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    What you need to know about a comprehensive exam for a physical


    These visits differ from other visits where the patient has a problem for which medical attention is sought. The age, gender and associated risk factors of the patient are important considerations while providing a preventive medicine service.

    The provider uses these factors to guide taking the patient history, performing the examination and making a thorough assessment of age and gender–related risk factors. Codes 99381-99397 include counseling/anticipatory guidance/risk factor reduction interventions which are provided at the time of the initial or periodic comprehensive preventive medicine examination.

    The “comprehensive” nature of the Preventive Medicine Services codes 99381-99397 reflects an age and gender appropriate history/exam and is not synonymous with the “comprehensive” examination required in Evaluation and Management codes 99201-99350. So, your exam is sufficient to bill the preventive medicine service. Just check the age of the patient to bill this section of codes.

    Suggestion: If the physician found something abnormal during the preventive service and performed the above-mentioned exam for that specific condition, then in addition to preventive service the physician also can bill office visit from the section 99201-99215 with Modifier 25.


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