Description of CPT code 99391, 99392, 99393, 99394, 99395, 99396 & 99397
99391 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 laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)
99392 early childhood (age 1 through 4 years)
99393 late childhood (age 5 through 11 years)
99394 adolescent (age 12 through 17 years)
99395 18-39 years
99396 40-64 years
99397 65 years and older
Periodic comprehensive preventive medicine services are typically well-patient examinations for established patients presenting for reevaluations and/or management of overall health condition with code selection dependent upon the patient’s age. These services include applicable patient history and examination, guidance/recommendation regarding personal risk factors, and any laboratory and/or diagnostic procedures ordered.
Clinicians are not required to report minor or self-limiting problems or complaints noted during the course of the preventive examination when those problems do not require any additional work or necessitate performing the key components of a problem oriented E/M service. Report 99391 for infants younger than 1 year of age; 99392 for children 1 to 4 years of age; 99393 for children 5 to 11 years of age; 99394 for adolescents12 to 17 years of age; 99395 for adult patients 18 to 39 years of age; 99396 for patients 40 to 64 years of age; and 99397 for patients 65 years of age and older.
Diagnoses Must Support Preventive Nature of the Visit CPT code 99391, 99392, 99393, 99394, 899395, 99396 & 99397
Every billed service must be supported by an ICD-10 code(s) that describe the reason for that service. In the case of a well visit—because there is no patient complaint—you should turn to so-called “Z codes” (Factors influencing health status and contact with health services). For example:
- Z00.110 Health examination for newborn under 8 days old
- Z00.111 Health examination for newborn 8 to 28 days old
- Z00.121 Encounter for routine child health examination with abnormal findings
- Z00.129 Encounter for routine child health examination without abnormal findings
- Z00.00 Encounter for general adult medical examination without abnormal findings
- Z00.01 Encounter for general adult medical examination with abnormal findings
- Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
- Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings