{"id":15771,"date":"2022-09-08T15:33:31","date_gmt":"2022-09-08T15:33:31","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15771"},"modified":"2025-05-10T16:31:55","modified_gmt":"2025-05-10T16:31:55","slug":"preventive-medicine-services-coding-guidelines","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/preventive-medicine-services-coding-guidelines\/","title":{"rendered":"Preventive Medicine Services Coding Guidelines"},"content":{"rendered":"<h2 style=\"text-align: left;\">Basics of Preventive Care<\/h2>\n<p style=\"text-align: left;\">Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care. This may also be called routine care. While coding, you need to understand the difference between preventive care and diagnostic care. Diagnostic care is related to services in which your provider is looking for something specific, often based on the results of a preventive test or screening. For example, a radiologist may ask for a follow-up mammogram for a patient. This follow-up is to check for something that may have been detected during the preventive or routine mammogram. The follow-up mammogram is diagnostic, and not covered as preventive care. Let\u2019s understand preventive medicine services <a href=\"https:\/\/www.medicalbillersandcoders.com\/Medical_Coding.aspx\">coding<\/a> guidelines for the year 2022.<\/p>\n<h2 style=\"text-align: left;\">Preventive Medicine Services Coding Guidelines<\/h2>\n<ul style=\"text-align: left;\">\n<li>Preventive medicine services include measurements (e.g., length\/ height, head circumference, weight, body mass index, blood pressure) and age- and gender-appropriate examination and history (initial or interval).<\/li>\n<li>Preventive medicine service codes are not time-based; therefore, time spent during the visit is not relevant in selecting the appropriate preventive medicine service code.<\/li>\n<li>If an illness or abnormality is discovered, or a pre-existing problem is addressed, in the process of performing the preventive medicine service, and if the illness, abnormality, or problem is significant enough to require additional work to perform the components of a problem-oriented evaluation and management (E\/M) service (i.e., using medical decision making or time spent), the appropriate office or other outpatient service code (99202\u201399215) should be reported in addition to the preventive medicine service code. Append modifier 25 to the office or other outpatient service codes (e.g., 99392 and 99213 25).<\/li>\n<li>An insignificant or trivial illness, abnormality, or problem encountered in the process of performing the preventive medicine service should not be separately reported.<\/li>\n<li>The comprehensive nature of the preventive medicine service codes reflects an age- and gender-appropriate history and physical examination and is not synonymous with the comprehensive examination required for some other E\/M codes (e.g., 99204, 99205, 99215).<\/li>\n<li>Immunization products and administration and ancillary studies involving laboratory, radiology, or other procedures, or screening tests (e.g., vision, developmental, hearing) identified with a specific CPT code, are reported and paid for separately from the preventive medicine service code.<\/li>\n<\/ul>\n<h3 style=\"text-align: left;\">Preventive Medicine Services: New Patients<\/h3>\n<p style=\"text-align: left;\">Initial comprehensive preventive medicine E\/M of an individual includes an age- and gender-appropriate history; physical examination; counseling, anticipatory guidance, or risk factor reduction interventions; and the ordering of laboratory or diagnostic procedures. A new patient is defined as one who has not received any professional face-to-face services rendered by physicians and other qualified health care professionals (QHPs) who may report E\/M services and reported by a specific CPT code(s) from a physician\/other QHP, or another physician\/other QHP of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.<\/p>\n<h3 style=\"text-align: left;\">Preventive Medicine Services: Established Patients<\/h3>\n<p style=\"text-align: left;\">Periodic comprehensive preventive medicine re-evaluation and management of an individual includes an age- and gender-appropriate history; physical examination; counseling, anticipatory guidance, or risk factor reduction interventions; and the ordering of laboratory or diagnostic procedures.<\/p>\n<h3 style=\"text-align: left;\">Preventive Medicine Services: With and Without Abnormal Findings<\/h3>\n<p style=\"text-align: left;\">The use of an ICD-10-CM code for with abnormal findings (e.g., Z00.121) does not mean that an additional E\/M service must or can be used. Abnormal findings can be trivial or incidental issues that do not require additional work, but the condition is still documented or listed as contributory. Examples of abnormal findings include abnormal screening results, new acute problems, or unstable or worsening chronic conditions. A stable chronic condition (whether addressed or not) would not warrant the use of an abnormal findings code. You can link an abnormal findings ICD-10-CM code to a screening if the screen is normal; the abnormality will be identified with the appropriate ICD-10-CM code so the payer will be aware.