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CPT code

Zakari Posted Fri 21st of September, 2012 16:02:41 PM

what is the cpt code for first visit 15 years old at a pcp office?
Thank you

SuperCoder Answered Mon 24th of September, 2012 20:34:43 PM

Many times, a surgeon will ask for the patient’s primary care physician (PCP) to give preoperative clearance before a major surgery because the PCP knows the patient’s health history in much more detail. These visits can be reported separately using the appropriate level of E/M code. Given that the patient usually is established to the PCP, the appropriate E/M codes would be 99241-99245.

The appropriate documentation requirements for a consultation must be met to bill these codes: request for a consultation (that is, clearance for surgery for the specific condition[s] that might cause complications with the surgery), documentation of the PCP’s visit (to substantiate the level of code billed), and a separate letter back to the surgeon detailing the findings. If these elements are not met, the appropriate established E/M code would be billed, 99211-99215.

Diagnosis code V72.83 (special investigations and examinations, other specified pre-operative examination) also should be used (as the primary or secondary diagnosis) to show the payer that the exam is being performed before surgery to ensure that the patient’s current health status does not counter-indicate undergoing the procedure or anesthesia.

These PCP preoperative exams normally are performed in an office setting, even when the surgery is performed in the hospital. This is routine and should not cause any "red flags" to the carrier.

Zakari Posted Fri 28th of September, 2012 18:17:29 PM

The patient is not having a surgery only office visit for the first time. Age 15. want to know what cpt code to use. thank you.

SuperCoder Answered Fri 28th of September, 2012 21:16:44 PM

Hi Zakari,

I need to know if the visit is a well child preventive visit or a new patient encounter for a problem-oriented encounter.


Zakari Posted Mon 01st of October, 2012 18:06:24 PM

Hi, it was a well child preventive visit. Thank you.

SuperCoder Answered Mon 01st of October, 2012 20:16:57 PM

Hi Zakari.
I believe the code you need is: 99384 - 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).
I hope this helps. Please let me know if you have further questions.
Leesa A. Israel, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions

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