Today, we will take you through an extensive guide on CPT Code 99396. This Current Procedural Terminology code for preventive medicine and annual wellness visits helps healthcare providers maintain accurate documentation and claim complete reimbursement against their services.
Preventive care, referred using CPT Code 99396, serves as a foundation to foster a healthy lifestyle in elderly patients by detecting potential health issues at an early stage. Moreover, it allows providers to assess the overall status of patients, enabling them to deliver personalized care.
What is CPT Code 99396?
The Code 99396 in Current Procedural Terminology classifies preventive evaluation and management (E/M) for elderly patients aged 65 or more. This code covers comprehensive annual wellness visits (AWV), including personalized preventive medicine planning.
The significance of 99396 lies in the fact that it assists primary care providers to examine the health status of elderly patients leading to the administration of accurate preventive care. Apart from the holistic assessment of older patients, this code involves many other elements considered vital for comprehensive care.
Some of these elements are:
- Medical history evaluation
- Physical examination
- Counselling services
- Screenings for disease and conditions
- Risk assessment for specific health concerns
Practicing preventive medicine evaluation and management (E/M) helps primary care physicians to provide personalized care to senior citizens. It helps them to detect and prevent ailments at an early stage and promote good health.
Grasping the intricacies of CPT Code 99396 and the guidelines associated with it are considered crucial to document the exact condition, create precise claims, and claim full reimbursement from the insurance. Without further ado, let’s discuss the details of the 99396 code, it’s significance in the medical billing world and primary care.
Components of CPT Code 99396
When assessing an elderly patient using 99396, primary care providers have to consider multiple key components. Considering these components during checkups and documentation allows them to stay compliant with regulations, create flawless patient bills, and extract complete payments against their service.
We’ve mentioned these necessary components for quick information.
Medical History
The first and foremost component of 99396 is collecting all the required information. This includes medical history, past ailments, surgeries, family history, and medications that the patient used in the past or is currently taking.
This allows for in-depth understanding of the patient’s past and current situation and also helps the doctor to identify risk factors leading to a well-planned preventive care strategy.
Physical Examination
A detailed physical assessment helps the provider evaluate the patient’s current health. This includes assessing the patient’s vital signs, body systems, and well-being.
Counselling
The code also encompasses counseling services. This component addresses multiple health concerns and allows for proper guidance on how to achieve and maintain a healthy lifestyle. Lastly, counseling educates people to prevent diseases.
Screenings
Screening is another significant aspect of a patient’s wellness visit. It involves the doctor performing crucial screenings for diseases like cholesterol, blood pressure, cancer, and immunization. These screenings help the provider detect diseases at an early stage and determine a suitable treatment.
Risk Assessment
Another integral component of code 99396 is evaluating the risks for major diseases. This assessment involves factors like family history, lifestyle, current environment and others factors that play a role in developing specific health conditions. Pinpointing these things assists healthcare providers in devising a preventive strategy accordingly.
Billing Guidelines for CPT Code 99396
We’ve mentioned some guidelines that help preventive care specialists ensure proper documentation and collect full reimbursements against CPT Code 99396.
Medical Necessity
The first billing guideline is all about the patient’s age and purpose to justify preventive evaluation and management (E/M) for elderly patients aged 65 or more. It helps doctors plan wellness accordingly.
Time documentation
The duration for the visit must not be less than 30 minutes. The doctor or their in-house staff must document the correct duration of the encounter to obtain full revenue against service provided.
Appropriate Modifier
Based on the history, if the doctor determines that the patient requires additional services during the wellness visit that can be billed and reimbursed separately, they must include precise modifiers to indicate the separate services.
Obtaining Consent or ABN
The doctor or their assistant must pre-inform the patient regarding any services that the insurance may not cover. It is essential to obtain their consent before initiating the treatment or notify them via an Advance Beneficiary Notice.
