03/17/2026
Preventive Visits: What Can (and Can’t) Be Included
Tip:
Preventive visits (993XX) do not qualify as FQHC PPS encounters. Coding must reflect medical necessity, not just the services documented.
Watch For:
1. Minor issues in the Review of Systems (ROS) or Assessment unintentionally triggering PPS
2. Missed problem-oriented visits that should be billed as PPS
Example Scenario: A patient comes in for a preventive visit (993xx). During the visit, the provider notes mild joint stiffness in the ROS but does not address or treat a specific problem.
1. Incorrect coding: Billing the visit as a PPS encounter because a minor issue was documented
2. Correct coding: Bill the preventive visit only; the minor ROS finding does not justify a PPS encounter
3. Now imagine the patient also has new hypertension identified during the same visit:
4. This problem-oriented visit can be billed separately as a PPS encounter if documented with medical necessity
Why It Matters?
Proper coding ensures:
1. Compliance with FQHC guidelines
2. Revenue protection by capturing only medically necessary PPS encounters
3. Avoidance of both overbilling and underbilling
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