Coding Corner: Making Sense of the New Add-on Codes: +99459 | Leslie Bradford, MD

Leslie Bradford, MD

The Society of Gynecologic Oncology, along with our partners at the American College of Obstetricians and Gynecologists, have long advocated for additional payment to recognize the practice expense necessary to provide a female pelvic examination. In September of 2022, the American Medical Association CPT® Editorial Panel approved CPT code +99459 (pelvic examination). The code has now been valued under the Medicare Physician Fee Schedule and may be used as of January 1, 2024.

This is a practice-expense only code, meaning it does not have any associated physician work RVUs. Additionally, this code is an add-on only code and therefore cannot be reported without an associated evaluation and management (E/M) visit. The E/M service captures work of the exam, while the add on code will capture the added clinical staff time and supplies required to perform a female pelvic exam. The code is valued at 0.68 practice expense RVUs, capturing four minutes of clinical staff time when chaperoning a pelvic exam and also the expense of the supply pack, including a speculum.

As an “add-on” code, this is listed separately on a separate claim line, in addition to the code for E/M service. Code +99459 may be added on the following services:

• Office visits: (99202-99215)
• Consult visits: (99242-99245)
• Preventive visits: (99383-99387, 99393-99397)

The best practice to report this new add-on code is to include a notation in the patient chart that a chaperone was present during the exam or, if chaperone was offered and denied, then this should be clearly documented as well.

We also recommend that physicians meet with their compliance officers or coding staff to ensure that everyone is meeting the expectations associated with billing this code.

Leslie Bradford, MD, is a gynecologic oncologist at Maine Medical Center in Scarborough, ME.