Internal Medicine Coding Alert
Preventive Care Guidelines by Age
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Answer: The CPT guidelines specify that to bill code series 99381-99397 (Preventive Medicine Services), "The extent and focus of the services will largely depend on the age of the patient the 'comprehensive' nature is not synonymous with the 'comprehensive' examination required in the E/M codes 99201-99350."
These vague guidelines of the definition of "comprehensive" for this section stir much debate over exactly what is meant. Some consultants will tell you to follow the guidelines of the specialty societies such as the American Academy of Internal Medicine. In addition, put your practice's definition of a comprehensive history and exam in writing into your corporate compliance plan as it relates to the Preventive Care section, based on each code (age-related exam). Your comprehensive exam on a young adult age 18-39 (99385 or 99395) will probably be different from a comprehensive exam on an adult age 65 or older (99387 or 99397).
Answers for You Be the Coder and Reader Questions were reviewed by Linda Bishop, CPC, CCS, corporate compliance officer, Pediatric Management Group at Childrens Hospital, Los Angeles; and Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.
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