20+ Common Family Practice Medical Billing Codes

Family practice is a prominent medical sector in healthcare. It involves the treatment of people, communities, and specifically families ranging from infants to older citizens. Bills containing family treatments make up a large portion of hospital revenue, that’s why it is essential to know family practice medical billing codes.

Entire medical billing is based on codes. Each code is made up of a combination of numbers which as a whole defines a specific service. This code then helps billers charge the patients and file claims. So, we can say that codes are the base of revenue collection because they directly impact the payer’s decision. 

Today, we will learn more about the service that comes under family practice medical billing with the help of some daily-use codes.

What Is Family Practice Healthcare?

Unlike a specific medical treatment for a certain health issue, family practice doctors focus on treating the person as a whole. This involves removing any health issue they may have, whether chronic diseases, minor injuries, or skin infections. Family treatment also works on studying family history so that they can identify the cause of the disorder considering the environment and genetic impact.

Overall, family practice is a comprehensive care of all body parts of each and every family member. This is a type of continuous care that requires long-term patient and provider relationships so that they can better know the patient’s history. 

Codes Used In Family Practice Medical Billing

Now that you know the basics about this type of healthcare category, let’s dive into the codes utilized during the billing process. We can’t list all the codes as they keep updated, but we still have a comprehensive list of top codes that are being used on a daily basis.

99201-99205 

These are the common codes that define the office visit of a new patient. The difficulty may also vary, where 99201 defines the shortest while 99205 defines the longest evaluation duration.

99211-99215

Similar to that of new codes, these codes define the visit of already-seen patients. And again, 99211 shows the quick evaluation while 99215 shows the most complicated visit.

99381-99387

These family practice medical billing codes define the first comprehensive preventive medical observation of new patients. This code category is divided into all age groups (infant, child, teenager, adult) to show the evaluation required at each life stage.

99391-99397

These codes are used for preventive medicine evaluation of established patients. It involves routine check-ups and regular health monitoring to identify any illness and prevent future health issues. This category is too divided into age groups.

99401-99404

These codes define the cases of preventive medical counseling. In these sessions, health concerns are discussed as a whole including precautions, lifestyle, diet, and risk factors to improve life span. The codes are used according to the session duration.

96160

This family practice medical billing code is used when a medical assessment instrument is administered. Such assessments involve asking questionnaires to patients to identify health risks. This data then helps in future health strategies i.e. medications or interventions.

97802-97804

These codes specify nutritional therapy conducted by professional healthcare providers. This therapy includes dietary evaluation, nutrition deficiency diagnosis, and intervention. This is a continued process since it also involves nutritional counseling sessions. Following is the division of these specific codes for different cases:

• 97802: used for initial evaluation, usually around 15 minutes
• 97803: used for follow-ups in case of nutritional reassessment and dietary modifications
• 97804: used for group nutritional therapy treatments

99241-99245

When consultations are performed upon the request of other physicians or any authentic medical source, these codes are used in family practice medical billing. The consultation involves the examination of patient history with a complex decision-making process. Codes are also divided based on the complexity of the case.

99341-99350

These codes indicate that medical care was conducted in the patient’s home. Following is the classification of the codes based on the new and established patients:

• 99341-99345: for new patients, with increased complexity
• 99347-99350: for established patients, with varied complexities

99495-99496

These codes are used to define the management of patients transitioning from inpatient hospital settings to community settings like homes. This is divided into 2 further scenarios:

• 99495: communication with the patient within 2 days after discharge, moderate-level medical decision-making, and a face-to-face visit within 14 days of discharge
• 99496: used for a more serious case, demanding communication within 1 day after discharge and within 7 days of face-to-face interaction, for highly complicated medical decision-making

99429

These codes are unique in the way they are used. 99429 is utilized for preventive medical services for those treatments that do not have a specific code. To sum up, if a service cannot be defined by any CPT code, this specific combination is used in family practice medical billing.

90716

This code is specifically and only used for the administration of chickenpox (varicella). It covers the entire treatment of chickenpox with medicine, including the cost of medicine itself which is billed separately.

90658

This code is specifically used for the administration of influenza vaccine. This defines the specific trivalent vaccine injected in the muscle, prescribed during seasonal flu.

90471-90474

These codes are used to bill the following administration scenarios of vaccines:

• 90471: used for one vaccine via a single injection
• 90472: used for every additional vaccine through injections
• 90473: used for the administration of one vaccine given orally or intranasally
• 90474: used for every additional vaccine given orally or intranasally

96110

This code is used when a developmental screening has been conducted on infants or young children. It involves standardized instruments used during development milestones and identifies any delays.

99406-99409

These codes are used for the counseling given for the cessation of smoking and tobacco use. It aims to help patients get rid of these addictive yet harmful substances.

• 99406: used for counseling sessions of 3-10 minutes
• 99407: used for counseling sessions of more than 10 minutes
• 99408 and 99409: used for substance abuse (other than tobacco) like alcohol screening and brief intervention, ranging from 15 to 30+ minutes

99218-99220

This code is used for family practice medical billing when a patient undergoes initial observation care in a hospital. Following are the codes used according to the level of complexity:

• 99218: shows low complexity observation care
• 99219: shows moderate complexity
• 99220: used for very complicated cases where seriously ill patients need comprehensive care

99224-99226

When a patient continues its stay period in the hospital after the initial day, this code is used. The duration and complexity of the cases are:

• 99224: used for straightforward and simple medical issues
• 99225: used for moderate-level cases
• 99226: used for serious cases which need proper management

99234-99236

This family practice medical billing code is used for a case when a patient is admitted to the hospital and discharged on the same date. These combinations too define relatively low, moderate, and highly complicated cases.

99238-99239

This code is used for the management of patient discharge from the hospital.

• 99238: used when it takes 30 minutes or less of the physician’s time
• 99239: used when discharge management requires more than 30 minutes

99304-99310

These codes are used when management, assessment, and care have been given specifically in the nursing facility setting.

99315-99316

This family practice medical billing code is used for the patient discharge management from the nursing facility. Again, these 2 codes are used for specific times (more and less than 30 minutes).

99497-99498

These codes define the discussion session for advance healthcare directives, done by a physician or other healthcare professional.

• 99497: used for the first 30 minutes of face-to-face session of advanced care planning
• 99498: used for each additional 30 minutes of consultation

99051

This code represents that the care was given in off-peak hours like evenings, weekends, or holidays. It shows that some treatments were given to the patients during the period other than business hours.

96160 (formerly 99420)

This code shows the interpretation of the health risk assessment of a patient conducted by using a questionnaire that evaluated the patient’s health based on their responses.

99490

This code is used for chronic health services of almost 20 minutes per month by clinical staff, directed by the physician or any professional.

Essential Coding Guide

As a medical coder, it is your duty to learn or at least remember codes for each treatment of the facility you are working for. Here we defined some of the family practice medical billing codes to give you an idea of how the coding system works according to the specific facility. 

Where we couldn’t mention many other codes, family practice runs mostly on these basic code combinations. So if you belong to this facility then we surely have made your work easier.