tci Outpatient Facility Coding Alert - 2015 Issue 1

Reader Question: Avoid 99381-99387 Alone for Biometric Coding

Question: An insurer asked us to use wellness codes 99381 to 99397 for biometric screening. However, as per the CPT ® guide lines, 99401 or 99402 would be more appropriate. Could you please explain in detail the right and appropriate code to be used? Texas Subscriber Answer: When coding for biometric screening, you should report 99429 (Unlisted preventive medicine service). Biometric screening alone does not support the Preventive Medicine Codes 99381-99387. These codes require much more intensive documentation and are typically only paid once per calendar/benefit year for subscribers. When the provider performs a preventive medicine service that is...

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