Are you one of the best pediatricians in town, but struggling with medical billing? Every medical specialty has its own designated CPT code set. Pediatricians have their specific CPT codes for preventive services, which are essential for insurance billing and reimbursement. Medical professionals must properly code each service to guarantee fair payment collection.
However, there are some codes and services that Medicare does not cover, and CPT code 99382 is one of them. Now, how will a physician get paid? Hold on and do not worry, this blog will explain ways you can charge for your services, so continue reading to find out.
CPT Code 99382 – Description
CPT code 99382 represents an “initial comprehensive preventive medicine evaluation and management (E/M)” procedure for children between the ages of 1 and 4 who meet the definition of a new patient.
Now, what is the definition of a new patient? A new patient is a person who has not received any professional services from a physician in the previous three years, or another qualified healthcare provider in the same specialty and subspecialty who is a member of the same group practice.
The well-child E/M visit includes a comprehensive physician examination to evaluate overall health of the child and identify possible problems early. The following services are covered under this code:
- An assessment of social interactions to guarantee proper developmental progress, motor skills, and language development.
- Weight, height, and body mass index (BMI) measurements to track growth.
- Physical examination, which includes screening for problems in hearing and vision.
- Vaccinations as advised by the schedule of the Advisory Committee on Immunization Practices (ACIP).
- Parental guidance on behavioral issues like sleep or tantrums, safety precautions (such as car seats and childproofing), and diet.
Scenarios Where CPT Code 99382 is Applicable
The following are some real-life scenarios that explain where a pediatrician can apply CPT code 99382.
Evaluating Child Development
Consider a scenario where a mother brings her three-year-old child to the pediatrician. The physician conducts a comprehensive developmental evaluation, which includes motions such as hand movement, walking, and climbing. Additionally, he measures social and emotional milestones with linguistic development. The pediatrician also gives the mother advice on early learning activities and nutrition. As the service falls under preventative care for a new patient, the pediatrician can use CPT code 99382 for billing and reimbursement.
Addressing Nutritional Concerns
Suppose the mother of an 18-month-old child comes to your practice. She is worried about her baby’s growth and nutrition. You examine the child’s BMI, evaluate the nutrient intake, and eating patterns. You also look for indications of vitamin or iron deficiency, anemia, and provide proactive advice on portion control, avoiding sugary drinks, and introducing new dietary patterns. Therefore, you can charge for this service with CPT code 99382 because a new patient’s nutritional and growth assessment is a component of preventive medicine E/M services.
Pre-School Checkup
Suppose a mother brings her 4-year-old daughter, who is all set to begin school, to a pediatric clinic. Before her child starts pre-school, she wants her to undergo a thorough checkup and a physical examination. The pediatrician performs a comprehensive physical examination to review the girl’s vaccination history, look for infectious diseases, and obtain documentation of her health clearance to attend school. Hence, the pediatrician can report CPT code 99382 to bill a preventive care appointment involving a comprehensive evaluation and documentation for a new patient.
Applicable Modifiers for CPT Code 99382
These are some modifiers that you may apply with CPT code 99382 to get accurate reimbursements.
Modifier 25
Modifier 25 indicates an independently identified evaluation and management (E/M) service that was rendered on the same day as another service. Modifier 25 is suitable, for instance, if a pediatrician performs a thorough child checkup and simultaneously needs to manage a new injury or vaccination. In this case, modifier 25 will be appended to CPT code 99382.
EP Modifier
The EP modifier signifies that the service is covered under Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children under 21. CPT code 99382 is used for a thorough preventive examination of new patients aged 1 to 4. Hence, a pediatrician must apply this modifier to 99382 when billing Medicaid.
CPT Code 99382 – Billing & Reimbursement Guidelines
Below are some essential billing guidelines that you must follow before submitting your claims with CPT code 99382.
Verify Service Coverage
The first and foremost thing to address is that Medicare does not cover CPT code 99382. Medicare generally does not cover preventive medicine codes. According to Statutory Exclusion, Section 1862(a)(7) of the Social Security Act, a liability waiver is not necessary when invoicing a preventative medicine appointment for a Medicare patient, and the patient bears full responsibility for the total amount of debt accrued. However, private payers like Cigna, Aetna, and Anthem do cover annual checkups.
Review Insurance Payer Policies
Medicaid covers these services, even though Medicare does not! It guarantees that Medicaid-eligible children receive early and periodic screening, diagnosis, and treatment as well as comprehensive healthcare services. On the other hand, if your patient is enrolled with any other insurance payer, you can always file claims with them. However, you need to check their policies to see whether they cover preventive services for children.
Include Supporting Documentation
When you want to submit claims to the insurance payer, how will you send them? Of course, with proper documents. However, there are some requirements that your documents must fulfill. They must mention the duration of service and a diagnostic code if the physician has diagnosed anything during a preventive checkup. Furthermore, these documents must contain the family history of the child and other essential details, such as the child’s age, height, and weight.
Use the Appropriate Code
You need to learn the correct use of the CPT code. Most pediatric billers confuse CPT codes 99382 with 99392. CPT code 99382 is used for the initial comprehensive preventive medicine evaluation and management of a new patient who is in early childhood (age 1-4 years). In contrast, CPT code 99392 is used for a periodic comprehensive preventive medicine reevaluation and management of an established patient who is in early childhood (age 1-4 years). Hence, if you are billing for children not older than 4 years and fulfill the definition of a new patient, you can bill CPT code 99382.
Conclusion
To sum up, CPT code 99382 denotes a preventive service for children aged 1-4. The physician performs a comprehensive examination of the child’s health throughout this procedure. There are several reasons to perform this, including monitoring the child’s growth or an immune checkup before school.
Since Medicare does not cover this service, but Medicaid does, modifiers 25 and EP are appended to this CPT code. You must also follow the essential billing guidelines that we have mentioned to avoid having your claim denied.
If you still find coding preventive well-patient visits challenging, you can opt for professional pediatric billing services. These services offer a specialized solution for your medical billing needs.
