What E/M (Evaluation and Management) code is used for a pre-employment physical visit?

E/M Coding for Pre-Employment Physical Visits

For pre-employment physical visits, you should use the preventive medicine CPT codes 99381-99397 based on the patient's age and whether they are new or established.

Understanding Pre-Employment Physical Coding

Pre-employment physicals are considered preventive services rather than problem-focused visits. The appropriate coding depends on:

1. Patient status (new vs. established)
2. Patient age
3. Complexity of the examination

Preventive Medicine Service Codes

• New Patients:

  • 99381: Infant (under 1 year)
  • 99382: Early childhood (1-4 years)
  • 99383: Late childhood (5-11 years)
  • 99384: Adolescent (12-17 years)
  • 99385: 18-39 years
  • 99386: 40-64 years
  • 99387: 65 years and older

• Established Patients:

  • 99391: Infant (under 1 year)
  • 99392: Early childhood (1-4 years)
  • 99393: Late childhood (5-11 years)
  • 99394: Adolescent (12-17 years)
  • 99395: 18-39 years
  • 99396: 40-64 years
  • 99397: 65 years and older

Documentation Requirements

Proper documentation for pre-employment physicals should include:

• Comprehensive age and gender-appropriate history
• Comprehensive physical examination
• Risk factor identification
• Counseling/anticipatory guidance
• Ordering of appropriate laboratory/diagnostic procedures
• Any employment-specific requirements

Special Considerations

When Additional Services Are Provided

If you address a significant, separately identifiable problem during the preventive visit:

• Bill the preventive medicine code (99381-99397) AND
• Add an appropriate E/M code (99202-99215) with modifier -25 1

Pre-Employment Specific Testing

If specific occupational testing is required:

• Document the specific requirements of the employer
• Include any specialized testing performed (e.g., drug screening, vision testing, audiometry)
• Add appropriate CPT codes for any additional procedures performed

Common Pitfalls to Avoid

1. Using problem-focused E/M codes (99201-99215) - These are inappropriate for preventive services like pre-employment physicals

2. Failing to document preventive components - Make sure to document all preventive elements to support the preventive medicine code

3. Overlooking employer-specific requirements - Document all specific requirements requested by the employer

4. Undercoding - Research shows that undercoding is common in primary care settings, with many visits that could be coded at higher levels being coded lower 2

By using the appropriate preventive medicine codes and thoroughly documenting all components of the pre-employment physical, you can ensure proper reimbursement while meeting both patient and employer needs.