Documentation for CPT Code 99396
In the healthcare industry, no one can deny the significance of accurate coding, as it basically helps you on multiple frontiers. Firstly, by maintaining correct documentation of CPT Code 99396, you’re fulfilling compliance requirements, and most importantly, you’re eligible to get full reimbursement against services rendered.
Here are some important elements required to ensure proper documentation.
Thorough Medical History
The medical history of the patient should include thorough details. It must include things like a patient’s past history, family history, current health-related issues, details regarding acute or chronic illnesses, surgeries done in the past, whether the patient is on medications and things like these.
Maintaining a detailed record is essential for further treatments, evaluations and preventive measures. It helps the doctors to choose the right treatment path.
Physical Examination Findings
The second vital part of the documentation is a detailed examination. The details help the doctor evaluate the patient’s health in general, giving them a chance to identify a risk, abnormality, or health vulnerability.
Documenting the findings after a detailed examination includes vital signs, overall appearance, body organ assessment, and other exams deemed necessary according to the patient’s gender and age. All in all, it helps to accomplish the precise coding required for creating claims.
Record of Counselling Services
Providing counseling to patients to promote healthy lifestyle, prevent diseases, etc., is a major aspect of CPT Code 99396. So, these counseling details like discussions, advice and recommendations must also be mentioned in the patient record. Why is this necessary? It helps to complete the documentation regarding preventive care treatment.
Screenings Performed
Screenings to find out about the diseases are an integral part of the treatment medically classified by CPT Code 99396. So, documenting these screenings to detect conditions like cancer, hypertension, cholesterol, cardiovascular issues and depression must clearly be mentioned.
Primary healthcare providers must ensure that they mention the findings after the screenings, as well as the results and follow-up treatments based on the findings.
Proper documentation of these components not only helps them stay compliant but also enables them to get full reimbursements using the CPT Code 99396.
The documentation serves as a proof that all the information related and required for the treatment is true. Moreover, it is a statement that required information can be used for coding and billing against preventive care services.
Important Billing Tips for Doctors Regarding CPT Code 99396
The following are some helpful tips for doctors and physicians that help them avoid common billing errors—which can lead to denials—and ensure proper reimbursement on time.
Complete Documentation
We can’t emphasize enough the importance of ensuring correct and detailed documentation of the encounter. It is pertinent to ensure that all components and requirements for CPT Code 99396 are thoroughly documented. This includes patient medical history, assessment findings, counseling services, and screenings.
Correctly Documenting Time
Documenting the correct time taken during the encounter is imperative. When the minimum billable duration of 30 minutes is met, it must be clearly documented in the patient’s medical record.
Separate Services
In case the patient complains about a specific acute or chronic condition(s) and it requires separate assessment or treatment sessions during the wellness visit, they must be billed and documented separately.
Accurate Coding
Another undeniable tip or advice is to always use the correct CPT codes to classify and mention the services delivered. Even after the encounter and during the claim creation process, ensure to check and verify whether you’ve used the proper codes. It helps to abstain from coding errors which result in claim denials or delayed payments.
Use of Modifier
In case the doctor provides any service, apart from those falling under wellness evaluation and management, and it is specified by a separate modifier, apply it correctly to show these separate services delivered.
Upcoding or Downcoding
Another important tip that many would already know is not to follow ill practices like upcoding and downcoding. So, it is necessary to always use the correct medical classification to refer to the level and kind of service provided during the visit.
Avoiding these practices of billing for a higher level of service instead of actual service or seeking reimbursement for a lower level of service than performed in reality would lead to denials, compliance errors, and potential audits.
Common Billing Errors to Avoid for CPT Code 99396
To achieve timely and accurate reimbursement against services rendered for CPT Code 99396, there are many necessities to look after. These include error-free documentation, use of correct modifiers to refer towards a separate service or avoiding undercoding and upcoding.
