# E/M codes 95 or 97 guidelines



## zztoolzz (Jul 10, 2013)

Is anyone billing preventative codes? We've never billed preventative we have always billed 99201-99203 or 99212-99214. We've been told recently that we need to bill preventative when a patient is coming in for an annual skin exam even though the preventative codes will be denied.

Can we use the entire office note to find HPI and ROS as long as we do not double dip?

For the 95 guidelines there are organ systems and body areas. If we do a full body exam which is listed out as each body part examined could we use all 10 body areas and that be a comprehensive exam? I see that it says 1 body area or organ system, 2-7 body systems, 8 or more body systems. Do you have to use the organ systems or do you have to use the organ systems with the body areas or can you just use the body areas? With the 97 guidelines it's hard for us to get a comprehensive exam so we are wondering if it may be easier to use the 95 guidelines.

What guidelines does everyone else use? If we have 10 body areas listed as examined can we use that as a comprehensive exam using the 95 guidelines?


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## JG24 (Jul 10, 2013)

Preventive codes for billing can be found in CPT codes 99381 - 99397.  You determine the code by asking two questions:  Is the patient new or established with the practice and how old is the patient?  I encourage you to read the CPT guidelines for these codes.  These are codes that are used when the patient comes in for routine physicals and have no medical problems.  Diagnoses codes for these CPT codes are found in the V codes in your ICD-9 book and should be listed as the first code.  For example, women who come in for their annual Pap smear and breast exam are billed with V72.31, routine annual physicals are normally billed with codes from the V70.- section.  However, if the patient is covered by Medicare you would need to use the appropriate G code from the HCPCs for these individuals.  With those CPT codes and G-codes, no co-pays are collected as these are covered at 100% per the Obama Healthcare plans.  

Your provider would document the visit as they would any regular visit, the CPT code tells the insurance company that it is a "preventive" visit and was not seen for any medical problems.

Hope this helps


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## zztoolzz (Jul 11, 2013)

JG24 said:


> Preventive codes for billing can be found in CPT codes 99381 - 99397.  You determine the code by asking two questions:  Is the patient new or established with the practice and how old is the patient?  I encourage you to read the CPT guidelines for these codes.  These are codes that are used when the patient comes in for routine physicals and have no medical problems.  Diagnoses codes for these CPT codes are found in the V codes in your ICD-9 book and should be listed as the first code.  For example, women who come in for their annual Pap smear and breast exam are billed with V72.31, routine annual physicals are normally billed with codes from the V70.- section.  However, if the patient is covered by Medicare you would need to use the appropriate G code from the HCPCs for these individuals.  With those CPT codes and G-codes, no co-pays are collected as these are covered at 100% per the Obama Healthcare plans.
> 
> Your provider would document the visit as they would any regular visit, the CPT code tells the insurance company that it is a "preventive" visit and was not seen for any medical problems.
> 
> Hope this helps



Do you work at a dermatologist? You've had these paid? We've been told Dermatologist are not allowed to bill for preventative services so we've never had a claim paid when billing preventative codes. Are we suppose to bill the preventative code even though we know it will be denied and then the patient will have to pay out of pocket for that service?


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