Pediatric Coding Alert

Adolescent preventive medicine exams for patients 12 to 17 years old can include ancillary and gynecological services that may not be covered in comprehensive preventive care exams, so pediatricians should be vigilant about recording any additional services they provide during these exams and clearly document services. The key to correctly coding adolescent preventive E/M exams is understanding what comprehensive preventive medicine services include, coding experts stress. You should use 99384 (Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, new patient; adolescent [age 12 through 17 years]) for new adolescent patients who are 12 through 17, according to CPT. Report 99394 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, established patient; adolescent [age 12 through 17 years]) for established 12- to 17-year-old patients. If the patient is 18 years of age or older and is a new patient, use CPT 99385 for an initial preventive medical evaluation. Report 99395 for established patients who are 18 or older. Use Separate Codes for Counseling Without Physicals In addition to the history and physical examination, 99384 and 99394 include counseling and risk-reduction intervention. During the exam, if the pediatrician determines that an adolescent needs guidance for any kind of problem, he or she may offer advice during the same office visit. Typically, pediatricians counsel adolescents during checkups on such issues as family problems, drug abuse, and sexual practices, says Kevin Perryman, practice administrator for Primary Pediatric Medical Association of Seguin, Texas.

If the adolescent sees a pediatrician just for counseling and does not have a preventive medical exam, however, you would not use 99384 or 99394. Instead, report 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes), 99402 (... approximately 30 minutes), 99403 (... approximately 45 minutes) or 99404 (... approximately 60 minutes), depending on the counseling session's duration.

Indeed, the preventive, risk-reduction counseling codes are not the same as those for counseling patients with established medical problems, so make sure you're clear regarding the reason the physician counsels an adolescent, coding experts warn. For instance, you would not use 99401-99404 when an adolescent has an established problem, says Richard Tuck, MD, FAAP, practicing pediatrician with Primecare Pediatrics of Zanesville, Ohio. Use these codes when the pediatrician provides general preventive counseling for a patient who may need advice on such issues as birth control or substance-abuse prevention. When an established patient is having psychological problems and needs counseling, however, [...]