2025 CPT code 48999
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Unlisted procedure, pancreas.
Modifiers may be applicable depending on the specific circumstances of the procedure. Refer to CPT guidelines for modifier usage.
Medical necessity must be established through supporting documentation. The rationale for choosing an unlisted procedure code must be clearly documented, along with a comparison of the performed procedure to similar, listed procedures.
The physician is responsible for performing the unlisted procedure on the pancreas and ensuring appropriate documentation is submitted to justify the medical necessity of the procedure.
In simple words: This code represents a procedure performed on your pancreas for which there isn't a specific code.Your doctor will provide additional documentation to explain exactly what was done.
This code is used for reporting procedures performed on the pancreas that do not have a dedicated CPT code. It is essential to submit supporting documentation with the claim, including a detailed operative report, to justify the medical necessity of the procedure and the billed amount.The documentation should compare the performed procedure to similar, listed procedures to provide context for valuation.
Example 1: A patient presents with a rare pancreatic cyst that requires drainage and biopsy using a novel endoscopic technique. As no specific CPT code exists for this procedure, code 48999 is reported., A surgeon performs a complex debridement of infected pancreatic necrosis following severe pancreatitis.Because this specific procedure is not described by an existing code, 48999 is used., A patient undergoes laparoscopic removal of a benign pancreatic tumor located in the tail of the pancreas. Due to the unique surgical approach, which is not covered by other codes, 48999 would be appropriate.
A detailed operative report describing the procedure, including the approach, instruments used, and findings. Supporting documentation comparing the procedure to similar listed procedures and justifying the medical necessity. Any imaging or diagnostic reports related to the condition necessitating the procedure.
** When reporting 48999, it is crucial to provide a comprehensive description of the procedure and compare it with similar existing procedures. This helps in accurate assessment and fair reimbursement.
- Revenue Code: P1G - Major Procedure - Other
- Specialties:General Surgery, Pancreatic Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center