Primary Care Coding Alert

Answer: If the visit that you are describing is for a well child who is being seen for the first time, you will have to report 99382 (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; early childhood [age 1 through 4 years]).

 

If the patient has already been seen by your FP (or another FP in the same group practice)previously, you will have to report 99392 (Periodic comprehensive preventive medicine reevaluation 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, established patient; early childhood [age 1 through 4 years]) for a patient who is two years old.

 

Coding tip: Choose from other codes, namely, 99381-99387 for new patients and 99391-99397 for established patients, depending on the age of the patient for reporting a wellness visit. The appropriate well child CPT® code should be supported by an appropriate ICD-9 code. You will report V20.2 (Routine infant or child health check) with the wellness visit code in this case, or else the claim will be denied. When you begin using ICD-10 codes, you will have to report Z00.129 (Encounter for routine child health examination without abnormal findings) instead of V20.2, assuming no abnormal findings from the encounter. Most health plans have a limit of one well-child visit per year.