To get full revenue, it is important to stay diligent and mindful of the errors, complexities and aspects involved in billing for CPT Code 99396 such as attaching screening and related information. Here are some common billing errors that you should avoid to enhance your financial gains.
| Billing Error Type | Results Or Consequences |
| Upcoding | Overbilling, Risk of Audit, Possible Litigation |
| Downcoding | Underpayment, Risk of Losing Credibility |
| Not Using the Right Modifiers | Coding Error, Claim Denial, Loss of Revenue |
| Inaccurate Coding | Loss of Revenue, Incorrect Reimbursement |
| Inaccurate Representation Level of Service | Underpayment, Inaccurate Documentation |
Upcoding
Upcoding is a common billing error to avoid. It means billing for a higher level of service than provided during the wellness exam classified using CPT Code 99396. To remain compliant and fulfill state and federal regulations, we suggest precisely documenting the complexity and services provided to avoid overbilling. If caught, it could damage your practice’s credibility and may lead to litigation.
Downcoding
To gain appropriate reimbursement against your services, experts advise you to steer clear from downcoding. As opposed to upcoding, this billing error is committed when the physician or their team bills for a lower service than the service performed.
This error won’t get you full reimbursements, and you’ll be underpaid, affecting your practice’s bottom line. Avoid this ill practice and pay attention to detail while documenting the service provided.
Not Using the Right Modifiers
Modifiers are vital when it comes to medical billing and getting full reimbursements against claims submitted for CPT Code 99396. They differentiate separate services provided during the same preventive care visit. Not using the correct modifiers or doing it carelessly results in errors in coding and eventually, claim denials.
Not heeding to correct modifiers means you’re leaving money on the table. Understand which modifiers are used in preventive care visits and use them wisely to churn out the correct amount of revenue.
Inaccurate Coding
Inaccurate coding is directly proportional to claim denials and no payments. Correct coding has a significant impact on how much revenue your practice gains. To ensure high revenue collection, it is crucial to stay updated with the latest CPT updates that include code additions, revisions, and deletions.
It helps you assign the precise codes for services provided and procedures performed. Doctors must arrange regular training for themselves and their staff to get acquainted with correct codes, which will eventually help them eliminate errors and gain monetary rewards.
Inaccurate Representation Level of Service
Maintaining error-free documentation is considered essential while referring to the level of service provided during a wellness exam – medically classified using CPT Code 99396. The inability to document the correct nature of the preventive care visit may result in underpayments. So, it is pertinent that the documentation entails all related information and clearly portrays the type of services offered.
The above-mentioned are some common errors reported while documenting and billing for preventive care services. By avoiding these errors, doctors can claim complete reimbursements against their services.
How to Maximize Reimbursement for CPT Code 99396?
Every doctor or preventive care provider wants maximum reimbursements against CPT Code 99396. However, it is only possible if you maintain efficiency in medical practices and documentation. If you think that coding and documentation for CPT Code 99396 is challenging and getting full reimbursements against services rendered is an uphill task to do on your own, outsource preventive care billing to I-Med Claims.
As one of the leading medical billing companies in the US, we specialize in streamlining your billing operations through our expert handling of each case. We work to optimize your billing cycle, eliminate errors, lower denials, and enhance revenue for your practice, clinic, or hospital.
One advantage of collaborating with I-Med Claims is that you’ll have the most experienced and professional resources at your disposal who’ll streamline the complexities involved in charge capturing, creating and submitting accurate claims. Also, handing over your billing worries to us allows you to focus on primary duties, i.e., providing top-notch care services to elderly patients aging 65 or above.
Here’s why we can be your best choice to maximize reimbursements.
- Customized RCM services designed according to your needs
- We’re adept in billing for CPT Code 99396
- Smooth handling of all complications involved
- Reduction in errors responsible for claim denials
- Correct claim creation and timely submission
- Streamlined revenue cycle through HIPAA-compliant billing
- Complete and on-time payment posting to your account
Partner with I-Med Claims today and see how we uplift your payment collections for CPT Code 99396.
