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CPT Code Changes for 2009


November 2008

The 2009 changes to Current Procedural Terminology (CPT®) are effective for reporting services provided on or after January 1, 2009. As we have been reporting, the most significant changes are those made to the normal newborn care, delivery room management and resuscitation, neonatal and pediatric intensive and critical care services, and pediatric critical care transport services. Other important changes include the deletion of modifier 21 and the introduction of new category III (new and emerging technology) codes for reporting online critical care services. The code revisions, code deletions, and new codes provided in this article include those services most often performed and reported by primary care pediatricians and pediatric subspecialists. Changes or revisions to existing codes or instructions are underlined and text that contains a strikethrough indicates deletions.

Evaluation and Management Services

Normal Newborn Care, Neonatal and Pediatric Intensive Care, Pediatric Critical Care Transport, and Inpatient Neonatal and Pediatric Critical Care

All existing codes that were used to report normal newborn, pediatric critical care transport, and neonatal pediatric intensive and critical care services will be renumbered to allow them to be placed together within the evaluation and management (E/M) section of CPT 2009. In addition, new codes will be introduced to report initial and subsequent day inpatient critical care E/M services to a child 2 through 5 years of age. The new codes are identified with a bullet (). Another important change is that the pediatric critical care transport codes (former codes 99289 and 99290; new codes 99466 and 99467) will be bundled with the same services and procedures as the neonatal and pediatric critical care services. Previously these services were bundled with the same procedures as those included with the hourly critical care codes (99291 and 99292).

Normal Newborn Care, Delivery Room and Resuscitation

99431 99460 Initial hospital or birthing center care, per day, for the E/M of the normal newborn infant
99432 99461 Initial care, per day, for the E/M of the normal newborn infant seen in other than hospital or birthing center
99433 99462 Subsequent hospital care, per day, for the E/M of a normal newborn
99435 99463 Initial hospital or birthing center care, per day, for the E/M of the normal newborn infant admitted and discharged on the same date
99436 99464 Attendance at delivery (when requested by the delivering physician) and initial stabilization of newborn
99440 99465 Delivery/birthing room Newborn resuscitation: provision of positive pressure ventilation or chest compressions in the presence of acute inadequate ventilation or cardiac output 

Initial and Continuing Intensive Care Services

99477  Initial hospital care, per day, for the E/M of the neonate, 28 days or younger, who requires intensive observation, frequent interventions, and other intensive care services
99298 99478 Subsequent intensive care, per day, for the E/M of the recovering very low birth weight infant (present body weight less than 1,500 g)
99299 99479 Subsequent intensive care, per day, for the E/M of the recovering low birth weight infant (present body weight of 1,500–2,500 g)
99300 99480 Subsequent intensive care, per day, for the E/M of the recovering infant (present body weight of 2,501–5,000 g)

Pediatric Critical Care Patient Transport

99289 99466 Critical care services delivered by a physician, face-to-face, during an interfacility transport of a critically ill or critically injured pediatric patient, 24 months or younger; first 30 to 74 minutes of hands-on care during transport
99290 99467 Critical care services delivered by a physician, face-to-face, during an inter-facility transport of a critically ill or critically injured pediatric patient, 24 months or younger; each additional 30 minutes (List separately in addition to code for primary service.)

Inpatient Neonatal and Pediatric Critical Care

99295 99468 Initial inpatient neonatal critical care, per day, for the E/M of a critically ill neonate, 28 days or younger
99296 99469 Subsequent inpatient neonatal critical care, per day, for the E/M of a critically ill neonate, 28 days or younger
99293 99471 Initial inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 29 days through 24 months of age
99294 99472 Subsequent inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 29 days through 24 months of age
99475  Initial inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 2 through 5 years of age
99476  Subsequent inpatient pediatric critical care, per day, for the E/M of a critically ill infant or young child, 2 through 5 years of age

To allow consistency in reporting all pediatric critical and intensive care services, new codes 99475 and 99476 (inpatient pediatric critical care for the E/M of the critically ill child 2 through 5 years of age) and revised codes 99466 and 99467 (pediatric critical care patient transport services) will include the same services as those bundled with the other inpatient neonatal and pediatric critical and intensive care codes (99468–99472 and 99477–99480). The following services, when performed by the physician providing intensive or critical care, may not be reported separately:

  • Routine monitoring evaluations (eg, heart rate, respiratory rate, blood pressure)

  • The interpretation of cardiac output measurements (93561, 93562), chest x-ray films (71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases, and information data stored in computers (eg, electrocardiograms, blood pressures, hematologic data [99090])

  • Gastric intubation (43752, 91105)

  • Temporary transcutaneous pacing (92953)

  • Ventilatory management (94002–94004, 94660, 94662)

  • Vascular access procedures (36000, 36400, 36405, 36406, 36410, 36415, 36591, 36600)

  • Endotracheal intubation (31500)

  • Surfactant administration (94610)

  • Central, peripheral catheterization (36555, 36000)

  • Umbilical catheterization (36510, 36660)

  • Other arterial catheterization (36140, 36620)

  • Vascular punctures (36420, 36600)

  • Intravenous fluid administration (90760, 90761)

  • Transfusion blood components (36430, 36440)

  • Pulmonary function testing (94375)

  • Lumbar puncture (62270)

  • Suprapubic bladder aspiration (51100)

  • Bladder catheterization (51701, 51702)

Any services performed that are not listed here should be reported separately.

