Question

question 24

a 75-year-old established patient sees his regular primary care provider for a physical screening prior to joining a group home. he has no complaints. the patient has an established diagnosis of cerebral palsy and type 2 diabetes and is currently on his meds. a comprehensive examination is performed. the provider counsels the patient on the importance of taking his medication and gives him a prescription. lab work was ordered. ppd was done and flu vaccine given. patient already had a vision exam. no abnormal historical facts or findings. what cpt® code is reported?

99397
99215
99387
99214

Explanation:

Identify the nature of the visit

The patient is a 75-year-old established patient presenting for a physical screening (preventive examination) prior to joining a group home, with no active complaints.

Determine the appropriate CPT code category

Because the encounter is for a routine preventive physical examination (screening) rather than an evaluation and management (E/M) visit for active illness, codes from the Preventive Medicine Services category (99381–99397) must be used instead of office visit codes (99211–99215).

Select the specific code based on patient status and age

• The patient is an established patient, which narrows the range to 99391–99397.
• The patient is 75 years old, which falls into the age group of 65 years and older.
• CPT code 99397 is defined as: "Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older."

Answer:

• (A) 99397 (Correct answer)
• (B) 99215
• (C) 99387
• (D) 99214