How To Use CPT Code 99382

CPT 99382 refers to the initial comprehensive preventive medicine evaluation and management for new patients aged 1 through 4 years. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99382.

1. What is CPT 99382?

CPT 99382 is a medical billing code used for initial comprehensive preventive medicine evaluation and management services provided to new patients aged 1 through 4 years. This code covers age and gender-appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.

2. 99382 CPT code description

The official description of CPT code 99382 is: “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).”

3. Procedure

The 99382 procedure involves the following steps:

1. Obtaining a comprehensive age and gender-appropriate history of the child.
2. Performing a comprehensive examination tailored to the child’s age and gender.
3. Providing counseling and anticipatory guidance to the caregiver.
4. Identifying and addressing risk factors for the child’s health and development.
5. Ordering appropriate laboratory and diagnostic tests as needed.

4. Qualifying circumstances

Eligibility for CPT code 99382 services includes:

• Children aged 1 through 4 years.
• New patients who have not received any professional services from the provider or another provider of the same specialty within the past three years.
• Patients who require preventive medicine services, such as well-child visits, rather than problem-focused visits.

5. When to use CPT code 99382

It is appropriate to bill the 99382 CPT code when providing initial comprehensive preventive medicine evaluation and management services to new patients aged 1 through 4 years. This includes well-child visits, routine check-ups, and other preventive care services tailored to the child’s age and gender.

6. Documentation requirements

To support a claim for CPT 99382, the following information should be documented:

• Comprehensive age and gender-appropriate history of the child.
• Comprehensive examination findings tailored to the child’s age and gender.
• Counseling and anticipatory guidance provided to the caregiver.
• Risk factors identified and addressed during the visit.
• Ordered laboratory and diagnostic tests, if applicable.

7. Billing guidelines

When billing for CPT code 99382, keep in mind the following guidelines:

• Ensure that the patient meets the age and new patient criteria for this code.
• Document all required information to support the claim, as mentioned in the documentation requirements section.
• If a separate problem-focused E/M service is provided during the same encounter, it may be billed in addition to CPT 99382 with the appropriate modifier.

8. Historical information

CPT 99382 was added to the Current Procedural Terminology system on January 1, 1992. There have been updates to the code description in 2002 and 2009, with the most recent change reflecting the inclusion of laboratory/diagnostic procedures in the description.

9. Similar codes to CPT 99382

Five similar codes to CPT 99382 and how they differ are:

• CPT 99381: Initial preventive medicine service for new patients aged younger than 1 year.
• CPT 99383: Initial preventive medicine service for new patients aged 5 through 11 years.
• CPT 99384: Initial preventive medicine service for new patients aged 12 through 17 years.
• CPT 99385: Initial preventive medicine service for new patients aged 18 through 39 years.
• CPT 99386: Initial preventive medicine service for new patients aged 40 through 64 years.

10. Examples

Here are 10 detailed examples of CPT code 99382 procedures:

1. A 2-year-old new patient’s well-child visit, including a comprehensive history, physical examination, and anticipatory guidance for the caregiver.
2. A 3-year-old new patient’s routine check-up, with a focus on developmental milestones, nutrition, and safety.
3. A 4-year-old new patient’s preventive care visit, including age-appropriate immunizations and laboratory tests.
4. A 1-year-old new patient’s well-child visit, with a comprehensive assessment of growth, development, and risk factors for future health issues.
5. A 2-year-old new patient’s preventive care visit, including a thorough examination, counseling on dental health, and ordering of necessary diagnostic tests.
6. A 3-year-old new patient’s well-child visit, focusing on social and emotional development, sleep habits, and age-appropriate screenings.
7. A 4-year-old new patient’s routine check-up, with a comprehensive history, physical examination, and discussion of preschool readiness.
8. A 1-year-old new patient’s preventive care visit, including a thorough assessment of growth, development, and risk factors for future health issues, as well as age-appropriate immunizations.
9. A 2-year-old new patient’s well-child visit, with a focus on developmental milestones, nutrition, safety, and anticipatory guidance for the caregiver.
10. A 3-year-old new patient’s routine check-up, including a comprehensive history, physical examination, and ordering of necessary diagnostic tests.