Preventive Medicine Visits

Revisions have been made to the introductory language of the preventive medicine service section (99381–99397) to clarify that screening services with separate CPT codes (eg, vision, hearing, developmental) and immunization and vaccine risk and benefit counseling should be separately reported when performed at the same session as a preventive medicine service. Clarification has been made stipulating that vaccine counseling is not included in the preventive medicine service codes. The preventive medicine service code descriptors are also revised to specifically remove reference to the "ordering of immunizations." Finally, the term vaccine products replaces immunization in the guidelines to clarify that vaccine supply, administration, and counseling are not included. Please refer to "Denial Den" for the position paper developed by the American Academy of Pediatrics Committee on Coding and Nomenclature that defines the vaccine-related work that is and is not included in the preventive medicine service codes.

Prolonged Physician Service With Direct (Face-to-face) Patient Contact

Revisions have been made to the introductory language and descriptors for codes 99354–99357. The language now clarifies that prolonged services with direct patient contact provided in the inpatient setting are reported based on the total duration of unit time spent by the physician and devoted to the one patient. Instructions further specify that time-based add-on codes (eg, prolonged services) may only be reported when the primary E/M code has an assigned time.

Codes 99354–99357 are used when a physician provides prolonged service involving direct (face-to-face) patient contact that is beyond the usual service in the inpatient or outpatient setting. This service is reported in addition to the designated E/M services regardless of level of complexity and other physician services provided at the same session. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period.

Codes 99354–99355 99357 are used to report the total duration of face-to-face time spent by a physician on a given date providing prolonged service in the outpatient setting, even if the time spent by the physician on that date is not continuous. Codes 99356–99357 are used to report the total duration of unit time spent by a physician on a given date providing prolonged service to a patient in the hospital or other inpatient setting, even if the time spent by the physician on that date is not continuous.

Code 99354 or 99356 is used to report the first hour of prolonged service on a given date, depending on the location of service.

Either code also may be used to report a total duration of prolonged service of 30-60 minutes on a given date. Either code should be used only once per day, even if the time spent by the physician is not continuous on that day. Prolonged service of less than 30 minutes' total duration on a given date is not separately reported because the work involved is included in the total work of the E/M codes.

Code 99355 or 99357 is used to report each additional 30 minutes beyond the first hour, depending on the location of service. Either code may also be used to report the final 15 to 30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.

The use of the time-based add-on codes requires that the primary E/M service have a typical or specified time published in CPT.

The examples below illustrate the correct reporting of prolonged physician service with direct patient contact in the office setting.

+99354 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); first hour (List separately in addition to code for office or other outpatient E/M service.) 


(Use 99354 in conjunction with codes 99201–99215, 99241–99245, 99324–99337, 99341–99350, 90809, 90815 99304–99350)

Total Duration of Prolonged ServicesCode(s)
Less than 30 min (less than ½ h)Not reported separately
30 to 74 minutes (½ h–1 h 14 min)99354 x
75 to 104 minutes (1 h 15 min–1 h 44 min)99354 x 1 AND 99355 x
105 or more minutes -134 minutes (1 h 45 min or more) – 2 hr. 14 min.) 99354 x 1 AND 99355 x 2 or more for each additional 30 minutes 
135 to 164 minutes (2 h 15 min–2 h 44 min) 99354 x 1 AND 99355 x 3 
165 to 194 minutes (2 h 45 min 3 h 14 min) 99354 x 1 AND 99355 x 4 


+99355 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face) patient contact beyond the usual service (eg, prolonged care and treatment of an acute asthmatic patient in an outpatient setting); each additional 30 minutes (List separately in addition to code for prolonged physician service.) 


(Use 99355 in conjunction with code 99354.)

+99356  Prolonged physician service in the inpatient setting, requiring unit/floor time direct (face-to-face) patient contact beyond the usual service (eg, maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); first hour (List separately in addition to code for inpatient E/M service.) 


(Use 99356 in conjunction with codes 99221–99233, 99251–99255, 99304–99310, 90822, 90829)

+99357 Prolonged physician service in the inpatient setting, requiring unit/floor time direct (face-to-face) patient contact beyond the usual service (eg, maternal fetal monitoring for high risk delivery or other physiological monitoring, prolonged care of an acutely ill inpatient); each additional 30 minutes (List separately in addition to code for prolonged physician service.) 

(Use 99357 in conjunction with code 99356.)

Modifiers

Modifier 21 (prolonged E/M services) has been deleted because it is considered obsolete given the reporting guidelines and use of the prolonged service codes (99354–99359).

21 Prolonged Evaluation and Management Services: When the face-to-face or floor/unit service(s) provided is prolonged or otherwise greater than that usually required for the highest level of evaluation and management service within a given category, it may be identified by adding modifier 21 to the evaluation and management code number. A report may also be appropriate. 

Category III Codes

New codes to report remote critical care were released on January 1, 2008, and effective for reporting services performed on July 1, 2008, and after. Please see the June 2008 issue of AAP Pediatric Coding Newsletter™ (Vol 3, No. 9), which addresses the guidelines for reporting these services.

0188T Remote real-time interactive videoconferenced critical care, E/M of the critically ill or critically injured patient; first 30 to 74 minutes
+0189T Remote real-time interactive videoconferenced critical care, E/M of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service.)

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.





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