2025 CPT code 93799
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Medicine Services and Procedures - Other Cardiovascular Procedures Cardiovascular Procedures Feed
Unlisted cardiovascular service or procedure.
Modifiers can be used with 93799 to provide further details about the service (e.g., modifier 22 for increased procedural services, modifier 59 for distinct procedural services).Appropriate modifier usage depends on the specific procedure.
Medical necessity for 93799 is determined on a case-by-case basis, requiring robust documentation demonstrating that the procedure was medically necessary, appropriate, and not redundant with other services.The documentation must justify the service and explain why standard codes were not used.
The provider performing the unlisted cardiovascular service or procedure is responsible for accurately documenting the procedure, comparing it to similar existing codes to justify the service, and providing supporting documentation to the payer for reimbursement consideration.
In simple words: This code is used when a doctor performs a heart or blood vessel procedure that doesn't have a specific billing code.The doctor needs to explain the procedure in detail on the bill to get paid.
CPT code 93799 is utilized for new, unusual, or unique cardiovascular services or procedures lacking a specific assigned CPT code.It serves as a catch-all for procedures not otherwise classifiable within the existing CPT code set.When using this code, detailed documentation outlining the procedure, including its rationale, comparison to similar existing codes, and justification for billing, must be submitted to ensure proper reimbursement. This documentation should be comprehensive enough to allow payers to assess medical necessity and appropriate payment.
Example 1: A cardiologist performs a novel ablation technique not yet included in the CPT code set.Detailed operative notes, including diagrams, and a rationale explaining why existing codes are insufficient are submitted with the claim., A surgeon implants a new type of cardiovascular stent not yet covered by a specific code.Comprehensive documentation on the stent's characteristics, the procedure's complexity, and justification for using 93799 are provided., A physician performs a complex diagnostic procedure involving a combination of techniques not captured by existing CPT codes, which requires extensive post-procedural analysis.The procedure and findings are comprehensively documented for billing and reimbursement purposes.The physician compares this to existing procedures and explains the differences and complexity.
* Detailed operative notes describing the procedure.* Justification for using 93799, citing the absence of a more specific code.* Comparison to similar, existing CPT codes to justify the billing amount.* Supporting documentation, such as images, lab results, and patient records.* Complete explanation of the work performed, time taken, and complexity of the procedure.
** Accurate coding and reimbursement for 93799 heavily rely on complete and detailed documentation supporting medical necessity and justifying the use of this unlisted code.Always consult payer-specific guidelines and local coverage determinations.
- Revenue Code: T2D (OTHER TESTS - OTHER)
- RVU: Relative Value Units (RVUs) for CPT code 93799 vary significantly depending on the specific procedure performed, geographic location, and payer.Detailed documentation is crucial for accurate RVU assignment and reimbursement.
- Global Days: The global period for 93799 is dependent on the specific procedure performed and is not consistently defined.Documentation must clarify the extent of the service(s) provided to determine the appropriate global period.
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier may apply depending on the specific services involved.Consider the context of the procedure and payer guidelines.
- Fee Schedule: Historical fee schedules for 93799 are not consistently documented due to the nature of the code as an unlisted procedure.Reimbursement is highly dependent on payer policies and provided documentation.
- Specialties:Cardiology, Cardiovascular Surgery, Interventional Cardiology
- Place of Service:The place of service is dependent on where the procedure is performed (e.g., Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center).This information should be explicitly documented.