Table of Contents

Basics of CPT code 99395

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. CPT code 99395 is reported for Patient age between 18 to 39 years.

99395 – 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;18-39 years

A preventive (well-patient), outpatient office visit for patient, ages 18-39 years old.

When to use E/M and CPT code 99395 together

If a patient comes with a preventive visit and E/M visit together, in such cases E/M visit can be billed if a significant separate abnormality which require extra work different from the diagnosis of preventive visit.

For example, if a patient with age 20 years comes for annual or periodic visit ( Dx Z00.00) and also has an E/M visit for a different diagnosis like DM or CKD in such cases both the procedure can be billed together with different diagnosis and 25 modifier to the E/M visit.

99395 – Dx Z00.00

(99212-99215)E/M with 25 modifier – Dx CKD or DM

Note: Both the Procedure should be linked to different ICD-10 codes, then only the both CPT codes can be paid, because 25 modifier is assigned only with a significant, separately identifiable evaluation and management (E/M) service provided , hence both diagnosis should be different for both exams.

The patient problem or an abnormality should warrant additional work and the documentation must support the necessary elements to justify the office visit that is billed.

Coding scenario for CPT code 99395

A 22-year-old established patient presents for an annual exam. When you ask about his current complaints, he mentions that he has had mild chest pain and a productive cough over the past week and that the pain is worse on deep inspiration. You take additional history related to his symptoms, perform a detailed respiratory and CV exam, and order an electrocardiogram and chest X-ray. You make a diagnosis of acute bronchitis with chest pain and prescribe medication and bed rest along with instructions to stop smoking. You document both the problem-oriented and the preventive components of the encounter in detail.

You should submit CPT code 99395, “Periodic comprehensive preventive medicine …, established patient; 18-39 years” and ICD-10 code Z00.00, “Routine general medical examination at a health care facility”; and the problem-oriented code that describes the additional work associated with the evaluation of the respiratory complaints with modifier -25 attached, ICD-10 codes J20.9, “Acute bronchitis” and R07.9, “Chest pain” and the appropriate codes for the electrocardiogram and chest X-ray.

CPT code & Diagnosis

CPT code 99395 Dx. Z00.00

99213 – 25 Dx. J20.9

93000 Dx R07.9

71010 Dx R07.9

Reference:

https://www.utmb.edu/fgp/newsletter/article/newsletter/2023/06/06/coding-clip-june23

https://www.aafp.org/pubs/fpm/issues/2004/0400/p49.html