How To Use CPT Code 99402

CPT 99402 refers to preventive medicine counseling and/or risk factor reduction intervention provided to an individual for approximately 30 minutes. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99402.

1. What is CPT 99402?

CPT 99402 is a medical billing code used to describe preventive medicine counseling and/or risk factor reduction intervention services provided to an individual patient. This code is specifically used for sessions that last approximately 30 minutes. The purpose of these counseling sessions is to educate and guide patients on how to prevent health problems and reduce risky behaviors based on their age, family history, and areas of concern.

2. 99402 CPT code description

The official description of CPT code 99402 is: “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes.”

3. Procedure

The 99402 CPT code procedure involves the following steps:

1. The provider meets with the patient for approximately 30 minutes.
2. Lab findings from recently performed tests, typically ordered at a preventive visit, are discussed.
3. Clinical findings from the preventive visit are also reviewed.
4. Based on the findings, patient’s age, circumstances, and family history, the provider discusses preventive measures and risk factor reduction strategies with the patient.
5. Topics covered during the session may vary depending on the patient’s age and concerns, such as healthy food choices for children, prevention of sexually transmitted diseases for teens, or heart disease prevention and exercise programs for adults.

4. Qualifying circumstances

Patients eligible to receive CPT code 99402 services include those who:

• Have recently undergone a preventive medicine visit and require further counseling based on the findings.
• Are at risk for developing health problems due to their age, family history, or lifestyle choices.
• Require guidance on preventive measures and risk factor reduction strategies tailored to their specific needs and circumstances.
• Have not received similar counseling services within a short period, as billing for multiple sessions within a short timeframe may be considered excessive and not medically necessary.

5. When to use CPT code 99402

It is appropriate to bill the 99402 CPT code when:

• The provider has conducted a separate preventive medicine counseling session lasting approximately 30 minutes.
• The counseling session is focused on preventive measures and risk factor reduction strategies based on the patient’s age, family history, and areas of concern.
• The session is not a part of a comprehensive preventive medicine visit, but rather a separate encounter.
• There is a clear medical necessity for the counseling session, and it is not being billed excessively or inappropriately.

6. Documentation requirements

To support a claim for CPT 99402, the following information needs to be documented:

• Date and duration of the counseling session.
• Reason for the counseling session, including the patient’s age, family history, and areas of concern.
• Specific topics discussed during the session, such as preventive measures and risk factor reduction strategies.
• Any recommendations or interventions provided by the provider during the session.
• A statement indicating that the session was separate from a comprehensive preventive medicine visit.

7. Billing guidelines

When billing for CPT code 99402, keep in mind the following guidelines and tips:

• Ensure that the counseling session is billed separately from a comprehensive preventive medicine visit.
• Verify that the session duration is approximately 30 minutes. If the session is shorter or longer, consider using other CPT codes within the 99401-99404 range, which are based on the amount of time involved.
• Document the medical necessity for the counseling session and ensure that it is not being billed excessively or inappropriately.
• Be aware of any payer-specific requirements or guidelines related to billing for preventive medicine counseling services.

8. Historical information

CPT 99402 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the descriptor since its addition.

9. Similar codes to CPT 99402

Five similar codes to CPT 99402 and how they differentiate are:

• CPT 99401: This code is used for preventive medicine counseling sessions lasting approximately 15 minutes.
• CPT 99403: This code is used for preventive medicine counseling sessions lasting approximately 45 minutes.
• CPT 99404: This code is used for preventive medicine counseling sessions lasting approximately 60 minutes.
• CPT 99411: This code is used for group preventive medicine counseling sessions lasting approximately 30 minutes.
• CPT 99412: This code is used for group preventive medicine counseling sessions lasting approximately 60 minutes.

10. Examples

Here are 10 detailed examples of CPT code 99402 procedures:

1. A 35-year-old patient with a family history of heart disease receives a 30-minute counseling session on heart-healthy nutrition and exercise habits.
2. A 16-year-old patient receives a 30-minute counseling session on safe sex practices and prevention of sexually transmitted diseases.
3. A 45-year-old patient with high cholesterol receives a 30-minute counseling session on dietary changes and lifestyle modifications to lower cholesterol levels.
4. A 28-year-old patient with a family history of diabetes receives a 30-minute counseling session on maintaining a healthy weight and managing blood sugar levels.
5. A 50-year-old patient with a history of smoking receives a 30-minute counseling session on smoking cessation strategies and lung health.
6. A 60-year-old patient with osteoporosis receives a 30-minute counseling session on bone health, including calcium and vitamin D intake, and appropriate exercise routines.
7. A 40-year-old patient with a family history of breast cancer receives a 30-minute counseling session on breast cancer prevention and early detection strategies.
8. A 20-year-old patient with a history of anxiety receives a 30-minute counseling session on stress management techniques and mental health resources.
9. A 55-year-old patient with a family history of colon cancer receives a 30-minute counseling session on colon cancer prevention, including the importance of regular screenings and dietary modifications.
10. A 30-year-old patient with a history of obesity receives a 30-minute counseling session on weight loss strategies, including healthy eating habits and physical activity recommendations.