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What qualifies as a preventative exam?
If a male patient came in for a preventive exam, and provider documented for exam:
Physical Examination: Wt: 204.4 lb Ht/Ln: 70 in BMI: 29.3 BP: 138/92 Pulse: 76 RR: 16 Temp: 98.9F Sat: 98
General: Patient is alert and orientated times three in no acute distress. Well developed, well nourished and well groomed.
Psych: Dynamic affect, makes good eye contact.
HEENT: Head is normocephalic, atraumatic. TMs are clear bilaterally. Oropharynx is non inflamed. Tonsils are large.
Eyes: PERRLA EOM’s intact. Lids and conjunctivae are clear.
Neck: Supple without lymphadenopathy or thyromegaly.
Lungs: Lungs are clear to auscultation bilaterally CV-Heart regular rate and rhythm without click, rub, or murmur. DX Z00.00.
Q: Would you consider this a preventive exam for a male patient?
A: Preventive medicine services are provided to individuals who are not in need of any immediate medical attention but need to undergo periodic health checkups as a preventive measure. Well–baby visits, well-woman visits and routine annual physical check-ups come under the purview of preventive medicine re-evaluation and management services.
These visits differ from other visits where the patient has a problem for which medical attention is sought. The age, gender and associated risk factors of the patient are important considerations while providing a preventive medicine service.
The provider uses these factors to guide taking the patient history, performing the examination and making a thorough assessment of age and gender–related risk factors. Codes 99381-99397 include counseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination.
The “comprehensive” nature of the Preventive Medicine Services codes 99381-99397 reflects an age and gender appropriate history/exam and is not synonymous with the “comprehensive” examination required in Evaluation and Management codes 99201-99350. So, your exam is sufficient to bill the preventive medicine service. Just check the age of the patient to bill this section of codes.
Suggestion: If the physician found something abnormal during the preventive service and performed the above-mentioned exam for that specific condition, then in addition to preventive service the physician also can bill office visit from the section 99201-99215 with Modifier 25.