Professional Documents
Culture Documents
Below please find the 2009 CPT changes and/or revisions as outlined in the American Medical
Association CPT 2009 Edition. If you have any questions regarding the information below, please
contact Jennifer Carlin Young at (904) 353-7878 ext. 123, jyoung@aace.com.
Modifiers
This list includes all of the modifiers applicable to CPT® 2009 codes.
►(Modifier 21 has been deleted. To report prolonged physician services, see 99354-99357)◄
Rationale
Modifier 21 for reporting a prolonged evaluation and management service has been deleted. This modifier provided
a duplicate mechanism for the same concept that is reported with prolonged Evaluation and Management Services
codes 99354-99359, violating the CPT® concept of unique methods of concept reporting.
►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 either the inpatient or outpatient setting. This service is reported in
addition to the designated evaluation and management services at any level and any other physician services
provided at the same session as evaluation and management services. Appropriate codes should be selected for
supplies provided or procedures performed in the care of the patient during this period.
Codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician on a given date
providing prolonged service, 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
services to a patient, 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 place of
service.
►Either code should be used only once per date, even if the time spent by the physician is not continuous on that
date. 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 evaluation and management codes.◄
►The use of the time based add-on codes requires that the primary evaluation and management service have a
typical or specified time published in the CPT® codebook.◄
+▲99354 Prolonged physician service in the office or other outpatient setting requiring direct (face-to-face)
patient contact beyond the usual service; first hour (List separately in addition to code for office or
other outpatient Evaluation and Management Service)
+▲99355 each additional 30 minutes (List separately in addition to code for prolonged physician service)
+▲99356 Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual
service; first hour (List separately in addition to code for inpatient Evaluation and Management
service)
+▲99357 each additional 30 minutes (List separately in addition to code for prolonged physician service)
Rationale
The guidelines for the face-to-face outpatient and inpatient prolonged evaluation and management services,
reported with codes 99354-99357, have been revised to indicate that these are intended to be reported with
evaluation and management services in addition to any other physician services reported at the same session. The
guidelines for the outpatient services have been revised to indicate that only the outpatient services are intended to
report the total duration of the time spent (continuous or non-continuous) by the physician on the unit.
Directions have also been added to instruct that if a time-based add-on code is reported, it can only be used with
evaluation and management services codes with typical or specified times included in their descriptors. An
abbreviated table of time examples has been revised for clarity. The referenced codes in the parenthetical
instructions following codes 99354 and 99356 have been revised to reflect appropriate services (psychotherapy
with medical evaluation and management) and sites of services (inpatient nursing facility services) for these
categories. These services should not be reported in addition to the team conference services (99366-99368),
telephone (99441-99443), or other non-face-to-face services.
General
►(For percutaneous needle biopsy other than fine needle aspiration, see 20206 for muscle, 32400
for pleura, 32405 for lung or mediastinum, 42400 for salivary gland, 4700, 47001 for liver, 48102
for pancreas, 49180 for abdominal or retroperitoneal mass, 60100 for thyroid, 62267 for nucleus
pulposus, intervertebral disc, or paravertebral tissue, 62269 for spinal cord)◄
Rationale
To support the addition of code 66267 to report percutaneous aspiration within the nucleus pulposus, intervertebral
disc, or paravertebral tissue for diagnostic purposes, the cross-reference following code 10022 was revised to refer
users to 62267 when reporting interdiscal percutaneous diagnostic aspiration.
Integumentary System
EXICISION – DEBRIDEMENT
+▲11001 each additional 10% of the body surface, or part thereof (List separately in addition to code for
primary procedure)
11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
+▲11201 each additional 10 lesions, or part thereof (List separately in additional to code for primary
procedure)
Rationale
Codes 11001, 11201, and 11922 have been editorially revised with the addition of “or part thereof” to clarify that
the existing phrase “each additional 10% of the body surface,” “each additional 10 lesions,” or “each additional
20.0 sq cm” is intended to include repair of any additional percentage within the stated measurement. These
revisions were made to address confusion regarding reporting for repairs over the initial measurement, whether by
percentage, number of lesions, or area measurement, and to provide consistency with other add-on integumentary
codes that include measurement as a reporting mechanism.
