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2025 CPT code 49999

Unlisted procedure on the abdomen, peritoneum, and omentum.

Always ensure that no other specific CPT code accurately reflects the service provided before utilizing code 49999.Thorough and detailed documentation is essential for successful reimbursement.

Modifiers may apply depending on the circumstances of the procedure.Modifiers such as 22 (increased procedural services), 52 (reduced services), and 53 (discontinued procedure) may be considered.Refer to the CPT guidelines for specific modifier usage.

Medical necessity for code 49999 is established through thorough documentation demonstrating that the procedure performed was medically necessary and not experimental or investigational. The documentation must clearly justify why no other specific CPT code is applicable.

The physician or qualified healthcare professional performing the surgical procedure on the abdomen, peritoneum, or omentum is responsible for accurate coding and documentation.This includes justifying the use of an unlisted code and providing all supporting medical records.

IMPORTANT:Use this code only when no other CPT code accurately describes the procedure.Detailed documentation comparing the procedure to similar coded procedures is crucial for successful claim processing.

In simple words: This code is used when a doctor performs a surgery on the abdomen, the lining of the abdomen (peritoneum), or a fatty membrane in the abdomen (omentum) that doesn't have a specific code.The doctor must explain exactly what they did in detail to get paid for the surgery.

CPT code 49999 is used to report surgical procedures performed on the abdomen, peritoneum, and omentum when no other specific CPT code accurately reflects the service provided.This unlisted code necessitates detailed documentation, including a comprehensive description of the procedure, justification for using this code instead of a more specific code, and comparison to similar coded procedures.The documentation should be submitted with the claim to support medical necessity and appropriate reimbursement.

Example 1: Laparoscopic removal of an unusual peritoneal adhesion causing bowel obstruction not otherwise specified in the CPT codebook., Open surgical repair of a rare omental injury resulting from a blunt trauma, requiring extensive tissue repair., Complex surgical management of a previously unreported congenital anomaly involving the peritoneum and omentum requiring specialized surgical techniques.

* Detailed operative report describing the procedure in sufficient detail to justify the use of code 49999.* Preoperative and postoperative diagnoses.* Justification for using the unlisted code, including a comparison to similar, coded procedures.* Any other relevant documentation supporting medical necessity.

** Accurate coding and extensive documentation are paramount when using CPT code 49999. Failure to adequately justify the use of this unlisted procedure code may result in claim denial or reduced reimbursement.Always refer to the most current CPT manual and payer-specific guidelines.

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