99395 CPT Code: Preventive visit, new patient, 18-39 years

What is 99395 CPT Code

The code represents a preventive visit for a new patient aged between 18 and 39 years. It is used primarily by healthcare providers to bill for a comprehensive evaluation that emphasizes disease prevention and health promotion. This visit typically includes a thorough assessment of the patient's health history, physical examination, and necessary screenings or vaccinations relevant to their age group.

Incorporating this code into billing practices allows healthcare professionals to ensure that they are compensated for the time spent on preventative care. It highlights the importance of early detection of health issues and encourages patients to engage in their health management proactively. Moreover, it aligns with broader public health goals to reduce the incidence of chronic diseases through regular check‑ups.

Services Covered Under 99395 CPT Code

This code covers a range of preventive services tailored for young adults. The following table provides a detailed overview of the services included.

Who Can Use the 99395 CPT Code?

This code can be applied by various healthcare providers focused on preventive medicine. Here are the professionals eligible to use this code:

• Primary Care Physicians: Family doctors and internists who provide general health care and preventive services.
• Pediatricians: Physicians who specialize in the health care of adolescents and young adults.
• Nurse Practitioners: Advanced practice nurses who can perform physical exams and provide preventive care.
• Physician Assistants: Health professionals who can conduct evaluations and provide patient education in preventive health.

How to Use 99395 CPT Code

Correctly applying this code involves specific documentation and service provision. Here are key steps:

• Document the patient’s health history: Ensure a detailed account of the patient's previous medical history is recorded. Example: A patient reports a family history of hypertension, which necessitates specific screenings.
• Record physical examination findings: Note all relevant physical examination results. Example: Blood pressure readings are taken and recorded accurately during the visit.
• Include conducted screenings: Detail any screenings performed during the visit. Example: Cholesterol levels are checked, and the results are documented in the chart.
• Discuss health counseling: Summarize discussions about lifestyle changes and preventive measures. Example: The provider discusses dietary adjustments and exercise with the patient.

Reimbursement Rates for 99395 CPT Code

The reimbursement rates for this code can vary significantly between private and public insurance providers. The table below outlines typical reimbursement rates:

Disclaimer: Reimbursement rates are subject to change based on various factors including location, specific insurance plans, and contractual agreements. This article will be updated regularly to reflect average prices.

Benefits of 99395 CPT Code

This code offers numerous benefits that enhance patient care and provider efficiency. The following table summarizes these advantages:

Common Mistakes to Avoid with 99395 CPT Code

Miscalculations in coding can lead to audits, claim denials, and financial losses for healthcare providers. Below are common errors to avoid:

• Inadequate Documentation: Failing to document all services provided during the visit can lead to denials. For example, neglecting to note counseling discussions might result in insufficient justification for billing.
• Incorrect Patient Age: Using this code for patients outside the 18-39 age range can lead to significant penalties. For instance, billing for a 40-year-old patient using this code would be considered improper coding.
• Not Including Necessary Screenings: Omitting relevant screenings can raise red flags during audits. An example is not documenting a cholesterol screening when it is standard practice for the age group.
• Failure to Update Patient History: Not keeping the patient's medical history current can lead to incomplete assessments. For example, missing updates on a patient’s medications can impact the overall evaluation.

99395 CPT Code vs other codes

Comparing this code with similar preventive codes can help clarify its specific use. The following table outlines key differences:

Conclusion

The 99395 CPT code serves as a crucial billing tool for preventive visits among new patients aged 18 to 39. It encompasses a comprehensive range of services, including health assessments, screenings, and counseling, all aimed at promoting long‑term health. Proper application of this code requires meticulous documentation and adherence to specific guidelines, ensuring that healthcare providers are adequately compensated for their services. By understanding its nuances, medical coding professionals can enhance their practice's efficiency and contribute to improved patient care.

Disclaimer: This article is for informational purposes only and does not constitute legal or medical advice. Always consult professional guidelines and regulatory bodies for specific compliance requirements.