Differences: Preventive vs. Office Visits in Medical Coding & Billing

Preventive-Visits-VS-Office-Visits

Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is crucial for navigating reimbursement processes effectively.

Learn the differences between these professional services to ensure proper coding and medical billing. In simple terms, preventive services are aimed at patients who have no symptoms or complaints, and doctor’s visits accusations are flying intended for patients who suffer from health problems that need to be treated by the healthcare provider.  Of course, there is more to it when it comes to insurance. A closer look at these two types of medical services will help you code and bill these claims correctly.

The Reason for a preventive visit

Preventive care refers to medical services that are carried out to check the patient’s health status and keep him healthy. Preventive care includes cancer screening, nutritional and obesity counseling, sexually transmitted infection testing, contraceptive prescription, etc.

According to the 2024 ICD-10-CM Official Coding and Reporting Guidelines, “Screening is the detection of diseases or  precursors of diseases apparently healthy people so that  those who test positive for the disease can be detected and treated early (e.g. mammography screening). ”

Screening codes are used to indicate that services with the primary goal performed to detect health conditions or illnesses before symptoms appear. Preventive visits are reported using screening Z codes along with CPT® or HCPCS Level II preventive service codes (depending on payer). The Z code indicates that the exam was scheduled and the CPT® or HCPCS Level II code indicates that the service was provided.

The Reason for an Office Visit

Office visits focus on treatment to restore the patient’s well-being. The purpose of these visits is to discuss any new or existing health problems, concerns, concerns, or symptoms. The provider may prescribe or change the patient’s medications, order tests, or refer the patient to another provider or specialist. Can practice visits and preventive visits be billed together?

The short answer is yes. CPT® codes 99381-99397 are used for comprehensive age-specific preventive assessments, from infancy to patients 65 years and older, for both new and established patients.  In accordance with CPT® guidelines, for codes 99381-99397, also code and add any separately identifiable and significant evaluation and management (E/M) services performed on the same day for significant issues requiring additional work the modifier 25 to

E for office/outpatient. /M code (99202-99215).  In this case, each encounter will have a different primary diagnosis. Scenario: A 40-year-old woman comes in for her annual exam and follow-up for her high blood pressure. The doctor refills his antihypertensive medication and finds that the patient’s home blood pressure levels are within normal ranges and he reports no other symptoms.

The coding is:

  1. 99396, Z00.0x
  2. 9921x-25, I10

Navigating Medicare billing: Comparing Preventive Services Vs Office Visits

It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services vs. Office Visits is crucial for navigating reimbursement processes effectively.

x

Request a Free Quote