Outpatient Facility Coding Alert
Avoid 99381-99387 Alone for Biometric Coding
Question: An insurer asked us to use wellness codes 99381 to 99397 for biometric screening. However, as per the CPT ® guide lines, 99401 or 99402 would be more appropriate. Could you please explain in detail the right and appropriate code to be used?
Texas Subscriber
Answer: When coding for biometric screening, you should report 99429 (Unlisted preventive medicine service). Biometric screening alone does not support the Preventive Medicine Codes 99381-99387. These codes require much more intensive documentation and are typically only paid once per calendar/benefit year for subscribers.
When the provider performs a preventive medicine service that is not represented by any of the standard and active CPT® codes, use 99429 (Unlisted preventive medicine service).
When reporting a procedure with an unlisted code, submit a cover letter to the insurance explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes, and compare your service to those codes to justify the claim amount you are billing. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.
Outpatient Facility Coding Alert
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