CPT code 90399 is an unlisted code used for reporting immune globulin products that do not have a specific code assigned.
CPT code 90399 is used to represent an unlisted immune globulin. This code is utilized when a healthcare provider administers an immune globulin product that does not have a specific CPT code assigned to it. Immune globulins are antibodies used to treat various conditions, such as immune deficiencies or autoimmune disorders. Since this code is categorized as "unlisted," it requires additional documentation to describe the specific product and its use, ensuring accurate billing and reimbursement.
For CPT code 90399, "Unlisted immune globulin," the use of modifiers may be necessary to provide additional information about the service provided. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services: This modifier may be used if the service provided required significantly greater effort than typically required. Documentation must support the substantial additional work.
2. Modifier 52 - Reduced Services: If the service was partially reduced or eliminated at the discretion of the physician or healthcare provider, this modifier can be applied.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: If the same procedure is repeated on the same day by the same provider, this modifier should be used.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure is repeated on the same day by a different provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is applicable if the patient requires a return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier when a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are applicable.
It is important to ensure that the use of any modifier is supported by appropriate documentation in the patient's medical record to justify the necessity and appropriateness of the modifier.
CPT code 90399, which is categorized as an unlisted immune globulin, may be reimbursed by Medicare, but it requires careful consideration and verification. Since it is an unlisted code, it does not have a predetermined reimbursement rate on the Medicare Physician Fee Schedule (MPFS). Instead, reimbursement is determined on a case-by-case basis by the Medicare Administrative Contractor (MAC) responsible for the specific geographic region where the service is provided.
Healthcare providers must submit detailed documentation to justify the medical necessity and appropriateness of using this unlisted code. The MAC will review the submission to determine if reimbursement is warranted. Providers should consult their local MAC for specific guidance and ensure that all necessary documentation accompanies the claim to improve the likelihood of reimbursement.
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