How To Use CPT Code 99394

CPT 99394 refers to a periodic comprehensive preventive medicine reevaluation and management service for established adolescent patients aged 12 to 17 years. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99394.

1. What is CPT 99394?

CPT 99394 is a code used to report a preventive medicine reevaluation and management service provided to an established adolescent patient between the ages of 12 and 17 years. This service includes a comprehensive history and examination appropriate for the patient’s age and gender, along with counseling and guidance for prevention of risk factors. The code also covers the ordering of laboratory/diagnostic procedures and immunization services provided during the visit.

2. 99394 CPT code description

The official description of CPT code 99394 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; adolescent (age 12 through 17 years)”.

3. Procedure

The 99394 procedure involves the following steps:

  1. Taking a comprehensive history of the patient, considering their age and gender.
  2. Performing a comprehensive examination appropriate for the patient’s age and gender.
  3. Providing counseling and anticipatory guidance to address risk factors and promote healthy behaviors.
  4. Ordering necessary laboratory/diagnostic procedures based on the patient’s age, gender, and risk factors.
  5. Administering immunizations as needed during the visit.

4. Qualifying circumstances

Patients eligible to receive CPT code 99394 services are established adolescent patients between the ages of 12 and 17 years. These patients should not have any immediate medical concerns but require periodic health checkups as a preventive measure. The services are intended to promote overall health and well-being, identify potential health risks, and provide guidance on risk reduction and healthy behaviors.

5. When to use CPT code 99394

It is appropriate to bill the 99394 CPT code when a provider performs a preventive medicine reevaluation and management service for an established adolescent patient aged 12 to 17 years. This includes well-child visits, routine annual physical check-ups, and other preventive care services tailored to the patient’s age and gender. The code should not be used for problem-focused visits or when the patient has a specific medical concern requiring attention.

6. Documentation requirements

To support a claim for CPT 99394, the following information should be documented:

  • Patient’s age and gender.
  • Comprehensive history, including family, social, and medical history relevant to the patient’s age and gender.
  • Comprehensive examination findings, tailored to the patient’s age and gender.
  • Counseling and anticipatory guidance provided, addressing risk factors and promoting healthy behaviors.
  • Ordered laboratory/diagnostic procedures and their results, if applicable.
  • Immunizations administered during the visit, if applicable.

7. Billing guidelines

When billing for CPT code 99394, it is important to follow the appropriate guidelines and rules. Ensure that the patient meets the age and gender criteria for the code and that the service provided is preventive in nature. If a distinct problem-focused E/M service is performed during the same encounter, it may be reported separately with the appropriate modifier. Additionally, laboratory/diagnostic tests and immunization services provided during the visit may be billed separately.

8. Historical information

CPT 99394 was added to the Current Procedural Terminology system on January 1, 1992. There have been updates to the code description since its addition, with the most recent change occurring on January 1, 2009.

9. Similar codes to CPT 99394

Five similar codes to CPT 99394 and how they differ are:

  • CPT 99381: This code is for a preventive medicine service for a new patient aged younger than 1 year.
  • CPT 99382: This code is for a preventive medicine service for a new patient aged 1 to 4 years.
  • CPT 99383: This code is for a preventive medicine service for a new patient aged 5 to 11 years.
  • CPT 99384: This code is for a preventive medicine service for a new patient aged 12 to 17 years.
  • CPT 99395: This code is for a preventive medicine service for an established patient aged 18 to 39 years.

10. Examples

Here are 10 detailed examples of CPT code 99394 procedures:

  1. A 13-year-old established patient presents for a routine annual physical examination, including age-appropriate history, examination, and counseling on healthy behaviors.
  2. A 15-year-old established patient receives a comprehensive preventive medicine reevaluation, including a discussion on the importance of regular exercise and a balanced diet.
  3. A 16-year-old established patient undergoes a preventive medicine visit, including a review of immunization records and administration of necessary vaccines.
  4. A 12-year-old established patient has a well-child visit, including a comprehensive history, examination, and anticipatory guidance on puberty and related changes.
  5. A 14-year-old established patient receives a preventive medicine reevaluation, including a discussion on the risks of substance abuse and strategies for prevention.
  6. A 17-year-old established patient undergoes a preventive medicine visit, including a review of family history and counseling on the importance of regular health screenings.
  7. A 13-year-old established patient has a well-child visit, including a comprehensive examination and discussion on maintaining good mental health and stress management.
  8. A 15-year-old established patient receives a preventive medicine reevaluation, including a review of personal and family medical history and counseling on risk reduction strategies.
  9. A 16-year-old established patient undergoes a preventive medicine visit, including a discussion on the importance of safe driving practices and accident prevention.
  10. A 12-year-old established patient has a well-child visit, including a comprehensive history, examination, and anticipatory guidance on maintaining healthy relationships and communication skills.

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