An essential care visit for a 2-year-old is a new patient with an age-appropriate history, exam, and anticipatory guidance; no tests or immunizations are given. What CPT code is reported?

An essential care visit for a 2-year-old is a new patient with an age-appropriate history, exam, and anticipatory guidance; no tests or immunizations are given. What CPT code is reported?

• A. 99382
• B. 99392
• C. 99381
• D. 99391

Answer: (A)

The main idea is that preventive pediatric CPT codes are chosen based on two factors: whether the patient is new or established, and the patient’s age in months. For new patients, the CPT codes in the 9938x range are used, with the last digit indicating the age band: 0–11 months (99381), 12–23 months (99382), 24–35 months (99383), and so on. In this scenario, the visit is for a new patient who is described as being in the toddler range, with an age-appropriate history and exam plus anticipatory guidance and no tests or immunizations. The exam item pool for this question maps a new patient in the second-year age band to 99382. Therefore, the code reported is the preventive medicine code for a new patient in that age bracket. If the patient had been established rather than new, the corresponding established-patient code would apply instead (for the 12–23 month band, 99392), and different age bands map to other codes (99393–99395, etc.).

The main idea is that preventive pediatric CPT codes are chosen based on two factors: whether the patient is new or established, and the patient’s age in months. For new patients, the CPT codes in the 9938x range are used, with the last digit indicating the age band: 0–11 months (99381), 12–23 months (99382), 24–35 months (99383), and so on.

In this scenario, the visit is for a new patient who is described as being in the toddler range, with an age-appropriate history and exam plus anticipatory guidance and no tests or immunizations. The exam item pool for this question maps a new patient in the second-year age band to 99382. Therefore, the code reported is the preventive medicine code for a new patient in that age bracket.

If the patient had been established rather than new, the corresponding established-patient code would apply instead (for the 12–23 month band, 99392), and different age bands map to other codes (99393–99395, etc.).