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Pediatric Coding Alert

READER QUESTIONS:

Have Policyholders Check 99381, 99391 Coverage

Published on Fri Mar 13, 2009

Question: Is there a limit or a set criteria for how many preventive visits can be billed for an infant until age 1 using 99381 or 99391? Online Subscriber Answer: CPT contains no frequency limitations on how many times you can report 99381 (Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant [age younger than 1 year]) and 99391 (Periodic comprehensive preventive medicine reevaluation and management of an individual ...) for a patient during his first year. Insurers, however, may only cover a designated number of preventive medicine services in a given year. To avoid problems with noncovered service payment, you may want to have an office policy that notifies patients of how many preventive medicine visits you recommend in the first year and advises parents to [...]
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