An E/M service may be provided that is not listed in this section
of CPT®. When reporting such a service, the appropriate unlisted code may be used to
indicate the service, identifying it by “Special Report,” as discussed in item D. The
“Unlisted Services” and accompanying codes for the E/M section are as follows:
99429 Unlisted preventive medicine service
99499 Unlisted evaluation and management service
SPECIAL REPORT: An unlisted service or one that is unusual, variable, or new may
require a special report demonstrating the medical appropriateness of the service. Pertinent
information should include an adequate definition or description of the nature, extent, and
need for the procedure and the time, effort, and equipment necessary to provide the service.
Additional items that may be included are complexity of symptoms, final diagnosis,
pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems,
and follow-up care.
CLINICAL EXAMPLES: Clinical examples of the codes for E/M services are provided
to assist in understanding the meaning of the descriptors and selecting the correct code.
The same problem, when seen by different specialties, may involve different amounts of
work. Therefore, the appropriate level of encounter should be reported using the
descriptors rather than the examples.
INSTRUCTIONS FOR SELECTING A LEVEL OF E/M SERVICE
Review the Reporting Instructions for the Selected Category or Subcategory: Most of
the categories and many of the subcategories of service have special guidelines or
instructions unique to that category or subcategory. Where these are indicted, eg,
“Inpatient Hospital Care,” special instructions will be presented preceding the levels of
E/M services.
