2025 CPT code 69399
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Auditory System Surgery Feed
Unlisted procedure on the external ear.
Modifiers may be applicable depending on the specifics of the procedure, including modifiers for multiple procedures (51), discontinued procedures (53), assistant surgeon (80, 81, 82), and others.
Medical necessity must be clearly established through supporting documentation, outlining the diagnosis, treatment plan, and the rationale for the chosen procedure.The documentation should demonstrate that the procedure is appropriate and necessary for the patient's condition.
The physician or other qualified healthcare professional performs the unlisted procedure on the external ear.Detailed documentation of the procedure is crucial for accurate coding and reimbursement.
In simple words: This code is for procedures on the outer ear that don't have a specific billing code.Your doctor will need to explain why they used this code and provide detailed medical records to support the billing.
CPT code 69399, "Unlisted procedure, external ear," is used to report procedures on the external ear that do not have a specific CPT code.This code requires detailed documentation justifying its use, including a comparison to similar coded procedures and a rationale for why no other code is appropriate.The documentation should also include operative notes or other relevant clinical information to support medical necessity and the billed amount.
Example 1: Reconstruction of a significant auricular defect due to trauma requiring complex tissue rearrangement and grafting techniques not specifically addressed by other CPT codes., Repair of a rare congenital malformation of the external ear requiring a novel surgical technique., Excision of an unusual benign tumor of the external ear with reconstruction using a specialized flap not explicitly covered by other codes.
* Detailed operative report describing the procedure performed.* Preoperative and postoperative photographs of the affected area.* Justification for using 69399, including comparison to similar coded procedures and explanation of why no other code is suitable.* Documentation supporting medical necessity.
** When using 69399, submit a cover letter clearly explaining the procedure and justification for using the unlisted code.Include details of similar codes, demonstrating why this code is necessary, and all relevant supporting clinical documentation.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: No RVUs are assigned to unlisted codes.Payment is determined on a case-by-case basis based on the provided documentation.
- Global Days: The global period will vary depending on the specific procedure performed.This should be clarified in the supporting documentation.
- Payment Status: Active, but payment is case-by-case based on documentation.
- Modifier TC rule: The applicability of the TC modifier depends on the nature of the procedure.If the procedure is split into professional and technical components, then a TC modifier may be appropriate.
- Fee Schedule: Fee schedules vary by payer and are not fixed for unlisted codes. Reimbursement depends on the detailed documentation supporting the medical necessity and complexity of the procedure.
- Specialties:Otolaryngology, Plastic Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center