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Frequently used codes relocated throughout CPT for 2009

From the January ACP Internist, copyright 2009 by the American College of Physicians

By By Debra Lansey

Current Procedural Terminology (CPT) code changes took effect Jan. 1. Members may have some questions about the codes they use frequently. The 2009 changes are notable for the number of services that have been “relocated” throughout the code book. In most cases, only the CPT code number has changed; in others, the code description was modified for clarity. Note the changes and how to update billing systems to reflect the new CPT code numbers and descriptions.

Q: What changed in the E/M section of the CPT code book for 2009?

A: The revision of the Prolonged Service codes is the change to the Evaluation and Management (E/M) section that is most relevant to internists. CPT changed the codes describing a prolonged service a physician provides that involves direct, face-to-face contact with the patient.

The parenthetical statement that referenced treatment of an acute asthmatic patient has been eliminated from the description of code 99354, which describes the first hour of a prolonged service to a patient in the outpatient setting. The description of code 99356, which describes the first hour of a prolonged service to a patient in the inpatient setting, was revised to specify that face-to-face time for an inpatient is defined as the time the physician devotes to the patient's care on the inpatient floor or unit. This change further clarifies the distinction from the outpatient definition which is actual face-to-face time with the patient. The parenthetical reference to specific clinical conditions as examples was also removed from 99356.

You can report an additional 30 minutes of prolonged service time beyond the extra hour by using 99355 for the outpatient setting and 99357 for the inpatient setting.

Highlighting the changes to these prolonged service code descriptions also provides an opportunity to remind internists that Medicare pays for a prolonged service that extends at least 30 minutes beyond typical time assigned to base E/M service (for example, an established patient office visit). Report the prolonged service code(s) in addition to the code for the E/M service describing the base encounter. To illustrate, a 90-minute prolonged service to an outpatient is properly reported by adding 99354 and 99355 to the code describing the appropriate level of service for an established patient office visit.

Q: What happened to the neonatal services codes? Were they deleted?

A: The neonatal and pediatric inpatient services have been assigned new code numbers in the E/M section, as the American Medical Association restructures the CPT code book. Re-numbering the codes allows CPT to keep similar services grouped together, in consecutive order.

CPT 2009 moves all the inpatient neonatal intensive care services, and pediatric and neonatal critical care services, to the same subsection in the E/M section of the book; they appear as new codes 99460 through 99480. Codes 99289, 99290, 99293, 99294, 99295, 99296, 99298, 99299, 99300 have been deleted. While internists generally do not use these codes, it is still important to note this significant change to the E/M section.

Frequently used codes relocated throughout CPT for 2009

Q: We used to code for IV infusion services with codes near the vaccine services, but I don't see them now. What happened?

A: The intravenous infusion services CPT codes 90760 through 90779 have been deleted and relocated to a more appropriate place in CPT. You will now find them with the other therapeutic injection and infusion codes. The services are now listed in the new location, with new code numbers 96360 through 96376.

Q: My office needs to submit claims for the bivalent HPV vaccine. Can we use code 90649?

A: No, there is now a code to represent the vaccine you describe. Plus, there are a few other changes to the vaccine codes.

New codes for HPV, rotavirus, and Japanese encephalitis vaccines are:

 

  • 90650 HPV vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use,
  • 90681 rotavirus human, attenuated, 2 dose schedule, live, for oral use, 90696 diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use,
  • 90738 Japanese encephalitis virus vaccine, inactivated, for intramuscular use
  • And, code 90698 has been revised to read: diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated (DTaP–Hib–IPV), for intramuscular use. Its 2008 FDA pending status has been removed.

Debra Lansey is Associate for Regulatory and Insurer Affairs in ACP's Washington, D.C. office.

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