Table of commonly reported ICD‐10‐CM codes for Preventive Services ICD‐10‐CM Code Descriptor Special Coding Conventions Encounter and Examination Codes Z00.110 Newborn check under 8 days old Outpatient codes only Z00.111 Newborn check 8 to 28 days old Outpatient codes only Z00.121 Z00.129 Routine child health examination with abnormal findings
Preventive screenings apply to patients who have no signs or symptoms of the specific disease. To appropriately assign an ICD-10 code for a screening service, reference the ICD-10-CM Official Guidelines for Coding and Reporting, Section IV, C.21.5, where screening is defined.
CPT CODE 99381, 99382 - 99385 - Preventive visit new patient - Medical Billing and Coding - Procedure code, ICD CODE. CPT CODE 99381, 99382 – 99385 – Preventive visit new patient Sep 25, 2016 | Uncategorized CPT Code and description
• For children age 18 (adolescent), use CPT code 99395. • Not all insurers pay for preventive medicine visits. For example, these visits are not covered by Medicare. If you suspect a patient does not have coverage, advise him or her of your billing policies.
“Routine” diagnosis codes are considered Preventive. For example: ICD-10-CM codes Z00. 121, Z00.
0 - 17 years inclusiveZ00. 129 is applicable to pediatric patients aged 0 - 17 years inclusive.
PREVENTIVE SCREENING CODE CROSSWALKPreventive screeningICD-9 codesICD-10 equivalentsLipoid disorder screeningV77.91 Screening for lipoid disordersZ13.220 Encounter for screening for lipoid disorders11 more rows
Example: A child has a well-child visit EPSDT (99381 – 99461), with a well child diagnosis code (Z-code) in the first position; the sick visit code (99211 – 99215) with the modifier 25 and with the illness diagnosis CPT code in the second position.
Z00.129ICD-10 Code for Encounter for routine child health examination without abnormal findings- Z00. 129- Codify by AAPC.
0 - 17 years inclusiveZ00. 121 is applicable to pediatric patients aged 0 - 17 years inclusive.
For established patients making a well baby/well child care visits: • For infants under age 1, use CPT code 99391. For children ages 1 to 4 (early childhood), use CPT code 99392. For children ages 5 to 11 (late childhood), use CPT code 99393.
Z00.00No specific diagnosis is required for the Annual Wellness Visit, but Z00. 00 or Z00. 01 is appropriate for the Annual Routine Physical Exam. A Depression Screening (G0444) is a required component within the initial Annual Wellness Visit (G0438) and should not be billed separately.
Z00.00ICD-10 Code for Encounter for general adult medical examination without abnormal findings- Z00. 00- Codify by AAPC.
Visual acuity testing (99173) is a covered, separately reimbursable service when performed in conjunction with a preventive medicine service code (99382, 99383, 99392, 99393) for patients aged 3-5 years.
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes.
99391 can be used multiple times throughout the first 12 months of life up to the baby's first BD. After their first BD, use 99392 up to the 5th BD; 99393 ages 5 - 11, etc.
Physicians should report CPT code, for developmental screening or other similar screening or testing, separate and distinct from the Preventive medicine service only when the testing or screening results in an interpretation and report by the physician being entered into the medical record.
A: Counseling, anticipatory guidance and risk factor reduction interventions are integral to a Preventive Medicine visit. Historical information may be obtained either through direct questioning or through completion of a written questionnaire. The responses on a questionnaire often identify areas for more focused interventions or treatments. Since this screening is part of a Preventive Medicine service, it is not reimbursed separately. Occasionally, a screening instrument requires interpretation, scoring, and the development of a report separate from the Preventive Medicine encounter. In those situations, where a CPT code exists for that service, screening, interpretation and development of a report is reimbursed separately from a Preventive Medicine service.
Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402] are comprehensive in nature, reflect an age and gender appropriate history and examination, and include counseling, anticipatory guidance, and risk factor reduction interventions, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a preexisting problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, Oxford will reimburse Preventive Medicine service plus 50% the Problem-Oriented E/M service code when that code is appended with modifier 25. If the Problem-Oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.
When a physician furnishes a Medicare beneficiary a covered visit at the same place and on the same occasion as a noncovered preventive medicine service (CPT codes 99381- 99397), consider the covered visit to be provided in lieu of a part of the preventive
Periodic comprehensive preventive medicine re-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 immunizations, laboratory/diagnostic procedures for an established patient.
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 immunizations, laboratory/diagnostic procedures for a new patient.
99381 – 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; infant (age younger than 1 year)
In these cases, the sign or symptom is used to explain the reason for the test.
If the answer is “yes,” the service is diagnostic, not screening, and the diagnosis code for the sign or symptom is listed on the claim for that encounter. If the answer is “no,” the service is preventive screening and should be coded, as such. Preventive screenings apply to patients who have no signs or symptoms of the specific disease.