Simplifying Preventive Visit Coding- Best Practices for CPT 99396.pptx

Master CPT 99396 coding for preventive visits with key guidelines on documentation, ICD-10 codes, modifiers, and billing best practices.

1. Simplifying Preventive Visit Coding Effective Coding In Healthcare Is Important, Especially In Terms Of Reimbursement And Payer Policy Compliance. Coding For Preventive Visits May Be Challenging At Times, Particularly For Cpt Code 99396. This Is For Preventive Medicine Services For Established Patients Aged Between 40 And 64 Years. To Ease Documentation And Billing, Medical Professionals Should Implement Best Practices To Reduce Errors And Maximize Efficiency. Here We Are Going To Make The Basics Of Cpt 99396 Easy To Understand, Which Includes Patient Criteria, Documentation Requirements, Billing Process, And Errors To Avoid: Understanding CPT Code 99396: CPT code 99396 is a preventive medicine evaluation and management (E/M) service. Preventive visits vary from problem-based visits as the former addresses health maintenance, disease prevention, and risk assessment rather than complaints. This service will typically include: A comprehensive review of the medical history A comprehensive physical examination Age- and health-status-appropriate screenings and risk assessments Counseling on preventive care and lifestyle recommendations Appropriate vaccinations and lab tests   https:// www.247medicalbillingservices.com   [email protected]

2. Key Components of CPT 99396 In order to bill CPT 99396, providers should include the following items: Patient Eligibility: Returning patients only: CPT 99396 is billed for returning patients between 40-64 years old. In case of a new patient, an alternative CPT code (99386) has to be used. Documentation Requirements:   Proper documentation is necessary to validate the claim. Providers must document: Comprehensive Medical History: History of previous illnesses, family history, current medications, and lifestyle. Physical Exam: Comprehensive examination of body systems based on age-related risk factors. Preventive Screens: Tests based on age, including blood pressure, cholesterol screening, cancer screenings (e.g., mammogram, colonoscopy), and vaccinations. Risk Assessments: Risk assessment for chronic disease based on family and personal history. Counseling and Health Education: Exercise, diet, quitting smoking, etc. ICD-10 Diagnosis Codes To warrant medical necessity, the correct ICD-10 "V" codes need to be used. The codes describe the preventive type of visit. A few more typical ICD-10 codes are: Z00.00 - Normal adult medical examination Z00.01 - Abnormal findings on the adult medical examination Z13.220 - Screening for lipid disorders Z12.11 - Screening for malignant neoplasm of the colon   https:// www.247medicalbillingservices.com   [email protected]

3. Billing Rules for CPT 99396 Proper Billing Ensures Proper Payment. In Fact, Important Things To Keep In Mind While Billing Are: 1. Time Requirement Although CPT 99396 Is Not Time-based, Providers Are Encouraged To Report Duration Of Visit Where Required By Some Payers. A Vast Majority Of Payers Expect A Comprehensive Visit That Takes A Lot Of Time. 2. Application Of The Modifier Modifier 25: If A Patient Presents With A New Or Chronic Issue That Requires More Evaluation Than Preventive Care, A Separate E/M Code Can Be Billed Along With modifier 25. Modifier 33: If Services Are Fully Covered Under The Affordable Care Act (Aca) Preventive Care Guidelines, Modifier 33 Can Be Applied. 3. Separate Billing For Non-preventive Services :  Read More In Detail: Https://Bit.Ly/3F2V36G   https:// www.247medicalbillingservices.com   [email protected]

4. Common Billing Errors and How to Avoid Them Billing errors can lead to claim denials, payment delays, and compliance problems. Some common errors and how to prevent them are listed below: Improper Diagnosis Codes: Preventive visits should always be billed with a correct ICD-10 Z code. When treating an acute condition, place the Z code first, followed by the relevant condition code. Failure to Document Preventive Nature of Visit: It is also required to make sure chief complaint contains " preventive visit " or "annual wellness visit" and separate preventive services from problem-oriented care clearly. Incorrect Use of Modifiers: In case another problem-focused E/M service is provided, use modifier 25, and document all elements required by CPT 99396 separately from the additional service. Upcoding or Downcoding : Avoid billing for a higher level of service than is actually done (upcoding) or a lesser level of service to avoid risk of audit ( downcoding ).   https:// www.247medicalbillingservices.com   [email protected]

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