Bone/Joint Studies
77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg,
hips, pelvis, spine)
►(For dual- energy X-ray absorptiometry (DEXA) body composition study, use 76499)◄
Rationale
A parenthetical note has been added following code 77082 to direct users to the appropriate code to report a dual-
energy absorptiometry (DEXA) body composition study.
Nuclear Medicine
Diagnostic
OTHER PROCEDURES
●78808 Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous
(eg, parathyroid adenoma)
Rationale
Nuclear medicine code 78808 was established to report an injection for radiopharmaceutical localization by non
imaging probe study. This code reflects the resources required to provide those radioactive drugs by intravenous
routes prior to gamma probe localization (eg, parathyroid tumors).
Non-imaging gamma probe procedures in which a radiopharmaceutical is prepared, injected, and handled in
accordance with acceptable regulatory and safety requirements are done during surgery as part of and during neck
exploration for parathyroid tumors or for sentinel nodes in cancer patients (usually breast and melanoma). A
parenthetical note has been added to clarify that code 38792 may be used for the interstitial injection preceding
surgery, during which a gamma probe may be used for localization of a sentinel node.
Evocative/Suppression Testing
►The following test panels involve the administration of evocative or suppressive agents, and the baseline and
subsequent measurement of their effects on chemical constituents. These codes are to be used for the reporting of
the laboratory component of the overall testing protocol. For the physician’s administration of the evocative or
suppressive agents, see 96360, 96361, 96372-96374, 96375; for the supplies and drugs, see 99070. To report
physician attendance and monitoring during the testing, use the appropriate evaluation and management code,
including the prolonged physician care codes if required. Prolonged physician care codes are not separately
reported when evocative/suppression testing involves prolonged infusions reported with 96360, 96361. In the code
descriptors where reference is made to a particular analyte (eg, Cortisol: 82533 x 2) the “x 2” refers to the number
of times the test for that particular analyte is performed.◄
84000 ACTH stimulation panel; for adrenal insufficiency. This panel must include the following:
Cortisol (82533 x 2)
Rationale
In support of the deletion and renumbering of codes 90760-90799, the Evocative/Suppression Testing guidelines
have been revised to reflect the appropriate codes to report for infusion services.
Chemistry
82960 screen
Rationale
In support of the deletion and renumbering of codes 90760-90799, the cross-reference following code 82960 has
been revised to reflect the appropriate codes to report for infusion services.
Vaccines, Toxoids
Rationale
In order to assist users in comparison and use of the infusion services procedures, codes 90760-90779 have been
deleted and renumbered for proximity to the chemotherapy and other complex infusion services reported with codes
96401-96549. In addition to deletion and renumbering of these services, movement of the codes allowed
condensation of the guidelines with revision to reflect overarching principles between each of the code series.
Endocrinology
▲95250 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for
a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient
training, removal of sensor, and printout of recording
►Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other
Highly Complex Drug or Highly Complex Biologic Agent Administration◄
►Physician work related to hydration, injection, and infusion services predominantly involves affirmation of
treatment plan and direct supervision of staff.◄
►If a significant, separately identifiable Evaluation and Management service is performed, the appropriate E/M
service code should be reported using modifier 25 in addition to 96360-96549. For same day E/M service, a
different diagnosis is not required.
If performed to facilitate the infusion or injection, the following services are included and are not reported
separately:
►When multiple drugs are administered, report the service(s) and the specific materials or drugs for each.
When administering multiple infusions, injections or combinations, only one “initial” service code should be
reported, unless protocol requires that two separate IV sites must be used. If an injection or infusions is of a
subsequent or concurrent nature, even if it is the first such service within that group of services, then a subsequent
of concurrent code from the appropriate section should be reported (eg, the first IV push given subsequent to an
initial one-hour infusion is reported using a subsequent IV push code).
When these codes are reported by the physician, the “initial” code that best describes the key or primary reason for
the encounter should always be reported irrespective of the order in which the infusions or injections occur.
