1. E/M Code Category Selection:
The patient is a 19-year-old seen by his primary care physician for an annual preventive exam. His last exam was four years ago, and he has no complaints, indicating a preventive rather than problem-focused visit.
CPT® Code 99385 is for a new patient preventive visit for ages 18-39. Since the patient’s last visit was four years ago, this qualifies him as a new patient by CPT® standards (a patient is considered new if they have not received any professional services from the physician within the past three years).
2. Rationale for Excluding Other Options:
Code 99395 is for an established patient preventive visit for ages 18-39, which does not apply here since the patient is considered new after four years.
Code 99394 is for a preventive visit for an established patient aged 12-17, which does not match the patient’s age.
Code 99384 is for a new patient preventive visit for ages 12-17, which also does not apply given the patient’s age of 19.
3. AAPC and CPT® Coding Guidelines:
According to CPT® guidelines, 99385 is appropriate for a new patient in the 18-39 age range for a preventive visit, especially when they have not seen the provider in over three years.
Therefore, the correct answer is A. 99385.
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