AMA CPT® Assistant - 1993 Issue 1 (Spring)
Evaluation and Management Codes for Preventive Services (Spring 1993)
Spring 1993 pages 14-33 Coding Tip Evaluation and Management Codes for Preventive Services The purpose of this article is to review and elaborate upon the appropriate use of E/M codes for reporting physician preventive medical services. These services include the "periodic or annual physical" for infants, children and adults, counseling and/or risk factor reduction, intervention and the administration of health risk assessment instruments. Background Information Some preliminary information may be helpful in understanding the original establishment of the age categories in the preventive medicine codes. Infants/Children: These codes were derived through the consensus of physician advisors that the type...
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Article Overview
This Spring 1993 CPT Assistant article explains the scope of preventive medicine evaluation and management services and how they relate to age-based preventive visits, counseling, risk factor reduction, health risk assessment instruments, and other preventive service reporting topics. It is aimed at coders, billers, and clinicians who need to understand the structure of preventive medicine codes, related documentation expectations, and the broad preventive care reference tables included with the article.
Why This Topic Matters
Preventive services coding has distinct rules and age categories that affect how routine visits, counseling, and related services are reported. Understanding this article helps readers determine when preventive medicine coding applies and how the preventive service references are organized in CPT 1993.
Article Sections
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Background Information
Introduces the age-based organization of preventive medicine services and the historical basis for the preventive code categories.
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Preventive Medicine Services
Presents the preventive medicine service code family and discusses the general scope of routine preventive visits and related services.
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Discussion
Explains the broad considerations used to distinguish preventive medicine services from other evaluation and management services.
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NEW PATIENT
Lists the preventive medicine services associated with new patients across the age-based categories.
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ESTABLISHED PATIENT
Lists the preventive medicine services associated with established patients across the age-based categories.
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Discussion
Addresses the broader factors used when selecting a preventive medicine code and how counseling services relate to preventive encounters.
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COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION NEW OR ESTABLISHED PATIENT
Introduces the counseling and risk factor reduction section and outlines its general purpose in preventive care reporting.
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PREVENTIVE MEDICINE, INDIVIDUAL COUNSELING
Lists the individual counseling service codes included in the preventive medicine section.
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PREVENTIVE MEDICINE, GROUP COUNSELING
Lists the group counseling service codes included in the preventive medicine section.
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OTHER PREVENTIVE MEDICINE SERVICES
Identifies additional preventive medicine services reported outside the standard visit and counseling categories.
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Discussion
Summarizes how counseling services fit alongside preventive medicine visits and other physician services.
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Health Risk Assessment and Unlisted Services
Covers reporting of health risk assessment instruments and unlisted preventive medicine services.
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Example of Preventive Service Visit
Provides a worked preventive service scenario illustrating how a preventive visit may be documented and discussed.
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Coding Rationale
Explains the general reasoning applied in the example to support preventive service reporting.
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Documentation
Describes the documentation elements expected to support preventive medicine and related services.
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Tables from "Guide to Clinical Preventive Services"
Introduces the reference tables that summarize preventive service topics by age group and risk category.
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Table A - Birth to 18 Months
Summarizes preventive service topics and screening, counseling, and immunization references for infants and very young children.
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Table Aa - High-Risk Categories for Birth to 18 Months
Lists the high-risk categories associated with the birth-to-18-month preventive service reference table.
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Table B - Ages 2-6
Summarizes preventive service topics and screening, counseling, and immunization references for early childhood.
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Table Ba - High-Risk Categories for Ages 2-6
Lists the high-risk categories associated with the ages 2-6 preventive service reference table.
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Table C - Ages 7-12
Summarizes preventive service topics and screening, counseling, and chemoprophylaxis references for school-age children.
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Table Ca - High-Risk Categories for Ages 7-12
Lists the high-risk categories associated with the ages 7-12 preventive service reference table.
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Table D - Ages 13-18
Summarizes preventive service topics and screening, counseling, and immunization references for adolescents.
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Table Da - High-Risk Categories for Ages 13-18
Lists the high-risk categories associated with the adolescent preventive service reference table.
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Table E - Ages 19-39
Summarizes preventive service topics and screening, counseling, and immunization references for younger adults.
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Table Ea - High-Risk Categories for Ages 19-39
Lists the high-risk categories associated with the ages 19-39 preventive service reference table.
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Table F - Ages 40-64
Summarizes preventive service topics and screening, counseling, and immunization references for middle-aged adults.
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Table Fa - High-Risk Categories for Ages 40-64
Lists the high-risk categories associated with the ages 40-64 preventive service reference table.
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Table G - Ages 65 and Over
Summarizes preventive service topics and screening, counseling, and immunization references for older adults.
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Table Ga - High-Risk Categories for Ages 65 and Over
Lists the high-risk categories associated with the ages 65 and over preventive service reference table.
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Table H - Pregnant Women
Summarizes preventive service topics and screening, counseling, and follow-up references for prenatal care.
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Table Ha - High-Risk Categories for Pregnant Women
Lists the high-risk categories associated with the pregnant women preventive service reference table.
What You Will Learn
- How preventive medicine services are organized by age and patient status
- What categories of counseling and other preventive medicine services are addressed
- How the article frames health risk assessment reporting and unlisted preventive services
- How the reference tables organize preventive service topics across life stages and pregnancy
- What documentation elements are discussed for preventive service visits
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Clinical documentation specialists
- Practice managers
Codes Discussed
Code Ranges Discussed
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