Wiki 99381-99387???

[jlb0807]

Hello!

I was wondering if I could get some clarification on these codes. My administrator said that she read an article and was thinking that maybe these codes apply to some of our patients.

My first question is when exactly to use these codes? For example: a patient comes in because they are 50 with no other problems, just need a routine colonoscopy. Would we use 99386 and that code only? Also, are insurance companies paying for this code?

Thanks for any help!
Jessica

 

[Kisalyn]

Medicare and most replacement plans do not cover the preventative medicine codes.

PCPs use these codes for their patient's annual wellness visits. This is when the physician/NP completes an age and gender appropriate history, exam, counseling/anticipatory guidance and risk factor reduction (smoking cessation, weight management, diet, immunizations, and labs/tests).

If you're not the PCP, I would be wary of using these codes because insurances typically have frequency restrictions (once a year or 12 months). Your claim may hit up against the PCP's claim. I don't have experience from other specialties billing these so maybe someone else will respond.