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Jeffrey Posted Wed 01st of November, 2017 15:30:57 PM
We are an otolaryngology practice. We had a patient who is doing an internship with the state highway patrol and they required him to have an ear and hearing exam. The physician did an evaluation of his ears and we performed an audiogram (92552). His exam and test were normal. He has private insurance. I am not sure what E&M code or ICD-10 should be used. I was looking at ICD-10 code Z02.1 and 99385 for the CPT. Please advise. Thank you, Tim
SuperCoder Answered Thu 02nd of November, 2017 02:56:42 AM

You should be billing preventive service code for this visit. CPT code 99385 is the appropriate CPT code for Initial comprehensive preventive medicine evaluation and management of an individual aged between 18 to 39 years. If the age of the patient is less or more, then there are other codes for different age groups. Refer to code range (99381 - 99387). 

Medicare does not pay preventive E&M codes but since yours is private insurance, there would be no problem in billing this CPT code.

ICD 10 CM code Z02.1 is for Encounter for pre-employment examination. The patient is an intern with the state highway patrol. If the E&M has been performed for seeing employment, then ICD 10 CM code Z02.1 is the appropriate code. Otherwise i would suggest using ICD 10 CM code Z01.10 (Encounter for examination of ears and hearing without abnormal findings).


Jeffrey Posted Wed 15th of November, 2017 10:46:23 AM
Thank you for the response. I do have a follow up question. 99385 states comprehensive E&M. The physician states the physical exam was limited to the ears only and the patient’s past medical history was relatively noncontributory. Would 99385 still be used? Thank you
SuperCoder Answered Thu 16th of November, 2017 01:16:29 AM

Hi Jeffrey,

Thank you for the question. As per coding guidelines, comprehensive nature of the preventive medicine codes reflects an age and gender appropriate history and is not synonymous with the comprehensive examination required in evaluation and management codes.

This means gender appropriate ear examination will get this code paid. 

Hope the provided information would be helpful.



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