Initial Preventive Medicine Codes Aren’t for Established Patients

Be careful not to apply initial preventive medicine codes (99381-99387) for established patients. A patient who has received any professional service from the provider within the past three years should be treated as an established patient, even if that patient has not previously received a preventive service from the provider.
CPT Assistant (August 1997) clarifies:

A common misconception is that the initial preventive medicine E/M service is reported for the first time the patient receives preventive medicine services, even if the patient has received problem-oriented services within the past three years. Because codes 99381-99387 are found within the new patient category, these codes should not be reported if a patient received any professional services from this or another physician of the same specialty from the same group practice, within the past three years.
Typically, the initial new patient preventive medicine E/M codes are used to report services provided to a patient who is new to an area and establishing him/herself with a new physician, without any presenting illness.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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