99397

Periodic Comprehensive Preventive Medicine Reevaluation, Age 65 and Older

CPT code 99397 describes a periodic comprehensive preventive medicine reevaluation and management service for an established patient who is 65 years of age or older. This service is designed to assess and maintain the patient's overall health status, identify risk factors for disease, and provide age-appropriate health guidance and screenings. Unlike a problem-oriented visit, the primary focus of 99397 is on health promotion, disease prevention, and early detection of conditions, rather than the management of an acute illness or exacerbation of a chronic disease. The service encompasses a comprehensive age- and gender-appropriate history, including a review of systems, family history, and social history, often with a focus on functional status, polypharmacy, and fall risk. A comprehensive physical examination is also performed, covering multiple organ systems. A key component involves health education and counseling on topics such as diet, exercise, safety, tobacco cessation, alcohol use, sexual health, cognitive function, and advance care planning. Additionally, the physician will discuss and, if appropriate, order recommended age-specific screening tests (e.g., for cancer, osteoporosis, vision, hearing, depression, cognitive impairment) and review immunization status. This preventive service aims to provide a holistic assessment of the elderly patient's health, ensuring they receive appropriate preventive care to optimize their well-being and maintain independence.

Clinical Indications

  • Routine annual health check-up for asymptomatic patients aged 65 and older.
  • Health maintenance and promotion.
  • Periodic assessment of overall health status and functional capacity.
  • Screening for age-related conditions such as cardiovascular disease, cancer, osteoporosis, diabetes, vision, hearing, and cognitive impairment.
  • Review and update of immunizations (e.g., influenza, pneumococcal, shingles, tetanus).
  • Counseling on healthy lifestyle choices, diet, exercise, safety, and fall prevention.
  • Discussion of advance directives and end-of-life care planning.
  • Medication reconciliation and polypharmacy review.
  • Assessment of social determinants of health and psychosocial well-being.

Procedure Steps

  1. Obtain a comprehensive age-appropriate medical history, including past medical history, family history, social history (e.g., living situation, support system, functional status), medication review (including over-the-counter and supplements), and a comprehensive review of systems.
  2. Perform a comprehensive physical examination, covering multiple organ systems (e.g., cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, skin, HEENT).
  3. Assess age-specific risk factors, including but not limited to, fall risk, nutritional status, cognitive function, depression screening, and polypharmacy.
  4. Provide age-appropriate health education and anticipatory guidance, discussing topics such as healthy diet, physical activity, injury prevention, home safety, substance abuse, and sexual health.
  5. Counsel on recommended age- and gender-specific screenings for conditions like colorectal cancer, breast cancer, prostate cancer, osteoporosis, diabetes, hypertension, hyperlipidemia, vision, and hearing impairment.
  6. Review and update immunization status, recommending and, if appropriate, administering vaccinations (e.g., flu, pneumonia, shingles, Tdap).
  7. Discuss and document advance care planning, including living wills and durable powers of attorney for healthcare.
  8. Order appropriate laboratory tests and diagnostic studies based on risk factors, current guidelines, and patient preferences.
  9. Facilitate referrals to specialists or other healthcare professionals as needed (e.g., ophthalmology, audiology, physical therapy, social work).
  10. Document findings, recommendations, and patient counseling comprehensively in the medical record.

Coding Guidelines

  • CPT code 99397 is used for a periodic comprehensive preventive medicine reevaluation for an *established* patient aged 65 years or older. This code is distinct from an 'initial' comprehensive preventive medicine evaluation (99387).
  • This code should be used when the patient is asymptomatic and the primary purpose of the encounter is for preventive services, not for the evaluation and management of an acute illness or the exacerbation of a chronic condition.
  • If a significant, separately identifiable problem or abnormal finding is identified and addressed during the preventive visit, a separate E/M service code (e.g., 99202-99215) may be reported in addition to 99397. In such cases, modifier 25 must be appended to the E/M code to indicate that a significant, separately identifiable evaluation and management service was performed by the same physician on the same day as the preventive visit.
  • The components of a comprehensive history, examination, and counseling/anticipatory guidance must be documented to support the use of this code.
  • This code does not typically include the Medicare Annual Wellness Visit (AWV) codes (G0438 for initial, G0439 for subsequent), which have specific requirements outlined by CMS and a different focus (e.g., health risk assessment, personalized prevention plan). While some elements may overlap, 99397 is a distinct, comprehensive preventive exam that may have different coverage under various payers.
  • Labs and diagnostic tests ordered during the preventive visit are typically billed separately using their respective CPT codes.
  • Immunizations administered during the visit are reported separately using immunization administration codes (e.g., 90460, 90471-90474) and vaccine product codes.

Associated ICD-10 Codes