2025 CPT code 49999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Unlisted Procedures Digestive System Feed
Unlisted procedure on the abdomen, peritoneum, and omentum.
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.
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.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The RVUs for 49999 will vary significantly depending on the complexity of the procedure performed.Detailed documentation is required for accurate valuation and reimbursement.Consult your specific payer's guidelines for more precise information.
- Global Days: The global period will depend on the specific procedure performed and should be determined based on the complexity of the surgery and associated postoperative care.Consult your payer's guidelines for clarification.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier depends on the specifics of the procedure and may not be applicable.Consult the CPT guidelines and payer specific requirements.
- Fee Schedule: Historical fee schedule data for CPT code 49999 is unavailable due to the nature of the code as an unlisted procedure. Reimbursement is determined on a case-by-case basis based on the documentation submitted.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center