Common Procedure Codes
DOCTOR
CHECKOFF
SERVICE
CODE
99213
92214
99385
99386
99395
99396
80053
82248
85025
81001
or
81003
DESCRIPTION
Office or outpatient visit for the evaluation and management of established patient,
which requires at least 2 of these 3 components: 1) an expanded problem focused history;
2) an expanded problem focused examination; 3) medical decision of low complexity, etc.
(WFI Physical Exam, Pg 11-14, CPT pg 10)
Office or outpatient visit for the evaluation and management of established patient,
which requires at least 2 of these 3 components: 1) a detailed history; 2) a detailed
examination; 3) medical decision of moderate complexity, etc. (WFI Physical Exam, Pg 1114, CPT pg 10)
Initial comprehensive preventive medicine evaluation and management of an individual
including an age and gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic
procedures, new patient, age 19-39 years (WFI Physical Exam, Pg 11-14, CPT pg 28)
Initial comprehensive preventive medicine evaluation and management of an individual
including an age and gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic
procedures, new patient age 40-64 years (WFI Physical Exam, Pg 11-14, CPT pg 28)
Periodic comprehensive preventive medicine re-evaluation and management of an
individual including an age and general appropriate history, examination, counseling
anticipatory guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, established patient 19-39 years. (WFI Physical Exam,
Pg 11-14, CPT pg 28)
Periodic comprehensive preventive medicine re-evaluation and management of an
individual including an age and general appropriate history, examination, counseling
anticipatory guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, established patient 40-64 years. (WFI Physical Exam,
Pg 11-14, CPT pg 28)
ANNUAL LABORATORY ANALYSIS
Blood Analysis
The minimum blood analysis to be conducted as a part of the annual medical examination
is as follows: white blood cell count (with differential); differential; platelet count; red
blood cell count (hemoglobin and hematocrit; liver enzymes (AST, ALT, LDH) and function
(alkaline phosphatase, bilirubin, albumin) tests; glucose - fasting; creatinine and
glomerular filtration rate (GFR); blood nitrogen; sodium; potassium; carbon dioxide; total
protein; calcium; lipid (cholesterol and triglycerides) - fasting.
Comprehensive Metabolic Panel - This panel must include the following: Albumin,
Biliruben: total, Calcium: total, Carbon dioxide (bicarbonate); Chloride, Creatinine,
Glucose, Phosphatase; alkaline, Potassium, Protein, total, Sodium, Transferase, Alanine
amino (ALT)(SGPT) and Transferase, Aspirate amino (AST)(SGOT), Urea Nitrogen (BUN)
Incl VAP: Triglycerides, c-reactive protein, high sensitivity (Ref: WFI)
Biliruben: direct
Complete CBC, automated (Hgb, Hct, RBC, WBC and platelet count) and automated
differential WBC count (WFI Blood Screen, Pg 15-18, CPT pg 285)
Urinalysis, by dip stick or tablet reagent for biliruben, glucose, hemoglobin, keytones,
leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these
constituents; automated with microscopy (WFI Urinalysis, Pg 15-18, CPT pg 275)
SFD HR
CHECKOFF
DOCTOR
CHECKOFF
SERVICE
CODE
94010
71020
93000
93015
G0103
77052
77057
88141 88155
84152
Varies
82270
86803
86703
DESCRIPTION
Heavy Metal and Special Exposure Screening (OPTIONAL) Encourage baseline and then
exposure based.
May be performed under special circumstances such as hazardous materials exposures;
recurrent exposures; other known exposures; or where under federal, state, or provincial
regulations requires it (such as OSHA standards).
VISION TEST
To include evaluation of distance, near, peripheral, and color vision (included in physical).
HEARING TEST
Baseline and annual audiograms are to be performed on all uniformed personnel.
Testing must be done in an ANSI-approved soundproof booth. The following frequencies
are tested: 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz, 6000 Hz and 8000 Hz. Pure tone
threshold testing must be performed separately in both ears and participants must not
use hearing aids during testing.
PULMONARY EVALUATION
Spirometry
Spirogram (FVC, FEV1, FEV1/FVC Ratio); peak expiratory flow rate; pre/post
bronchodilator; DLCO; lung volumes (WFI Lung Capacity, Pg 20, CPT pg 335)
Initial Baseline Chest X-Ray
Two views, frontal and lateral (WFI Chest X-ray Pg 20, CPT pg 242)
AEROBIC / CARDIOVASCULAR EVALUATION
A resting ECG shall be performed annually.
Cardiovascular stress test using maximal or sub-maximal treadmill or bicycle exercise,
continuous electrocardiographic monitoring, and/or pharmacological stress with
physician supervision, with interpretation and report. (WFI Cardiac Stress Test Pg 21, CPT
pg)
CANCER SCREENING
Frequency Limitations: Screening prostate specific antigen tests (PSA) are covered at a
frequency of once every 12 months for men who have attained age 50. *Internet
Breast Examination (included in Women's health care professional screening below):
Mammogram (beginning at age 40 by WFI due to rate of exposure) - may be done
annually at Women's health care professional or can be referred by clinic.
Pap Smear - recommended annually - may be done annually at Women's health care
professional or can be referred by clinic
Prostate Specific Antigen (PSA) (males beginning at age 40) (WFI Colorectal Screen Pg 21,
CPT pg 283)
Colonoscopy (beginning at age 40 and then every 5 years unless indicated otherwise.
Blood occult, by peroxidase activity (i.e., guaiac), qualitative; feces, consecutive collected
specimens with single determination, for colorectal neoplasm screening (i.e., patient was
provided 3 cards or single triple card for consecutive collection. (WFI Colorectal Screen Fecal Occult blood testing Pg 22, CPT pg 276)
IMMUNIZATIONS
NOTE: Uniformed personnel are expected to be up to date on all required
immunizations.
INFECTIOUS DISEASE SCREENING
Hepatitis C antibody (WFI Infectious Disease Screening Pg 23, CPT pg 290)
Tuberculosis (performed in-house) (WFI Infectious Disease Screening Pg 23 CPT pg )
Human Immune Deficiency Virus (HIV) (Optional) Counseling assigned (WFI Infectious
Disease Screening Pg 23, CPT pg 290)
SFD HR
CHECKOFF