2025 CPT code 41599
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Unlisted Procedures Surgery Feed
Unlisted procedure performed on the tongue or floor of the mouth.
Modifiers such as 22 (increased procedural services), 52 (reduced services), 53 (discontinued procedure), 59 (distinct procedural service), 62 (two surgeons), and 66 (surgical team) may be applicable depending on the specific circumstances of the procedure.Appropriate documentation is required for each modifier used.
The medical necessity should be established based on clinical findings, including but not limited to: the nature of the pathology, its location, size and extent; patient's history; clinical presentation; and the need for the specific procedure performed. It needs to be demonstrated that the chosen procedure is appropriate and necessary for the patient's condition.
The provider performs a procedure on the tongue or floor of the mouth not represented by an existing CPT code.Pre-authorization with the payer is recommended.
In simple words: This code is used when a doctor performs a procedure on the tongue or the floor of the mouth that doesn't have its own specific billing code.The doctor needs to provide detailed notes explaining what they did and why a special code is needed to get paid for the work.
This CPT code, 41599, reports procedures on the tongue or floor of the mouth lacking a specific CPT code.It's used when no other appropriate CPT code accurately reflects the service provided.Detailed documentation, including a comparison to similar coded procedures and justification for using an unlisted code, is crucial for successful reimbursement.The documentation should also include operative notes and other relevant clinical information.
Example 1: A surgeon performs a complex excision of a large, deep-seated lesion on the tongue, requiring significant hemostasis and meticulous tissue repair. This procedure is far more extensive than any other coded tongue procedure., An oral surgeon performs a unique reconstructive procedure on the floor of the mouth following a significant trauma, involving multiple tissue grafts and advanced microsurgical techniques., A physician performs a novel laser ablation of a precancerous lesion on the lateral border of the tongue using a newly-developed technique, not previously described in CPT codes.
* Detailed operative report clearly describing the procedure performed.* Justification for using an unlisted code, with comparison to similar coded procedures.* Pre-authorization from the payer (if possible).* Complete medical records supporting the medical necessity of the procedure.* Photographs or imaging (if applicable).
** Submitting a cover letter with the claim explaining the reason for using the unlisted code and comparing it to similar coded procedures can greatly improve the chance of successful reimbursement.Expect a potentially longer processing time than for standard codes.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: RVUs will vary depending on the specific procedure performed and the payer.Detailed documentation is necessary to support the billed amount.A comparison to similar, coded procedures with known RVUs may be helpful to determine an appropriate value.
- Global Days : The global period will depend entirely on the specific procedure performed.This should be specified in the documentation.
- Payment Status: Active, but reimbursement is dependent on detailed documentation and payer-specific policies.
- Modifier TC rule: Not applicable for this unlisted code.
- Fee Schedule : Fee schedules vary greatly depending on the payer and the specifics of the procedure. Historical fee schedules can vary significantly, requiring review of documentation at the time of service to establish value.
- Specialties:Oral and Maxillofacial Surgery, Otolaryngology, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)