equipment necessary to provide the service.”
What is included in a special report?
Pertinent information should include an adequate definition or description of the nature extent, and need for the procedure; and the time effort, and equipment necessary to provide the service.” The special report should also provide information about the time, effort, and equipment necessary to provide the service.
Additional information that may be helpful to the carrier includes: The complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures performed, concurrent problems, and planned follow-up care. This data gives the payer a better understanding of what the procedure is, what was required to perform it, and how it should be reimbursed.