<\/p>\n<p style=\"text-align: left;\"><a href=\"https:\/\/bit.ly\/3OYgSDT\"><strong>Medical Billers and Coders (MBC)<\/strong><\/a> is a leading medical billing company providing complete medical billing and coding services. We referred <a href=\"https:\/\/www.aap.org\/coding\">\u2018Coding and valuation page of American Academy of Pediatrics (AAP)\u2019<\/a> to discuss preventive medicine services coding guidelines.<\/p>\n<p style=\"text-align: left;\">Still, you can refer to payer-specific coding guidelines and reimbursement policies to receive accurate insurance reimbursements. For any assistance in medical billing and coding for your practice, email us at: <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a> or call us: <a href=\"tel:888-357-3226\"><strong>888-357-3226<\/strong><\/a>.<\/p>\n<h2>FAQs<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1746894560177\"><strong class=\"schema-faq-question\"><strong>1. What is preventive care?<\/strong><\/strong> <p class=\"schema-faq-answer\">Preventive care involves services like annual check-ups, immunizations, and screenings that help detect or prevent serious health issues before they become major problems.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894585230\"><strong class=\"schema-faq-question\"><strong>2. How is preventive care different from diagnostic care?<\/strong><\/strong> <p class=\"schema-faq-answer\">Preventive care is routine care aimed at preventing illness, while diagnostic care focuses on finding and addressing a specific issue based on test results. For example, a follow-up mammogram is considered diagnostic if it is done to investigate something detected in a previous preventive screening.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894601600\"><strong class=\"schema-faq-question\"><strong>3. What are preventive medicine service codes?<\/strong><\/strong> <p class=\"schema-faq-answer\">Preventive medicine service codes reflect age- and gender-appropriate exams and history-taking during routine check-ups. These codes are not based on time spent during the visit.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894615554\"><strong class=\"schema-faq-question\"><strong>4. Can an illness discovered during a preventive visit be billed separately?<\/strong><\/strong> <p class=\"schema-faq-answer\">Yes, if a significant illness or abnormality is discovered during a preventive service that requires additional work, you should report both the preventive medicine service code and an appropriate office\/outpatient E\/M code (99202\u201399215) with a modifier 25.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894633516\"><strong class=\"schema-faq-question\"><strong>5. What happens if an insignificant issue is found during preventive care?<\/strong><\/strong> <p class=\"schema-faq-answer\">Insignificant or trivial findings during preventive care do not warrant a separate report or billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894653558\"><strong class=\"schema-faq-question\"><strong>6. How do you code for new and established patients in preventive care?<\/strong><\/strong> <p class=\"schema-faq-answer\">1. <strong>New Patients<\/strong>: If the patient has not received face-to-face services from the physician or practice in the last three years, they are considered a new patient.<br\/>2. <strong>Established Patients<\/strong>: For patients with regular visits, the code covers periodic comprehensive preventive evaluations.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894674082\"><strong class=\"schema-faq-question\"><strong>7. Do abnormal findings during a preventive exam always require extra billing?<\/strong><\/strong> <p class=\"schema-faq-answer\">Not necessarily. Abnormal findings may be incidental or trivial and may not require additional billing. Only significant conditions that need extra work are reported separately.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1746894689975\"><strong class=\"schema-faq-question\"><strong>8. Are immunizations and lab tests included in preventive medicine service codes?<\/strong><\/strong> <p class=\"schema-faq-answer\">No, immunizations, lab tests, and other procedures like radiology are billed separately from the preventive medicine service code.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Basics of Preventive Care Preventive care helps detect or prevent serious diseases and medical problems before they can become major. Annual check-ups, immunizations, and flu shots, as well as certain tests and screenings, are a few examples of preventive care. This may also be called routine care. While coding, you need to understand the difference [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":15774,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[2919,1746,3650,738,2168,82,2871,1361,3649,58,27],"class_list":["post-15771","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-accurate-cpt-codes-and-modifiers","tag-coding-guidelines","tag-diagnostic-care","tag-e-m-services","tag-evaluation-and-management","tag-icd-10-codes","tag-icd-10-cm-codes","tag-preventive-care","tag-preventive-medicine-services","tag-rcm","tag-revenue-cycle-management-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Preventive Medicine Services Coding Guidelines<\/title>\n<meta name=\"description\" content=\"The follow-up mammogram is diagnostic, and not covered as preventive care. 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Let\u2019s understand preventive medicine services coding guidelines for year 2022.