CPT Code 99396 – A Comprehensive Guide for Primary Care Providers

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CPT Code 99396 A Comprehensive Guide for
Primary Care Providers
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CPT Code 99396 A Comprehensive Guide for
Primary Care Providers

• Basics of CPT Code 99396
• CPT code 99396 refers to a preventive medicine
  evaluation and management (E/M) service for
  patients aged 65 years or older. It involves a
  comprehensive annual wellness visit (AWV),
  including personalized preventive medicine
  planning. This code emphasizes the importance of
  preventive care and allows primary care providers
  to assess the overall health status of their
  elderly patients. Understanding this code and its
  associated guidelines is crucial for accurate
  medical billing and reimbursement. So, lets dive
  into the details of CPT code 99396 and explore
  its importance in primary care practices.
• Components of CPT Code 99396
• CPT Code 99396 comprises various components that
  primary care providers need to consider when
  performing the service. Lets break down these
  components
• Medical history This component involves
  obtaining a detailed medical history, including
  past illnesses, surgeries, family history, and
  medications. Understanding the patients medical
  background helps in identifying potential risk
  factors and designing appropriate preventive care
  strategies.
• Physical examination A comprehensive physical
  examination is crucial to assess the patients
  current health status. It includes evaluating
  vital signs, body systems, and overall physical
  well-being.

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CPT Code 99396 A Comprehensive Guide for
Primary Care Providers

• Counseling CPT Code 99396 also includes
  counseling services, where the primary care
  provider addresses various health-related
  concerns, provides guidance on maintaining a
  healthy lifestyle, and educates patients on
  disease prevention.
• Screening As part of the comprehensive wellness
  visit, screenings for various diseases and
  conditions are performed. This may include blood
  pressure checks, cholesterol screenings, cancer
  screenings, and immunization assessments. These
  screenings are vital for early detection and
  timely intervention.
• Risk assessment Evaluating the patients risk
  factors for different diseases is an integral
  part of CPT Code 99396. This involves assessing
  lifestyle choices, family history, and
  environmental factors that may contribute to the
  development of certain conditions. Identifying
  these risks allows primary care providers to
  tailor preventive measures accordingly.
• Billing Guidelines for CPT Code 99396
• To ensure accurate billing and reimbursement for
  CPT Code 99396, primary care providers should
  follow these billing guidelines
• Medical necessity The visit must be justified by
  the patients age and the purpose of the visit.
  The primary aim is to provide preventive care and
  wellness planning.
• Time The visit must have a minimum duration of
  30 minutes. Documenting the time spent during the
  encounter is crucial for proper billing.

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CPT Code 99396 A Comprehensive Guide for
Primary Care Providers

• Modifier use If additional services are provided
  during the wellness visit that are separately
  billable, appropriate modifiers should be used to
  indicate the separate services.
• Consent and advance beneficiary notice (ABN)
  Inform the patient about any potential
  non-covered services and obtain their consent or
  ABN if applicable.
• Billing Tips for CPT Code 99396
• To avoid common billing errors and ensure timely
  reimbursement, consider the following tips
• Thorough documentation Accurate and detailed
  documentation is essential for proper billing.
  Ensure that all components of CPT Code 99396 are
  clearly documented, including medical history,
  physical examination findings, counseling
  services provided, and screenings performed.
• Time documentation Document the exact time spent
  on the visit to meet the minimum duration
  requirement of 30 minutes. Make sure the time is
  clearly recorded in the patients medical record.
• Separate services If the patient presents with
  specific acute or chronic conditions that require
  additional evaluation or treatment during the
  wellness visit, bill and document them
  separately.
• Coding accuracy Assign the appropriate CPT codes
  based on the services rendered during the visit.
  Double-check the codes to ensure accuracy and
  avoid coding errors that can lead to claim
  denials or underpayment.
• Modifier Usage If any services provided during
  the wellness visit require a separate modifier,
  ensure that the modifiers are correctly applied
  to indicate the distinct services performed.

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CPT Code 99396 A Comprehensive Guide for
Primary Care Providers

• Upcoding or downcoding It is important to
  accurately represent the level of service
  provided during the wellness visit. Avoid
  upcoding (billing for a higher level of service
  than actually performed) or downcoding (billing
  for a lower level of service than actually
  performed) to maintain compliance and prevent
  potential audits.
• CPT Code 99396 is a crucial code for primary care
  providers, emphasizing the importance of
  preventive care for patients aged 65 years or
  older. By understanding the components, following
  billing guidelines, avoiding common errors, and
  addressing denial reasons, primary care providers
  can ensure accurate medical billing and maximize
  reimbursement.
• At Legion Healthcare Solutions, we specialize in
  medical billing services and can assist primary
  care providers in streamlining their billing
  operations, minimizing errors, and optimizing
  revenue. By partnering with our experienced team,
  you can focus on delivering high-quality patient
  care while leaving the complexities of medical
  billing to us. Contact us today at 727-475-1834
  or email us at info_at_legionhealthcaresolutions.com
  to learn more about our services and how we can
  support your practices success.

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