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Thread: difference between 99381 and 99391

  1. #1

    Default difference between 99381 and 99391

    AAPC: Back to School
    In the CPT manual it states that 99381 is an "Initial" and 99391 is a "Periodic" comprehensive preventive exam. How can I tell from the documentation if it is an initial versus periodic exam? Is there certain wording the physicians use to distingish each exam? Any help please to educate the physicians! -Edie

  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    The 9938x codes are for new patients; 9939x codes are for established patients.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Join Date
    Apr 2007
    Kansas City, MO


    Quote Originally Posted by Lisa Curtis View Post
    The 9938x codes are for new patients; 9939x codes are for established patients.

    Agree...but I always found the wording on this confusing....I mean you can certainly have an established patient that you are doing an "initial" preventative exam....of course, I just am anal and notice things like this...but the description does say "new patient" way at the bottom.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  4. #4
    Join Date
    Apr 2007
    Greeley, Colorado


    That is why we have to pay close attention to detail!
    Lisa Bledsoe, CPC, CPMA

  5. #5

    Default difference

    Thank you both, I read it and missed it each time!

  6. #6


    It states in CPT, a new patient is one that has not received any professional services from the physician or another physician of the same speciality who belongs to the same group practice, within the past three years. If the doctor sees a newborn patient in the hospital, say example 99460 or 99461, then sees them in the office(for the first time to the office) for example code 99381 which falls under "new patient", it states in CPT this is allowed...this is confusing to the new patient rule. Can you explain why this is ok for new if they were seen in the hospital for newborn care?

  7. #7
    Join Date
    Apr 2007

    Default Where does it say that in CPT?

    To the best of my knowledge this is not correct and I can't find where it states it is.

    I can tell you that we get rejections when this happens stating the patient is not new and the cpt code used is incorrect.

    Laura, CPC, CPMA, CEMC

  8. #8
    Join Date
    Apr 2007

    Default Preventative Exam/V-codes Educational Materials for a Provider?

    I am hoping that someone can guide me in the right direction... I have a provider who said "as far as I remember from residency program it is usually impossible to get paid for V codes.". I have been searching for a provider friendly document that will help explain the appropriateness of V-codes.
    Can anyone help?

    Thank you!

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