Understanding Preventive Medicine Services
- Katharine Barbagallo CPC,CPMA, CRC, CPC-I
- Aug 10, 2017
- 2 min read
Does your provider know the difference between CPT® Preventive Medicine Services (codes 99381-99397) and Medicare Preventive Service Annual Wellness Visit (G0402, G0438 & G0439)? While doing documentation/coding reviews and meeting with providers, I often notice that providers struggle with the differences between the two. If the patient was scheduled for an annual physical but they are actually there for an annual wellness visit, the documentation requirements are quite different. Improper documentation and code assignment can present problems and may lead to financial paybacks. Proper documentation and coding is essential to billing compliance. Medicare Part B does not cover CPT® Preventive Medicine Services codes 99381 thru 99397. These services are traditionally referred to as annual physicals and are covered once a year by commercial carriers, MCO’s and HMO’s. Preventive medicine services have specific requirements that must be met, the extent and content is determined by the age and gender of the patient. The comprehensive nature of the Preventive Medicine Services reflect an age and gender appropriate history/ and exam and is not the same as a comprehensive examination required in Evaluation and Management codes¹. Preventive medicine services include counseling, risk factor reductions¹, review of immunizations, and ordering or reviewing preventive diagnostic testing. It is important to note that some carriers have limits on what they will cover.
A preventive medicine service is a non-problem focused visit. If a problem is encountered and is significant enough to require additional services, an additional Evaluation and Management code can be added with the proper documentation.
In 2009, CMS created several new services for Medicare Part B beneficiaries in the area of preventive care. They include the following:
Initial Preventive Physical Examination (IPPE -G0402)- A face-to-face visit limited to a new beneficiary during the first 12 months of Medicare enrollment.
Initial Annual Wellness Visit (IAWV -G0438)- All Medicare Part B beneficiaries that are not within 12 months of initial enrollment and have not received IPPE are eligible for this service.
Subsequent Annual Wellness Visit (AWV –G0439) – All Medicare Part B beneficiaries are eligible annually after the IAWV.
These services have guidelines and documentation requirements that must be met. To learn more about appropriate documentation and how to optimize your workflow for these services, see our recently published articles in hfm.
® CPT is a registered trademark of the American Medical Association.
¹ CPT® 2017 Professional page 37 & 38