Services included in a well-child visit
Each well-child visit should document:
- Health and developmental history (physical and mental)
- Physical exam
- Health education and anticipatory guidance
- BMI percentile (counseling for nutrition and physical activity)
Well-child visit billing
Follow these guidelines to avoid HEDIS® record audits for well-child visits.
Documenting well-child visit during a sick visit
- When a sick patient comes in and is due for a well-child visit, document all the components of a well-child visit. They can be reported in addition to the problem-oriented visit.
- Documentation must support that both services were provided in their entirety as significant and separately identifiable services. Then report the problem-oriented E&M service with the 25 modifier. This allows us to capture data for the well-child visit and will reimburse for both services.
If a child needs a sports physical for school and is due for a well-child visit, complete all the services of a well-child visit. Use appropriate diagnosis codes.
New patient preventive visits
Complete and document all well-child visit components and report them.
Ages 0-30 months
- Newborn visit 3-5 days post discharge
- AT 2, 4, 6, 9, 12, 15, 18, 24 and 30 months (at least 6 visits in the first 15 months)
- CPT codes 99381, 99382, 99391, 99392, 99461
Ages 3-6 years
- 1 visit per year
- CPT codes 99382, 99383, 99392, 99393
Ages 7-18 years
- 1 visit per year
- CPT codes 99383, 99384, 99385, 99393, 99394, 99395
Well-child visits for 0-15 months, 3–6 year olds and 7-12 year olds are PCP Incentive Program (PCP-IP) measures.
To find patients needing well-child visits: Use the online Patient Profile tool to sort your patients by missed visits.
- Preventive service codes
- Vaccine codes
- Vaccine administration
- Flu vaccines
- Lung cancer CT screenings
- Pelvic & breast exams, Pap tests
- Prenatal & maternity care
- Long-acting reversible contraceptives, Medicaid
- Well-child visits
- Medicare preventive services