CPT code 91299 is an unlisted diagnostic gastrointestinal procedure used when no specific code exists for a particular service.
CPT code 91299 is used to classify an unlisted diagnostic gastrointestinal procedure. This code is applied when a specific gastrointestinal procedure is performed that does not have a designated CPT code. It allows healthcare providers to report and bill for unique or experimental procedures that fall outside the established coding system, ensuring that they can still receive reimbursement for services rendered.
For CPT code 91299 (Unlisted diagnostic gastrointestinal procedure), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used when an E/M service is performed on the same day as the procedure.
3. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by a different provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed during the postoperative period.
10. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the performed procedure, ensuring accurate billing and reimbursement.
CPT code 91299 is not typically reimbursed by Medicare. As an unlisted procedure code, it is not included in the Medicare Physician Fee Schedule (MPFS). Healthcare providers should consult their local Medicare Administrative Contractor (MAC) for specific guidance on billing and potential reimbursement for this code. In most cases, MACs require additional documentation and may review claims with unlisted codes on a case-by-case basis.
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