This brings to our attention probably the most egregious misuse of these codes, or lack of their use. Primarily because Medicare does not cover these services, providers have long had a tendency to substitute 99214 or 99215 for preventive services because the history and examinations were often similar in their breadth and depth. When two services are provided, for example an annual preventive service and the management of several chronic problems code both. These services are notable for the fact that there – is no medical decision making in their description. Check with other commercial or third-party payers to see if there is a protocol or method of reporting combined services of this nature. Many carriers will not pay for two such services on the same day, or their computer systems will routinely deny one of the codes. Bring the situation to their attention. Quick Comparison Preventive Medicine Services New Patient – Medical E/M Patient Age History Exam Decision Code Status Making1 No Under 1 Age and gender Age and gender Ordering 99381 complaints year appropriate appropriate lab/diagnostic procedures No 1-4 Age and gender Age and gender Ordering 99382 complaints years appropriate appropriate lab/diagnostic procedures No 5-11 Age and gender Age and gender Ordering 99383 complaints years appropriate appropriate lab/diagnostic procedures No 12-17 Age and gender Age and gender Ordering 99384 complaints years appropriate appropriate lab/diagnostic procedures No 18-39 Age and gender Age and gender Ordering 99385 complaints appropriate appropriate lab/diagnostic procedures No 40-64 Age and gender Age and gender Ordering complaints years appropriate appropriate lab/diagnostic procedures No 65 and Age and gender Age and gender Ordering 99387 complaints over appropriate appropriate lab/diagnostic procedures
This brings to our attention probably the most egregious misuse of these codes, or lack of their use. Primarily because Medicare does not cover these services, providers have long had a tendency to substitute 99214 or 99215 for preventive services because the history and examinations were often similar in their breadth and depth. When two services are provided, for example an annual preventive service and the management of several chronic problems – code both. These services are notable for the fact that there is no medical decision making in their description. Check with other commercial or third-party payers to see if there is a protocol or method of reporting combined services of this nature. Many carriers will not pay for two such services on the same day, or their computer systems will routinely deny one of the codes. Bring the situation to their attention. Quick Comparison Preventive Medicine Services – New Patient E/M Code Patient Status Age History Exam Medical Decision Making1 99381 No complaints Under 1 year Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures 99382 No complaints 1-4 years Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures 99383 No complaints 5-11 years Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures 99384 No complaints 12-17 years Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures 99385 No complaints 18-39 Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures No complaints 40-64 years Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures 99387 No complaints 65 and over Age and gender appropriate Age and gender appropriate Ordering lab/diagnostic procedures
AppendixPolicyProcedureManual.docx