Although the general perception is that an Annual Wellness Visit and a Physical Exam are the same and often the terms are used interchangeably, they are not from your clinician’s perspective or how your insurance cover for these types of visits.
A physical exam is a medical evaluation following a pertinent complaint you bring up as a Chief Complaint. An annual physical visit is a yearly check-up with your primary care physician to assess your overall health and well-being. During this visit, your doctor will review your medical history, perform a physical exam, and order necessary screening tests or immunizations.
How Does the Visit Work?
During the visit, your doctor will review your medical history to ensure that your current medications, allergies, and medical conditions are up-to-date. This is known as medication reconciliation and is essential to prevent adverse drug interactions or other health complications.
Your doctor will also ask about your social and habits history, including any alcohol or tobacco use, and your family history to assess your risk for certain hereditary conditions. Your nutrition and physical activity are reviewed to ensure that healthy habits are being implemented.
In addition to reviewing your medical history and habits, your doctor will perform a physical exam to assess your overall health, including your blood pressure, heart rate, respiratory rate, and other vital signs. Your doctor may also order specific screening tests, such as blood work or imaging studies, to check for any underlying health issues.
Finally, your doctor will discuss any necessary immunizations, such as the flu shot or pneumococcal vaccine, and may also discuss advanced care planning, including end-of-life care decisions.
Why is an Annual Physical Visit Important?
An annual physical visit is a significant opportunity to assess your overall health and identify any potential health issues before they become more serious. By reviewing your medical history, habits, and family history, your doctor can identify potential risk factors and develop a plan to manage them.
Screening tests can also help detect health issues early when they are often easier to treat. Finally, discussing advanced care planning can help ensure that your wishes for end-of-life care are understood and respected.
Common CPT Codes for Annual Physical Visits
CPT is the language insurance companies and regulators use to interpret the intellectual and physical work your clinician and their team did to provide you with a service. The most common CPT codes used to bill for an annual physical visit are:
99385: Initial comprehensive preventive medicine evaluation and management of a patient, ages 18-39 years old
99386: Initial comprehensive preventive medicine evaluation and management of a patient, ages 40-64 years old
99395: Periodic comprehensive preventive medicine evaluation and management of an individual, ages 18-39 years old
99396: Periodic comprehensive preventive medicine evaluation and management of an individual, ages 40-64 years old
In conclusion
An annual physical visit is a significant opportunity to assess the following:
- Medical and family history
- List of current medical providers
- Height, weight, BMI, BP and other appropriate routine measurements
- Review risk factors such as tobacco use
- Review of functional ability
- Establish a written screening schedule for next 5-10 years
- Order screening laboratory and imaging studies as appropriate depending on age and sex
- Discuss immunizations