When these codes are reported by the facility, the following instructions apply. The initial code should be selected
using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services
which are primary to hydration services. Infusions are primary to pushes, which are primary to injections.
When reporting codes for which infusion time is a factor, use the actual time over which the infusion is
administered. Intravenous or intra-arterial push is defined as: (a) an injection in which the health care professional
who administers the substance/drug is continuously present to administer the injection and observe the patient, or
(b) an infusion of 15 minutes or less.◄
►Codes 96360-96361 are intended to report a hydration IV infusion to consist of a pre-packaged fluid and
electrolytes (eg, normal saline, DF-1/2 normal saline+30mEq KC1/liter), but are not used to report infusion of
drugs or other substances. Hydration IV infusions typically require direct physician supervision for purposes of
consent, safety oversight, or intraservice supervision of staff. Typically such infusions require little special
handling to prepare or dispose of, and staff that administer these do not typically require advanced practice training.
After initial set-up, infusion typically entails little patient risk and thus little monitoring. These codes are not
intended to be reported by the physician in the facility setting.◄
+● 96361 each additional hour (List separately in addition to code for primary procedure)
►(Do not report 96361 for hydration infusion intervals of greater than 30 minutes beyond
1 hour increments)◄
►Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other
Highly Complex Drug or Highly Complex Biologic Agent Administration◄
►A therapeutic, prophylactic, or diagnostic IV infusion or injection (other than hydration) is for the administration
of substances/drugs. When fluids are used to administer the drug(s), the administration of the fluid is considered
incidental hydration and is not separately reportable. These services typically require direct physician supervision
for any or all purposes of patient assessment, provision of consent, safety oversight, and intra-service supervision of
staff. Typically, such infusions require special consideration to prepare, dose or dispose of, require practice training
and competency for staff who administer the infusions, and require periodic patient assessment with vital sign
monitoring during the infusion. These codes are not intended to be reported by the physician in the facility setting.
See codes 96401-96549 for the administration of chemotherapy or other highly complex drug or highly complex
biologic agent services. These highly complex services require advanced practice training and competency for staff
who provide these services; special considerations for preparation, dosage or disposal; and commonly, these
services entail significant patient risk and frequent monitoring. Examples are frequent changes in the infusion rate,
prolonged presence of nurse administering the solution for patient monitoring and infusion adjustments, and
frequent conferring with the physician about these issues.◄
►(Do not report 96365-96379 with codes for which IV push or infusion is an inherent part of the
procedure [eg, administration of contrast material for a diagnostic imaging study])◄
● 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up
to 1 hour
CPT® 2009 Changes: An Insider’s View
©2008 American Medical Association
All rights reserved.
9
+● 96366 each additional hour (List separately in addition to code for primary procedure)
►(Report 96366 for infusion intervals of greater than 30 minutes beyond 1 hour increments)◄
+● 96367 additional sequential infusion, up to 1 hour (List separately in addition to code for primary
procedure)
►(Report 96367 in conjunction with 96365, 96374, 96409, 96413 if provided as a secondary or
subsequent service after a different initial service is administered through the same IV access.
Report 96367 only once per sequential infusion of same infusate mix)◄
+● 96368 concurrent infusion (List separately in addition to code for primary procedure)
● 96369 Subcutaneous infusion for therapy or prophylaxis (specify substance or drub); initial, up to 1 hour,
including pump set-up and establishment of subcutaneous infusion site(s)
►(Use 96370 for infusion intervals of greater than 30 minutes beyond 1 hour increments)◄
+● 96371 additional pump set-up with establishment of new subcutaneous infusion site(s). List separately in
addition to code for primary procedure)
►(96372 does not include injections for allergen immunotherapy. For allergen immunotherapy
injections, see 95115-95117)◄
● 96373 intra-arterial
+● 96375 each additional sequential intravenous push of a new substance/drug (List separately in
addition to code for primary procedure)
►(Use 96375 in conjunction with 96365, 96374, 96409, 96413)◄
+● 96376 each additional sequential intravenous push of the same substance/drug provided in the
facility (List separately in addition to code for primary procedure)
►(Do not report 96376 for a push performed within 30 minutes of a reported push of the same
substance or drug)◄