Primary Care Coding Alert

Question: A patient scheduled an appointment because they needed to have a physical before they could start a new job. According to their chart, they haven’t had a physical of any kind in the past 12 months. Can this count as their annual preventive visit, in terms of coding and billing, or should it be reported differently?

Missouri Subscriber

Answer: Most payers will cover only one preventive physical exam per year — and, generally, that means every 365 days, not calendar year. You can check directly with the respective payer to make sure you’re following their guidelines and policies for preventive visits, especially regarding timing.

If the patient has not already had an annual preventive visit, you may be able to use one of the following CPT^® codes for the encounter — assuming the encounter is comprehensive and meets the requirements listed in the descriptor and the patient does not bring up any specific concerns:

• 99382-99387 (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 laboratory/diagnostic procedures, new patient ...) for new patients
• 99392-99397 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...) for established patients

These visit codes should include a comprehensive exam that could be appropriate for a preemployment physical.

If you’re looking for a diagnosis code, check out Z02.1 (Encounter for pre-employment examination).

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC