Wiki 99459

[cjorr65]

Quick question. I have found conflicting documentation when trying to get clarification on the following: If a patient has a problem visit E/M with pelvic exam , 99459, and then has a procedure on the same day( example iud insertion) would you consider the 99459 bundled to the procedure? I would think yes, but am unsure based on the information I have found. Our coders here disagree on the issue and I would like clarification please.

 

[TThivierge]

The Chaperone CPT code
Cjorr65
CPT code 99459 is an add-on code that can be reported with evaluation and management (E/M) codes for new and established patients. It can be used with the following E/M codes:
The documentation requirements for Current Procedural Terminology (CPT) code 99459, a pelvic examination, include:

• Supporting the need for the pelvic exam in the patient's medical record
• Confirming the use of a chaperone in the patient's medical record

• Office or other outpatient visit for the evaluation and management of a new patient codes (99202-99205)
  
  
• Consultation codes (99242–99245)
  
  
• Preventive medicine codes (99383–99387 for new patients, 99393–99397 for established patients)
  

CPT code 99459 is a practice expense code that covers the cost of supplies, such as disposable speculums, and the sterilization cost of metal speculums. It also covers 4 minutes of staff time, such as room setup time and chaperone time.

I would consider it redundant thus bundled into the CPT 58300 IUD insertion process.

I hope this data helps you
Lady T

 

[nielynco]

Quick question. I have found conflicting documentation when trying to get clarification on the following: If a patient has a problem visit E/M with pelvic exam , 99459, and then has a procedure on the same day( example iud insertion) would you consider the 99459 bundled to the procedure? I would think yes, but am unsure based on the information I have found. Our coders here disagree on the issue and I would like clarification please.

In addition to the other answer, ACOG stated this in their coding corner (available to ACOG members only): Do NOT report with the E/M service if, during the same encounter, a procedure is reported that requires a pelvic exam (e.g., colposcopy, endometrial biopsy, IUD placement, etc.) as these procedure codes are already included in the additional costs