A 75-year-old established patient presents for a preventive physical before joining a group home; comprehensive history and examination; no new problems. What CPT code is reported?

A 75-year-old established patient presents for a preventive physical before joining a group home; comprehensive history and examination; no new problems. What CPT code is reported?

• A. 99387
• B. 99214
• C. 99215
• D. 99397

Answer: (D)

Preventive medicine CPT codes are chosen by patient status (new vs established) and by age. Here, the patient is established and 75 years old, coming in for a routine preventive physical with a comprehensive history and exam and no active problems. That lines up with the established-patient preventive code for seniors, which is 99397. This code is specifically used for preventive visits in patients aged 65 and older. The problem-focused outpatient codes (like 99214 or 99215) would apply only if there were active, non-preventive problems to address, which isn’t the case here. A preventive visit for a new patient or for a different age group would use a different preventive code, not the established-65-and-older code.

Preventive medicine CPT codes are chosen by patient status (new vs established) and by age. Here, the patient is established and 75 years old, coming in for a routine preventive physical with a comprehensive history and exam and no active problems. That lines up with the established-patient preventive code for seniors, which is 99397. This code is specifically used for preventive visits in patients aged 65 and older. The problem-focused outpatient codes (like 99214 or 99215) would apply only if there were active, non-preventive problems to address, which isn’t the case here. A preventive visit for a new patient or for a different age group would use a different preventive code, not the established-65-and-older code.