How To Use CPT Code 99384

CPT 99384 is a preventive medicine evaluation and management service for new adolescent patients aged 12-17 years. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99384.

1. What is CPT 99384?

CPT 99384 is a code used to report a comprehensive preventive medicine evaluation and management service provided to a new adolescent patient aged between 12 and 17 years. This service includes a comprehensive history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures. The purpose of this code is to ensure proper billing and documentation for preventive medicine services for adolescents.

2. 99384 CPT code description

The official description of CPT code 99384 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; adolescent (age 12 through 17 years)”.

3. Procedure

The 99384 procedure involves the following steps:

  1. Obtaining a comprehensive age and gender-appropriate history of the patient.
  2. Performing a comprehensive examination tailored to the patient’s age and gender.
  3. Providing counseling, anticipatory guidance, and risk factor reduction interventions based on the patient’s history and examination findings.
  4. Ordering appropriate laboratory/diagnostic procedures to assess the patient’s health status and identify potential health risks.

4. Qualifying circumstances

Patients eligible to receive CPT code 99384 services are:

  • New patients aged between 12 and 17 years.
  • Adolescents who have not received a comprehensive preventive medicine evaluation and management service from the same provider or practice within the past three years.
  • Patients who require a preventive medicine service, including a comprehensive history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.

5. When to use CPT code 99384

It is appropriate to bill the 99384 CPT code when a provider performs a comprehensive preventive medicine evaluation and management service for a new adolescent patient aged 12-17 years. This includes taking a comprehensive history, performing a comprehensive examination, providing counseling and guidance for prevention of risk factors, and ordering laboratory/diagnostic tests as needed.

6. Documentation requirements

To support a claim for CPT 99384, the following information needs to be documented:

  • Patient’s age and gender.
  • Date of service.
  • Comprehensive history, including past medical, family, and social history.
  • Comprehensive examination findings, tailored to the patient’s age and gender.
  • Counseling, anticipatory guidance, and risk factor reduction interventions provided.
  • Ordered laboratory/diagnostic procedures and their results, if available.
  • Provider’s signature and credentials.

7. Billing guidelines

When billing for CPT code 99384, keep in mind the following guidelines and rules:

  • 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-oriented E/M service is provided during the same encounter, it may be billed in addition to CPT 99384 with the appropriate modifier.
  • Immunization services provided during the visit can be reported separately.

8. Historical information

CPT 99384 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 age and gender-appropriate history and examination.

9. Similar codes to CPT 99384

Five similar codes to CPT 99384 and how they differentiate are:

  • CPT 99381: This code is for new patients aged younger than 1 year.
  • CPT 99382: This code is for new patients aged 1-4 years.
  • CPT 99383: This code is for new patients aged 5-11 years.
  • CPT 99385: This code is for new patients aged 18-39 years.
  • CPT 99386: This code is for new patients aged 40-64 years.

10. Examples

Here are 10 detailed examples of CPT code 99384 procedures:

  1. A 13-year-old new patient presents for a comprehensive preventive medicine evaluation, including a complete history, physical examination, counseling on healthy lifestyle choices, and ordering of laboratory tests.
  2. A 15-year-old new patient undergoes a comprehensive preventive medicine evaluation, including a detailed history, examination, anticipatory guidance on puberty-related changes, and ordering of age-appropriate screenings.
  3. A 17-year-old new patient receives a comprehensive preventive medicine evaluation, including a thorough history, examination, counseling on substance abuse prevention, and ordering of laboratory tests to assess overall health.
  4. A 12-year-old new patient has a comprehensive preventive medicine evaluation, including a complete history, examination, counseling on maintaining a healthy weight, and ordering of laboratory tests to screen for potential health risks.
  5. A 16-year-old new patient undergoes a comprehensive preventive medicine evaluation, including a detailed history, examination, anticipatory guidance on safe driving practices, and ordering of age-appropriate screenings.
  6. A 14-year-old new patient receives a comprehensive preventive medicine evaluation, including a thorough history, examination, counseling on mental health and stress management, and ordering of laboratory tests to assess overall health.
  7. A 13-year-old new patient presents for a comprehensive preventive medicine evaluation, including a complete history, physical examination, counseling on healthy sleep habits, and ordering of laboratory tests.
  8. A 15-year-old new patient undergoes a comprehensive preventive medicine evaluation, including a detailed history, examination, anticipatory guidance on maintaining healthy relationships, and ordering of age-appropriate screenings.
  9. A 17-year-old new patient receives a comprehensive preventive medicine evaluation, including a thorough history, examination, counseling on tobacco and alcohol prevention, and ordering of laboratory tests to assess overall health.
  10. A 12-year-old new patient has a comprehensive preventive medicine evaluation, including a complete history, examination, counseling on proper nutrition and exercise, and ordering of laboratory tests to screen for potential health risks.

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