CPT codes are crucial in healthcare billing and coding, ensuring the proper documentation and reimbursement of services provided. Among the many is CPT Code 99395, a preventive outpatient office visit medicine service. If you are a health provider, a medical coder, or anyone in medical billing, you should know what this code entails to avoid confusion and ensure accurate billing.

99395 CPT Code Description

The 99395 CPT Code refers to preventive medicine services for established patients. Specifically, it is used for an annual physical exam or wellness visit for patients aged 18 to 39 years. The visit includes a comprehensive review of the patient’s health, screenings, immunizations, and other preventive measures. It must be noted that this is only for established patients, which means the patient has been seen by the healthcare provider before as a follow-up, not a first-time patient.

Key Elements of CPT Code 99395

As part of the 99395 CPT Code, in billings, some aspects should be documented, and these include the following:

  1. Comprehensive History: The physician must take an extended medical history, including family, lifestyle-related issues and other changes that might have occurred between the previous and current visits. It must include chronic conditions and risk factors, which would continue to require observation.
  2. Physical Examination: A thorough physical exam assesses the patient’s health. This includes checking vital signs (blood pressure, heart rate, temperature, respiratory rate), performing basic tests, and physically examining the body for abnormalities or health concerns.
  3. Screening Tests: Screening tests are a part of this visit. This may include cholesterol testing, blood glucose testing, cancer screening, mammograms, Pap smears, STIs, and so on, based on what they might need for that patient’s history and risk factors.
  4. Counseling and Risk Factor Reduction: Counseling on healthy lifestyles should not miss the preventive visit. Diet, exercise, weight control, smoking cessation, and alcohol use constitute such counseling. Teaching the patient how to understand the management of health conditions he already has, for instance, hypertension and diabetes, to prevent further complications is another role of risk factor reduction.
  5. Immunizations: Ensuring patients are up-to-date with their vaccinations is another crucial part of preventive care. This includes administering vaccines as needed, such as flu shots, Tdap, HPV, and others, based on the patient’s age and health history.
  6. Documentation of Findings: The results of all investigations, including history, physical exam, screenings, and counseling, need to be placed in the patient’s medical record. Correct documentation ensures that the service qualifies for billing purposes and allows the provider to validate the requirement for the visit.

Who Can Use the 99395 CPT Code?

CPT Code 99395 is given to established patients aged 18 to 39. Usually, this CPT code refers to a visit for preventive care and is not related to the patient’s illness or injury. Specifically, it involves an annual check-up or physical exam for well-being, concentrating on preventing disease in the future.
Providers Authorized to use It include:

Primary care physicians, or PCPs
Internal medicine doctors
Family practice doctors
Nurse practitioners (if they provide the preventive care services)
Physician assistants

What is the Difference Between CPT Codes 99395 and 99396?

Both the 99395 CPT Codes and 99396 are preventive medicine visits, but the difference here is the age of the patient:

For patients aged 18 to 39 years, the CPT Code is 99395
For patients aged 40 to 64 years, the CPT Code is 99396

The difference would be the patient’s age, which will determine the code used. Both codes cover similar services, such as comprehensive health assessments, screenings, counseling, and immunizations. All these, by the condition of age, will determine the appropriate code that will be used in billing.

How to Bill for the 99395 CPT Code

When submitting a claim for CPT Code 99395, all services provided during the visit should be documented correctly. This includes:

Ensure that the visit date is recorded correctly.
The physician or healthcare provider must document a thorough patient history.
Document all vital signs and any abnormalities found during the physical exam.
Document all screenings (e.g., blood pressure, cholesterol, vaccinations).
Record all patient counseling sessions, including advice on lifestyle changes.
Record all the vaccines administered during the visit.

The provider should be guaranteed that the picked CPT code is supported by related ICD 10 diagnosis code(s) that will show the patient’s health status and risk factors for the preventive visit.

General Issues with Billing Using the CPT Code 99395

As with most other billing codes, 99395 CPT Code may cause coding errors or denials unless the code is applied appropriately. Some of the common issues include:

The patient is outside the 18-39 age range, so the CPT 99395 cannot be used.
The claim might be denied if the required components of the preventive visit are not documented.
The services rendered must correspond to the CPT code applied. Billing for services not provided could lead to audits or penalties.

The provider should be guaranteed that the picked CPT code is supported by related ICD 10 diagnosis code(s) that will show the patient’s health status and risk factors for the preventive visit.

How Hello MDs Streamlines the Billing Process for CPT Code 99395

Hello MDs simplifies the billing process for 99395 CPT Code by giving users an efficient, user-friendly portal for telehealth consultations. The participants can make virtual preventive visits, document patient histories, undertake physical exams, and administer screenings all through the same integrated system using Hello MDs. An essential automated collection of all needed information ensures proper documentation and minimizes coding errors. By simplifying the workflow, Hello MDs seamlessly helps providers submit claims for CPT 99395, reducing administrative burden and ensuring timely reimbursement.

Conclusion

CPT Code 99395 plays a crucial role in billing preventive medicine services. This code particularly pertains to annual physicals or wellness visits for established patients between 18 and 39 years of age. Understanding the components of this code can help ensure proper documentation of preventive services by healthcare providers with easy billing processes.

Hello, MDs is a platform that offers telehealth providers the efficiency of virtual consultations, patient documentation, and preventive screenings. It reduces administrative burden, minimizes coding errors, and ensures on-time reimbursement. Proper use of CPT 99395 allows for the delivery of comprehensive preventive care while still being within compliance with billing standards.
In the end, proper billing and documentation help healthcare providers and ensure that patients get the best preventive care possible to promote long-term health and wellness.

Frequently Asked Questions

What are the services provided under CPT Code 99395?
CPT Code 99395 is used for preventive medicine services, which include a comprehensive history, physical examination, preventive screenings such as cholesterol and blood glucose, counseling about lifestyle changes, and administering vaccines. It is an annual wellness visit for established patients aged 18 to 39 years.
Is CPT Code 99395 for new patients?
No, CPT Code 99395 is for an established patient only; in this case, the patient has already been seen by the healthcare provider before any visit. New patients will require other CPT codes for their preventive services.
What's the difference between CPT Codes 99395 and 99396?
The key difference is that of a patient's age, which is:

  • CPT Code 99395 is for an age of 18 to 39 years.

  • CPT Code 99396 is for an age of 40 to 64 years.

Both codes relate to similar preventive services, but the age difference decides which one is applied.
What if CPT Code 99395 is misapplied?
A claim will be denied if CPT Code 99395 is wrongly applied to a patient aged between 18 and 39 or if there is insufficient documentation. Care must be taken to ensure that the services rendered align with the code being applied and that all critical documentation is in place.
How does Hello MD assist with billing for CPT Code 99395?
Hello MD streamlines the process by providing a user-friendly telehealth consultation platform. Providers can conduct virtual preventive visits, document patient histories, perform screenings, and ensure accurate coding all in one system. This reduces errors and administrative workload and streamlines the billing process for CPT Code 99395.