How To Use CPT Code 99393

CPT 99393 refers to a periodic comprehensive preventive medicine reevaluation and management service for established patients aged 5 through 11 years. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99393 procedures.

1. What is CPT 99393?

CPT 99393 is a code used to report a preventive medicine reevaluation and management service provided to an established patient who is between the ages of 5 and 11 years old. The service includes a comprehensive history and examination appropriate for the child’s age and gender, along with counseling and guidance for prevention of risk factors. Laboratory/diagnostic tests and immunization services provided during the visit may be reported separately.

2. 99393 CPT code description

The official description of CPT code 99393 is: “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; late childhood (age 5 through 11 years).”

3. Procedure

The 99393 CPT code procedure involves the following steps:

1. Taking a comprehensive history appropriate for the child’s age and gender.
2. Performing a comprehensive examination appropriate for the child’s age and gender.
3. Providing counseling and anticipatory guidance for prevention of risk factors.
4. Ordering and obtaining laboratory/diagnostic procedures as needed.
5. Administering immunizations if required during the visit.

4. Qualifying circumstances

Eligibility for CPT code 99393 services is determined by the following criteria:

• The patient must be an established patient, meaning they have previously received professional services from the provider or another provider within the same group and specialty within the past three years.
• The patient must be between the ages of 5 and 11 years old.
• The service must be a preventive medicine reevaluation and management service, not a problem-focused visit.

5. When to use CPT code 99393

It is appropriate to bill the 99393 CPT code when a provider performs a preventive medicine reevaluation and management service for an established patient aged 5 through 11 years. This includes well-child visits, routine check-ups, and other preventive care services. The code should not be used for problem-focused visits or visits where the patient has a specific complaint or issue requiring medical attention.

6. Documentation requirements

To support a claim for CPT 99393, the following information must be documented:

• A comprehensive history appropriate for the child’s age and gender, including a review of systems, past medical history, family history, and social history.
• A comprehensive examination appropriate for the child’s age and gender, covering all body systems and areas relevant to the patient’s age and gender.
• Counseling and anticipatory guidance provided for prevention of risk factors, including any educational materials or resources given to the patient or their caregiver.
• Any laboratory/diagnostic procedures ordered and their results, if available.
• Immunizations administered during the visit, if applicable.

7. Billing guidelines

When billing for CPT code 99393, keep in mind the following guidelines and tips:

• Ensure that the patient meets the age and established patient criteria for this code.
• Document all required components of the service, including history, examination, counseling, and any laboratory/diagnostic procedures or immunizations provided.
• Bill separately for any laboratory/diagnostic tests and immunization services provided during the visit.
• If a distinct problem-focused E/M service is performed during the same encounter, it may be reported separately with the appropriate E/M code.

8. Historical information

CPT 99393 was added to the Current Procedural Terminology system on January 1, 1992. There have been updates to the code description since then, with the most recent change occurring on January 1, 2009.

9. Similar codes to CPT 99393

Five similar codes to CPT 99393 and how they differ are:

• CPT 99381: This code is for a new patient preventive medicine visit for infants up to 1 year of age.
• CPT 99382: This code is for a new patient preventive medicine visit for early childhood (age 1 through 4 years).
• CPT 99383: This code is for a new patient preventive medicine visit for late childhood (age 5 through 11 years).
• CPT 99391: This code is for an established patient preventive medicine visit for infants up to 1 year of age.
• CPT 99392: This code is for an established patient preventive medicine visit for early childhood (age 1 through 4 years).

10. Examples

Here are 10 detailed examples of CPT code 99393 procedures:

1. A 6-year-old established patient presents for a routine well-child visit. The provider takes a comprehensive history, performs a comprehensive examination, provides counseling on healthy eating habits, and orders a complete blood count (CBC) test.
2. An 8-year-old established patient comes in for a routine check-up. The provider takes a comprehensive history, performs a comprehensive examination, discusses dental hygiene and oral health, and orders a urinalysis.
3. A 10-year-old established patient presents for a well-child visit. The provider takes a comprehensive history, performs a comprehensive examination, provides counseling on the importance of physical activity, and orders a lipid panel.
4. An 11-year-old established patient comes in for a routine check-up. The provider takes a comprehensive history, performs a comprehensive examination, discusses puberty and its associated changes, and orders a thyroid function test.
5. A 7-year-old established patient presents for a well-child visit. The provider takes a comprehensive history, performs a comprehensive examination, provides counseling on sun protection and skin care, and orders a vision screening.
6. An 8-year-old established patient comes in for a routine check-up. The provider takes a comprehensive history, performs a comprehensive examination, discusses mental health and stress management, and orders a hearing screening.
7. A 9-year-old established patient presents for a well-child visit. The provider takes a comprehensive history, performs a comprehensive examination, provides counseling on injury prevention and safety, and orders a scoliosis screening.
8. An 11-year-old established patient comes in for a routine check-up. The provider takes a comprehensive history, performs a comprehensive examination, discusses substance abuse prevention, and orders a hemoglobin A1c test.
9. A 5-year-old established patient presents for a well-child visit. The provider takes a comprehensive history, performs a comprehensive examination, provides counseling on proper handwashing and hygiene, and orders an iron level test.
10. An 8-year-old established patient comes in for a routine check-up. The provider takes a comprehensive history, performs a comprehensive examination, discusses bullying prevention and coping strategies, and orders a lead level test.