Coding for the Pelvic Examination Practice Expense Code, CPT 99459
Authors: The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Steve Rad, MD, FACOG; Trisha Malisch, CCS-P, CPC.
The add-on CPT code 99459 Pelvic examination (List separately in addition to code for primary procedure), is a practice expense code, which covers supplies, such as disposable speculum, or the sterilization cost of metal speculum, and 4 minutes of staff time (for example, room setup time, chaperone time).
CPT 99459 can only be reported as an add on code in addition to the following Evaluation and Management codes performed in an Office place of service:
· New and established patient office visit (99202-99205, 99212-99215)
· Office/outpatient consultation (99242-99245)
· Preventive medicine (99383-99387, 99393-99397)
While chaperone time may be included as part of the staff time, the CPT code does not require the presence of a chaperone. Furthermore, reimbursement for this code is Payer specific, and therefore, we recommend checking with your individual Payers.
Members should submit any coding questions to the SMFM Coding Committee Ask a Coding Question website (https://www.smfm.org/coding/questions/new). Additional information and resources are also available on our coding website. Thank you very much.