What is CPT code 29999?
CPT code 29999 is an unlisted procedure code used to report arthroscopic procedures that do not have a specific code in the Current Procedural Terminology (CPT) manual. This includes advanced procedures such as iliopsoas lengthening, arthroscopic graft implantation, labral repair, or work involving foreign body or loose body removal, especially in joints not yet represented by established procedure codes.
CPT 29999 requires a detailed description of the surgical procedure performed, including its complexity, medical necessity, and how it compares to similar procedures with defined CPTs. It is most often used in hip arthroscopy and musculoskeletal system cases where coding gaps exist due to evolving techniques.
Because this is an unlisted procedure, claims are subject to manual review by payers. Providers must submit documentation, such as operative reports, to support insurance coverage, particularly for procedures involving same-day surgery, arthroscopic debridement, or those related to arthritis, cartilage, or joint conditions.
Always refer to coding practices recommended by the American Medical Association and check payer guidelines to ensure correct submission and billing.
Documentation requirements
When using CPT code 29999 to report an unlisted procedure arthroscopy, healthcare providers must include comprehensive documentation to justify medical necessity and support proper billing and insurance coverage. The following components are essential:
- Detailed operative report: Include a complete detailed description of the surgical procedure performed, especially for advanced procedures like hip arthroscopy, labral repair, or foreign body removal.
- Indication and surgical technique: Clearly define the patient’s diagnosis (e.g., arthritis, joint pain, cartilage damage) and the arthroscopic method used.
- Comparison to existing CPTs: If possible, compare the unlisted procedure to a specific code to help insurance carriers assess reimbursement and medical review.
- Implants or tools used: Specify any equipment, arthroscopic debridement tools, or materials used during the procedure.
- Pre-op and post-op diagnosis: Document the diagnostic findings, surgical goals, and outcomes related to the musculoskeletal system.
Billing guidelines
CPT code 29999 is an unlisted procedure code, which means it does not have a predefined relative value unit (RVU) or standard reimbursement rate. Instead, insurance coverage and payment are determined case-by-case based on the submitted documentation, medical necessity, and comparison to a specific code representing a similar surgical procedure.
To ensure proper billing and reduce the risk of denials, healthcare providers must submit:
- A detailed description of the procedure performed
- An operative report
- A comparison to existing CPT codes from the current procedural terminology list that closely resemble the advanced procedures being reported (e.g., hip arthroscopy, labral repair, or arthroscopic debridement)
Because CPT 29999 involves unlisted codes, prior authorization is strongly recommended. Providers should also review payer-specific guidelines, particularly for procedures involving same-day surgery, foreign body removal, or complex cases involving the musculoskeletal system.
Frequently asked questions
Yes, when billing CPT code 29999, you should submit a comparable CPT code that reflects a similar surgical procedure in complexity and scope. Include your proposed fee, a detailed description, and the rationale for using an unlisted procedure code. This helps payers assign reimbursement on a case-by-case basis.
Yes, prior authorization is strongly advised for CPT 29999 by nearly all payers, especially commercial insurers and Medicare Advantage plans. This is due to its unlisted status, which requires a review of documentation before approval. Failing to obtain authorization may result in claim denial.
No, CPT code 29999 is designated for arthroscopy procedures only. If you are billing for an unlisted open procedure, use CPT 27599, which applies to unlisted procedures of the lower extremity. Always ensure the code aligns with the surgical approach to maintain accurate billing and coding practices.
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