CPT Code Changes for 2009

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

Initial and Continuing Intensive Care Services

Pediatric Critical Care Patient Transport

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.

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

(Use 99355 in conjunction with code 99354.)

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

(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).

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.