What is CPT® 90999?
CPT® 90999 is an unlisted procedure code used to report dialysis procedures that do not have a specific CPT code assigned. This code typically covers unique or less common dialysis treatments, including variations of hemodialysis, peritoneal dialysis, or specialized dialysis services not otherwise described in the CPT manual.
When to Use CPT® 90999
Use CPT® 90999 when:
- The dialysis procedure performed does not match any existing listed CPT codes (e.g., 90935 for hemodialysis, 90945 for peritoneal dialysis).
- The procedure involves novel techniques, customized treatment protocols, or unique equipment that distinguishes it from standard dialysis procedures.
- Detailed documentation and description of the service are necessary to support billing and reimbursement.
Examples include:
- Experimental or specialized dialysis methods
- Dialysis performed with adjunctive therapies not separately coded
- Procedures performed outside standard dialysis settings or schedules
Key Billing Information
- Because CPT® 90999 is an unlisted code, detailed documentation and a procedure description must accompany the claim to justify medical necessity and explain the service performed.
- Payors typically require additional clinical information or reports to process claims using unlisted codes.
- It is essential to communicate with insurance carriers before billing to ensure proper reimbursement and reduce claim denials.
- This code may also be used for customized billing when multiple dialysis-related services are combined or modified.
Documentation Requirements
To support billing for CPT® 90999, documentation must include:
- Thorough description of the dialysis procedure performed
- Rationale for using an unlisted code instead of a standard dialysis code
- Time spent and technical details of the dialysis treatment
- Patient’s clinical status and treatment response
- Provider signature and date of service
Why Accurate Coding Matters
Using CPT® 90999 appropriately ensures that unique dialysis services are recognized and reimbursed, avoiding inappropriate denials. Accurate and detailed documentation supports compliance with payer guidelines and facilitates transparent communication of complex procedures.
How OptiMantra Streamlines Dialysis Documentation and Billing
OptiMantra supports dialysis providers by offering:
- Customizable documentation templates
- Automated prompts to ensure complete capture of procedure details
- Integrated superbill generation and claims management to handle complex billing scenarios efficiently
- Real-time coding support and payer communication tools to reduce denials and speed reimbursement
With OptiMantra, dialysis centers can accurately document specialized treatments and navigate the challenges of unlisted procedure billing, all while focusing on delivering high-quality patient care.
Try OptiMantra for free here!
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