Clinical Context
A typical patient is an adult receiving a documented preventive or chronic care visit in an outpatient primary care clinic where performance measures are tracked. The clinician documents completion of a specific preventive service or quality measure that is reported using 0509F. The workflow: patient presents for routine follow-up or annual exam; nurse collects vitals and reviews preventive needs; clinician confirms eligibility for the measure, delivers the preventive service or documents that it was not indicated or refused; coder/biller assigns 0509F to indicate the measure result and bundles the code with the visit claim for quality reporting. Typical site of service is an outpatient clinic or office-based setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|
25 | Significant, separately identifiable E/M service by the same physician on the day of a procedure | Use when an evaluation and management visit is distinct from the preventive measure documented by 0509F. |
| 59 | Distinct procedural service | Use when another procedure or service occurred on the same day and is separate from the quality reporting action associated with 0509F.
| 91 | Repeat clinical diagnostic laboratory test | Use when repeat testing is performed for confirmation related to the measure documented by 0509F.
| GQ | Via asynchronous telecommunications system | Use when the service or documentation supporting 0509F is completed using store-and-forward telehealth methods where applicable.
| GT | Via interactive real-time telemedicine service | Use when the visit and documentation for 0509F occur via real-time telehealth and payer requires the modifier.
| 52 | Reduced services | Use when the preventive service or measure was partially performed and the reduced nature must be indicated.
| 53 | Discontinued procedure | Use when the preventive action associated with the measure was started but aborted and documentation supports discontinuation.
| 57 | Decision for surgery | Use when documentation includes a preoperative decision that affects reporting of the measure on the same day as 0509F.
| 73 | Discontinued outpatient procedure prior to anesthesia | Use when an outpatient procedure related to the measure was discontinued before anesthesia was administered.
| 74 | Discontinued outpatient procedure after anesthesia | Use when an outpatient procedure related to the measure was discontinued after anesthesia was administered.
| Taxonomy Code | Specialty | Notes |
|---|
207Q00000X | Family Medicine | Primary care clinicians who commonly document preventive measures and quality reporting. |
| 207R00000X | Internal Medicine | Adult medicine clinicians responsible for chronic care and preventive service documentation.
| 208D00000X | General Practice | Office-based general practitioners who perform routine preventive care and quality reporting.
| 207VP0102X | Preventive Medicine | Specialists focused on population health and preventive service measure tracking.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Commonly billed on the same day when a clinician performs an E/M visit and documents the preventive measure tracked by 0509F. |
| 99406 | Smoking and tobacco use cessation counseling intermediate, greater than 3 minutes up to 10 minutes | May be performed and documented alongside the preventive measure if tobacco cessation counseling is delivered during the visit.
| 81002 | Urinalysis, non-automated, without microscopy (screening) | Frequently ordered as part of routine preventive screening workflows that feed quality measure documentation.
| 36415 | Collection of venous blood by venipuncture | Common ancillary service when laboratory testing is required to satisfy preventive measure components documented with 0509F.
| G0444 | Annual depression screening, 15 minutes | Often performed in primary care preventive workflows and reported in conjunction with quality measure documentation represented by 0509F.