In the medical billing and coding world, there are certain procedures that don’t have a defined CPT code attached to them. For the above scenarios, practitioners bill CPT Code 64999. This code represents “Unlisted procedure, nervous system.” It is applied when a physician does some sort of work on the nerve that doesn’t fall into any other CPT code.
However, since CPT code 64999 is an “unlisted procedure,” it requires precise documentation, proper billing and well-executed negotiations with insurance companies. This guide will teach you when to use CPT 64999, how to document for it correctly, and how not to get burned (both by lost revenue and an audit).
What is CPT Code 64999?
As the code says you “cannot unbundle” (take apart) these services for separate billing.CPT code 64999 is in the Current Procedural Terminology Codes (CPT) system written and maintained by the American Medical Association. It operates as an open code in which providers can report new or rare nerve procedures.
With new medical technology comes innovation to help alleviate or control pain, such as nerve ablation and stimulation for which an exact code does not yet exist. For those types of situations, 64999 is that bridge. It serves as a “placeholder” until the development of a permanent CPT code.
Simply put, this code helps doctors get reimbursed when the procedures are real, necessary and beneficial to patients but not yet listed in the CPT manual.
When to Use CPT Code 64999?
CPT 64999 is appropriate when:
- It’s a procedure that includes the central nervous system, and there is no other CPT code like it.
- You do an nerve surgery that is new, or experimental.
- The technology you use is special or advanced and doesn’t have tf-code yet.
- The service is like another procedure code but has some very big differences.
Some examples include:
- Peripheral nerve stimulation for a new found nerve.
- A new way to destroy nerves for chronic pain.
- An innovative neuromodulation approach with a novel controller.
If there is already a good code for your process, you’d rather use it. CPT 64999 is to be used only when absolutely necessary.
How to Code for Description of CPT 64999
As CPT 64999 is an unlisted procedure, documentation takes the forefront in importance. So the point is insurance companies can’t automatically process or price this code in any easy way, and they rely on your documentation to know what was performed.
It is important to always provide the following when submitting CPT 64999:
There should be detailed description of the procedure- You must describe what was really done step-by-step.
- Location – Identify the anatomical site, that is to say nerve or body part.
- Apparatus/Technology – Identify any instruments, devices, or systems used.
- Indication for the procedure – Describe what you are treating and why this procedure is appropriate.
- Reference CPT code – Recommend an existing comparable coding to assist the payer in determining payment.
- Rationale – Provide a clear explanation why there is no other CPT code that applies.
Submitting this level of information assists the insurance company in understanding medical necessity, approving faster and processing your claim sooner.
Coding Changes and General Guidelines for CPT 64999
There are some additional steps that need to be taken to use CPT 64999 properly. Here are a few useful tips on billing:
- Always preauthorize -Since this code is unlisted, payers will usually require authorization before you do the procedure.
- Attach supporting material – Surgery note and manufacturer information on new devices or medical literature.
- Put to a comparison code — that tells a price and time story. For instance, if you’re procedure is like a CPT 64555 then annotate that.
- Verify coding accuracy twice – Confirm your staff are keying the correct provider, place of service and add modifiers where applicable.
- Be prepared for manual review – A number of payers report reviewing CPT 64999 claims manually, meaning the process will be slower.
- Pursue denials – If you are denied one of these claims, you can always refile with additional documentation and a detailed letter of why the denied item is service-connected.
Solid documentation and swift communication can mean the difference between getting paid and being denied.
Common Mistakes to Avoid
Generally, providers faced rejections in claims on the use of unlisted codes. Avoid these common mistakes:
- Billing CPT 64999 where a code already exists.
- Submitting claims without enough detail.
- Compare code or explanation not attached.
- Ignoring prior authorization requirements.
- Given that all insurers handle unlisted codes similarly.
Each company has its own rules. Be sure to always review the payer’s policy against unlisted procedures prior to submitting a claim.
The way Insurance Carriers Pay CPT 64999
Claims filed for CPT code 64999 are under constant scrutiny of insurance companies and manually reviewed. Because it’s not a procedure coded in the same manner, payers will have to manually validate the service, review documentation and figure out payment based on other procedures that are similar.
This procedure may last even more than under normal conditions, and payment postponements are quite usual. But such long delays can be minimized by clear and complete documentation.
To increase your likelihood of getting repaid:
- Include the OR report or full procedure note.
- Add published evidence or clinical data, if there is new technique.
- Make medical necessity and results crystal clear.
Real-Life Example
It would be like watching a pain specialist do genicular nerve branch peripheral NRV stimulation for knee pain. As we have no CPT code for this specific nerve, the based upon the above documentation that includes implantation of the lead through the sacrum into the dorsal splanchnic nerve and there is a code available for a peripheral neurostimulator, then an unlisted procedure code is reported.
Here’s what they file with the claim:
- The operative note for the procedure in its entirety.
- Device information and FDA approval papers.
- A parallel code (such as CPT 64555 for peripheral nerve stimulation).
- A brief letter giving the reasons why theses codes do not apply.
This nitty-gritty information assists the insurer as well…. knowing what the hell you’re doing and then paying appropriately.
Best Practices for Providers
- Before using unlisted codes, refer to payer guidelines.
- Maintain a code of frequently used comparison codes.
- Then, next up: Comprehensively educate your billing staff on when and when not to report CPT 64999.
- Keep the channels of communication open with payers on new technologies and coverage policies.
- Keep all documents for compliance and audit purposes.
By getting ahead of things, you can minimize denials and improve cash flow and remain compliant with payer policies.
Key Takeaways
- For unlisted nervous system procedures, CPT code 64999 is utilized.
- You should only use it when there is no specific CPT code.
- The more detailed the documentation and comparison code, the better.
- It makes more likely you that are approved (if you can contact your insurance rep).
- You should expect a manual review and maybe some delay, but good documentation helps.
Conclusion
CPT 64999 is one of the work horses in reporting novel or rare nerve surgeries. It allows health care providers to bill for valuable services even when a particular CPT code isn’t on the books yet.
For best use of this code, provide extensive documentation, clear explanation for your rationale and engage in open dialogue with payers. Used appropriately, CPT 64999 allows practices to maintain compliance, get paid correctly and remain at the forefront of providing complex care to their patients.
