EM Coding Alert

Question: We have a 70-year-old patient that came in for a reevaluation and management as she does on occasion. When I submitted 99397, Medicare denied the claim. How can we get paid for this? 

Maine Subscriber

Answer: If there is a chronic condition that the physician is addressing, the appropriate code choice would come from the established patient visit range (99211-99215 Office or other outpatient visit for the evaluation and management of an established patient, …), based on the documented history, exam, and medical decision making. 

Code 99397 (Periodic comprehensive preventive medicine reevaluation and management of an individual …) is a non-covered service by Medicare. However, some Medicare replacements do pay for the 99397 once a year. Check with your individual payers about their policies.