The 99396 CPT code is a standard code used in healthcare for medical evaluations for preventive care and treatment. For healthcare professionals or patients trying to understand the meaning of this code, this article will give an in-depth look at its significance and purpose and why it’s important for prevention-based healthcare.

What is the 99396 CPT code?

Healthcare professionals utilize the CPT Coding 99396 to provide the periodic preventive medicine evaluation and management service for already established patients. The service is focused on prevention-based care and is designed to ensure that patients are healthy by providing regular checks. Instead of visits that focus on identifying illnesses or addressing chronic ailments, 99396 is about maintaining health screening for diseases and preventing health problems in the future.

It is important to remember that it is generally employed to treat adult patients. It focuses on services that analyze the individual’s health, preventive health needs, and lifestyle aspects. It’s part of a larger set of preventive codes created to ensure long-term health, identify diseases earlier, and reduce the risk of future health costs.

Key Features of CPT Code 99396

1. Age Range:

This code is intended to treat patients aged 40-64.
This is because people of this age group are thought to be in a vital stage in their lives where prevention and care may make the biggest difference. Regularly scheduled exams for heart health, cancer, diabetes, and other conditions that could be a concern are more crucial as we get closer to middle age.

2. What It Includes:

An in-depth review of the patient's medical History, including family history, lifestyle, and any relevant health screenings.
A complete physical examination to evaluate your health, monitoring vital indicators like weight, blood pressure, and heart rate.
Numerous tests and screenings are performed to detect conditions such as cancer, heart disease, diabetes, and more. The particular screenings are based on the patient's gender, age, and medical background.
The importance of vaccinations is to ensure that your patient is up-to-date with any required vaccinations, like vaccines against tetanus and flu.
The discussion will focus on lifestyle elements like exercise, diet, smoking, drinking alcohol, mental health, and other behaviors that may impact the long-term health of a person.
Evaluation of potential hazards by analyzing the patient's medical History and lifestyle, which may affect their health in the future.

3. Duration of Service:

99396 is typically employed for long-lasting visits of forty minutes or more. That is why it's usually more extensive than a typical office visit.

Why is Preventive Medicine Important?

Preventive medicine, such as the services provided under CPT code 99396, is essential in maintaining public health and reducing healthcare expenses. By identifying risks early and encouraging patients to adopt healthier lifestyles, health professionals can avoid costly and dangerous ailments in the future.

Preventive screenings, for instance, could help identify elevated blood pressure and high cholesterol as well as early indications of cancer. Early detection usually leads to a better treatment option and a better outcome. In addition, counseling offered on eating habits, exercise, and mental well-being can assist patients in maintaining the quality of their lives while also preventing heart disease, obesity, diabetes, and other chronic diseases.

What Happens During a 99396 Visit?

A typical visit to CPT Code 99396 requires several actions, including:

The doctor will obtain details about the patient's medical History, including current medications, any recent surgeries or illnesses, and their family medical background.
A doctor may conduct a physical exam and check vital signs, examine the major systems (e.g., the musculoskeletal, cardiovascular, and neurological), and assess for any health concerns that require additional examination.
The doctor will assess the patient's age, gender, and risk factors; he will provide screenings (such as mammograms, blood tests, colonoscopies, etc.).) along with lifestyle guidance (e.g., the need to quit smoking or drinking, weight control, physical exercise, and psychological health).
The doctor records the patient's History, examination findings, the results of any tests or screenings completed, any counseling services provided, and any follow-up recommendations. This document ensures that the visit is correctly recorded and invoiced.

Who Should Use CPT Code 99396?

The code is designed for established patients, that is, patients who have been treated by the same doctor or healthcare professional before. It is not applicable for new patient visits.
Healthcare providers specializing in preventive health, such as general practitioners and internal medicine physicians, utilize this code to conduct routine checks.
Patients within this age group are advised to visit their doctor to schedule preventive appointments, especially those with risk factors such as a family medical history of chronic illness, sedentary lifestyles, or other unhealthy habits.

CPT Code 99396 and Insurance Reimbursement

Insurance companies usually provide preventive health care with the CPT code 99396, particularly for those who meet certain age and health requirements. As per the Affordable Care Act (ACA), most preventive services are covered without out-of-pocket cost for the patient. However, coverage could differ by insurance company, the type of plan, and the region in which you live.

Healthcare professionals must accurately code and record the services they provided by 99396 to ensure that they receive the correct reimbursement from insurance companies.

Key Takeaways

CPT code 99396 is used for periodic preventive medicine evaluation and management for established patients aged 40-64.
This package includes complete medical background reviews, physical exams, immunizations, screenings, and lifestyle advice.
The code is crucial to the early detection and prevention of illness, ultimately improving the quality of life and reducing the cost of healthcare.
Insurance companies usually provide preventive care similar to this within the ACA; however, specific details regarding coverage can differ.

How Hello MDS Streamlines the CPT Code 99396 Process

Hello MDs simplifies processes for the CPT code 99396 process by automating the key aspects of preventive health documentation and the coding process. The system streamlines patient information collection, incorporates medical history reviews, and guarantees accurate records of examinations and screenings. With Hello MDs, healthcare professionals can quickly create detailed reports, eliminate code errors, and accelerate billing to ensure smoother and faster reimbursement for preventive appointments. This ease of use helps reduce administrative burdens, allowing doctors to concentrate more on patient care.

Final Thoughts

CPT Code 99396 emphasizes the significance of preventive care in healthcare. Regular preventive visits enable health professionals to spot any health problems that could be present earlier, provide valuable lifestyle tips, and ultimately assist patients in living longer and healthier lives. Preventive codes like 99396 are crucial to maintaining the best health through middle age if you’re a healthcare professional or a patient user.

Frequently Asked Questions

What is CPT code 99396?
CPT Code 99396 serves to perform preventive medicine assessments and management of older patients, usually between 40 and 64. The code is utilized for healthcare providers who conduct an extensive preventive examination that includes medical History reviews, physical examinations, screenings, and lifestyle counseling.
Who is eligible for a CPT Code 99396?
CPT Code 99396 is used to treat patients aged 40 to 64 who receive preventive treatment. These patients may be at risk or may need regular checks to ensure their good health.
What is included in CPT code 99396?
The services include a thorough examination of the person's medical background, physical exam, prevention-based screenings (like blood tests or cancer screenings), vaccinations, and advice on lifestyle aspects like exercise, diet, smoking cessation, and mental health.
What is the length of the CPT Code 99396 visit typically take?
A typical visit under CPT Code 99396 usually lasts approximately 40 minutes or more due to an exhaustive examination of the patient's health situation and prevention recommendations.
Do I have to use CPT Code 99396 on new patients?
No, CPT Code 99396 is only designed for existing patients. If you're treating a new patient, a different code could be used to indicate the new patient's preventive visit.