Simplifying Preventive Visit Coding- Best Practices for CPT 99396
                     SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
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SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
Effective coding in healthcare is important, especially in terms of 
reimbursement and payer policy compliance. Coding for preventive visits may 
be challenging at times, particularly for CPT code 99396. This is for preventive 
medicine services for established patients aged between 40 and 64 years. To 
ease documentation and billing, medical professionals should implement best 
practices to reduce errors and maximize efficiency. In this blog, we are going to 
make the basics of CPT 99396 easy to understand, which includes patient 
criteria, documentation requirements, billing process, and errors to avoid.
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e-visit-coding-best-practices-for-cpt-99396
 
Understanding CPT Code 99396
CPT code 99396 is a preventive medicine evaluation and management (E/M) 
service. Preventive visits vary from problem-based visits as the former 
addresses health maintenance, disease prevention, and risk assessment rather 
than complaints.
This service will typically include:
A comprehensive review of the medical history
A comprehensive physiHcTaTPl Se://xWWaWm.24i7nMaEDtIiCoALnBILLINGSERVICES.COM/ 
Age- and health-status-appropriate screenings and risk assessments
Counseling on preventive care and lifestyle recommendations
Appropriate vaccinations and lab tests
SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
Key Components of CPT 99396
In order to bill CPT 99396, providers should include the following items:
1. Patient Eligibility
Returning patients only: CPT 99396 is billed for returning patients between 40-64 years 
old.
In case of a new patient, an alternative CPT code (99386) has to be used.
2. Documentation Requirements
Proper documentation is necessary to validate the claim. Providers must document:
Comprehensive Medical History: History of previous illnesses, family history, current 
medications, and lifestyle.
Physical Exam: Comprehensive examination of body systems based on age-
related risk factors.
Preventive Screens: Tests based on age, including blood pressure, cholesterol screening, 
cancer screenings (e.g., mammogram, colonoscopy), and vaccinations.
Risk Assessments: Risk assessment for chronic disease based on family and 
personal history.
Counseling and Health Education: Exercise, diet, quitting smoking, etc.
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SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
3. ICD-10 Diagnosis Codes
To warrant medical necessity, the correct ICD-10 "V" codes need to be used. The codes 
describe the preventive type of visit. A few more typical ICD-10 codes are:
Z00.00 - Normal adult medical examination
Z00.01 - Abnormal findings on the adult medical examination
Z13.220 - Screening for lipid disorders
Z12.11 - Screening for malignant neoplasm of the colon
Billing Rules for CPT 99396
Proper billing ensures proper payment. In fact, important things to keep in mind while 
billing are:
1. Time Requirement
Although CPT 99396 is not time-based, providers are encouraged to report duration of 
visit where required by some payers. A vast majority of payers expect a comprehensive 
visit that takes a lot of time.
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SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
2. Application of the Modifier
Modifier 25: If a patient presents with a new or chronic issue that requires more 
evaluation than preventive care, a separate E/M code can be billed along with 
modifier 25.
Modifier 33: If services are fully covered under the Affordable Care Act (ACA) 
preventive care guidelines, modifier 33 can be applied.
3. Separate Billing for Non-Preventive Services
If the patient has a preventive visit but also requires management of an acute or 
chronic problem, the physician should bill another E/M code (e.g., 99213, 99214) 
with modifier 25. The documentation must clearly indicate that the two services 
were done separately.
4. Payer-Specific Guidelines
Policies on preventive visits vary from insurance payer to insurance payer. Providers 
should refer to individual payer requirements for coverage, documentation, and 
bundling rules.
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SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
Common Billing Errors and How to Avoid Them
Billing errors can lead to claim denials, payment delays, and compliance problems. Some 
common errors and how to prevent them are listed below:
Improper Diagnosis Codes: Preventive visits should always be billed with a correct ICD-
10 Z code. When treating an acute condition, place the Z code first, followed by the relevant 
condition code.
Failure to Document Preventive Nature of Visit: It is also required to make sure 
chief complaint contains "preventive visit" or "annual wellness visit" and separate preventive 
services from problem-oriented care clearly.
Incorrect Use of Modifiers: In case another problem-focused E/M service is provided, 
use modifier 25, and document all elements required by CPT 99396 separately from the 
additional service.
Upcoding or Downcoding: Avoid billing for a higher level of service than is actually done 
(upcoding) or a lesser level of service to avoid risk of audit (downcoding).
Why Accurate Coding is Critical?
Proper coding of CPT 99396 assures timely reimbursement, fewer denials, and enhanced 
patient care. Primary care physicians can allow seamless billing and prevent most errors by 
proper documentation and payer compliance.
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SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
Help Needed with Preventive Visit Coding?
Medical billing can be a headache, but working with experienced billing 
professionals will make the experience seamless. 24/7 Medical Billing Services 
specialize in outsourcing medical billing and coding services to help providers 
optimize reimbursement and maintain compliance.
Therefore, providers can simplify preventive visit coding, reduce claim denials, 
and optimize efficiency in their practice by following these best practices for CPT 
99396. Accurate documentation, accurate use of modifiers, and compliance with 
payer guidelines are the keys to seamless medical billing and reimbursement 
processes.
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SIMPLIFYING PREVENTIVE VISIT CODING: BEST PRACTICES FOR CPT 99396
About 24/7 Medical Billing Services:
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service provider catering services to more than 42 specialties across 
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Call us today at 888-502-0537 to know more on how we can help 
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