A preventive medicine service is an age and gender appropriate history and exam and includes anticipatory guidance, a discussion about risk factor reduction, and provision or referral for immunizations and screening tests. The medical history recorded, the examination performed, as well as the content of advice can vary by the gender and the age and of the patient.
A problem-oriented visit is the one which addresses an acute or chronic condition and documents history, exam, and medical decision making related to the condition.
As per the CPT; the preventive visiting codes include 99381-99397 which cover counseling/anticipatory guidance/risk factor and reduction interventions. Nevertheless, when such counseling is delivered as part of a separate problem-oriented encounter, it could be billed using preventive medicine codes 99401to 99409.
For example, if you deliver significant counseling on smoking cessation during a visit for an ankle sprain, you can be billed for the counseling for submitting to an E/M office visit code for the problem-oriented service.
A rundown of the counseling needs to be included in the documentation. Furthermore; ICD-9 codes for preventive counseling requires pairing with the CPT codes.
Medicare explains that the goals of these wellness visits are health promotion and disease prevention and detection. Preventive medicine services focus on 3 specialty areas which include:
- Aerospace medicine
- Occupational medicine
- Public health and general preventive medicine
Medical coding services to document preventive visits involve using the correct CPT and ICD-10 codes to report the services provided.
Preventive medicine services provided will vary by patient circumstance. While the services for a young child will assess physical growth and developmental milestones such as speech, crawling, and sleeping habits, an adolescent preventive service may include scoliosis screening, assessment of growth and development, and a review of immunizations.
A comprehensive preventive visit for an adult female patient will include a gynecologic examination, pap smear, and breast exam and for an adult male’s exam, services would include a checkup of the penis testes and the prostate for older individuals.
Even though the Affordable Care Act i.e. ACA requires insurers to cover recommended preventive services without any patient cost-sharing, exact coverage and reporting requirements may vary from payer to payer. Experienced medical billing and coding companies like Medisys can provide the services of skilled medical coders who are up to date with the coding changes and updates related to E/M and preventive medicine services.