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.medicalbillersandcoders.com\/blog\/preventive-medicine-services-coding-guidelines\/\" \/>\n<meta property=\"og:site_name\" content=\"Medical Billing and RCM Blogs\" \/>\n<meta property=\"article:published_time\" content=\"2022-09-08T15:33:31+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-05-10T16:31:55+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/09\/Blog-Preventive-Medicine-Services-Coding-Guidelinesjpg.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"748\" \/>\n\t<meta property=\"og:image:height\" content=\"288\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Medical Billers and Coders\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Medical Billers and Coders\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/\"},\"author\":{\"name\":\"Medical Billers and Coders\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#\\\/schema\\\/person\\\/76d3509f0e1252992227e858251f1a8b\"},\"headline\":\"Preventive Medicine Services Coding Guidelines\",\"datePublished\":\"2022-09-08T15:33:31+00:00\",\"dateModified\":\"2025-05-10T16:31:55+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/\"},\"wordCount\":1039,\"publisher\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2022\\\/09\\\/Blog-Preventive-Medicine-Services-Coding-Guidelinesjpg.jpg\",\"keywords\":[\"accurate CPT codes and modifiers\",\"Coding Guidelines\",\"diagnostic care\",\"E\\\/M services\",\"Evaluation and management\",\"ICD-10 codes\",\"ICD-10-CM codes\",\"preventive care\",\"preventive medicine services\",\"RCM\",\"revenue cycle management\"],\"articleSection\":[\"Medical Billing Services\"],\"inLanguage\":\"en-US\",\"copyrightYear\":\"2022\",\"copyrightHolder\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#organization\"}},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/\",\"name\":\"Preventive Medicine Services Coding Guidelines\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2022\\\/09\\\/Blog-Preventive-Medicine-Services-Coding-Guidelinesjpg.jpg\",\"datePublished\":\"2022-09-08T15:33:31+00:00\",\"dateModified\":\"2025-05-10T16:31:55+00:00\",\"description\":\"The follow-up mammogram is diagnostic, and not covered as preventive care. 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Coders\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/3041c51926983b0f25500c647fc6164a5c96abebfa441f7f348298f70b360628?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/3041c51926983b0f25500c647fc6164a5c96abebfa441f7f348298f70b360628?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/3041c51926983b0f25500c647fc6164a5c96abebfa441f7f348298f70b360628?s=96&d=mm&r=g\",\"caption\":\"Medical Billers and Coders\"},\"description\":\"Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894560177\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894560177\",\"name\":\"1. What is preventive care?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Preventive care involves services like annual check-ups, immunizations, and screenings that help detect or prevent serious health issues before they become major problems.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894585230\",\"position\":2,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894585230\",\"name\":\"2. How is preventive care different from diagnostic care?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Preventive care is routine care aimed at preventing illness, while diagnostic care focuses on finding and addressing a specific issue based on test results. For example, a follow-up mammogram is considered diagnostic if it is done to investigate something detected in a previous preventive screening.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894601600\",\"position\":3,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894601600\",\"name\":\"3. What are preventive medicine service codes?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Preventive medicine service codes reflect age- and gender-appropriate exams and history-taking during routine check-ups. These codes are not based on time spent during the visit.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894615554\",\"position\":4,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894615554\",\"name\":\"4. Can an illness discovered during a preventive visit be billed separately?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes, if a significant illness or abnormality is discovered during a preventive service that requires additional work, you should report both the preventive medicine service code and an appropriate office\\\/outpatient E\\\/M code (99202\u201399215) with a modifier 25.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894633516\",\"position\":5,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894633516\",\"name\":\"5. What happens if an insignificant issue is found during preventive care?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Insignificant or trivial findings during preventive care do not warrant a separate report or billing.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894653558\",\"position\":6,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/preventive-medicine-services-coding-guidelines\\\/#faq-question-1746894653558\",\"name\":\"6. 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