# Common Primary-Care Conditions, Combos & Billing — Care-Plan Coverage Reference The master list of what primary-care physicians most commonly **see and bill**, the typical codes, and whether a patient **care plan** and **bill/receipt** template exists for it. - **Plan?** ✅ = care plan in the live gallery/engine · ⬜ = target, not built yet - E/M: established-patient office visit level is shown (`99213` low–moderate, `99214` moderate, `99215` high). New-patient equivalents are `99203/99204/99205`. - Codes are representative, not exhaustive. --- ## 1 · Most common ACUTE presentations | Condition | ICD-10 | Typical E/M | Other codes | Plan? | | ---------------------------------- | ------------- | ----------- | ------------------------ | ----- | | Upper respiratory infection (cold) | J06.9 | 99213 | — | ✅ | | Acute pharyngitis (sore throat) | J02.9 | 99213 | 87880 rapid strep | ✅ | | Strep throat | J02.0 | 99213 | 87880 | ✅ | | Acute sinusitis | J01.90 | 99213 | — | ✅ | | Acute bronchitis | J20.9 | 99213 | — | ✅ | | Influenza | J11.1 | 99214 | 87804 flu antigen | ✅ | | COVID-19 | U07.1 | 99214 | 87811 antigen | ⬜ | | Acute otitis media (ear infection) | H66.90 | 99213 | — | ✅ | | Conjunctivitis (pink eye) | H10.9 | 99213 | — | ✅ | | Urinary tract infection | N39.0 | 99213 | 81003 UA | ✅ | | Sexually transmitted infection | A74.9 / A54.x | 99214 | 87491/87591 NAAT | ✅ | | Acute gastroenteritis | K52.9 | 99213 | — | ⬜ | | Low back pain | M54.50 | 99213 | — | ✅ | | Ankle sprain / strain | S93.40xA | 99213 | 73610 ankle X-ray | ✅ | | Fracture (e.g. distal radius) | S52.50xA | 99214 | 73110 X-ray; splint/cast | ✅ | | Headache / migraine | G43.909 | 99213 | — | ✅ | | Allergic rhinitis | J30.9 | 99213 | — | ✅ | | Skin: rash / dermatitis | L30.9 | 99213 | — | ⬜ | | Skin: lesion / biopsy referral | D49.2 | 99213 | 11102 biopsy | ✅ | | Cellulitis | L03.90 | 99214 | — | ⬜ | | GERD / heartburn | K21.9 | 99213 | — | ✅ | | Anxiety | F41.9 | 99214 | 96127 screen | ✅ | | Depression | F32.9 | 99214 | 96127 PHQ-9 | ✅ | ## 2 · Most common CHRONIC conditions | Condition | ICD-10 | Typical E/M | Notes | Plan? | | ------------------------------- | ------- | ----------- | ---------------------------------- | ----- | | Essential hypertension | I10 | 99214 | home BP log | ✅* | | Type 2 diabetes | E11.9 | 99214 | A1c, eye/foot, nephropathy | ✅* | | Hyperlipidemia | E78.5 | 99214 | lipid panel, statin | ✅* | | Obesity | E66.9 | 99214 | BMI, counseling 99401 | ⬜ | | Prediabetes | R73.03 | 99214 | A1c, lifestyle | ✅ | | Hypothyroidism | E03.9 | 99213 | TSH | ⬜ | | Asthma | J45.909 | 99214 | spirometry 94010 | ⬜ | | COPD | J44.9 | 99214 | spirometry | ⬜ | | Osteoarthritis | M19.90 | 99213 | — | ⬜ | | Chronic kidney disease | N18.30 | 99214 | eGFR, ACR | ⬜ | | Atrial fibrillation | I48.91 | 99214 | anticoagulation | ⬜ | | Osteoporosis | M81.0 | 99213 | DEXA 77080 | ⬜ | | BPH | N40.0 | 99213 | — | ⬜ | | Depression/anxiety (chronic) | F33/F41 | 99214 | 96127 | ✅ | \* Covered by the combined **Hypertension + Diabetes + Lipids** care plan (the "trifecta"). ## 3 · Common COMBINATIONS (what PCPs actually manage in one visit) | Combination | ICD-10 | E/M (MDM) | Plan? | | --------------------------------------------- | --------------------- | ----------- | ----- | | Hypertension + Diabetes + Hyperlipidemia | I10 + E11.9 + E78.5 | 99214/99215 | ✅ | | Hypertension + Hyperlipidemia | I10 + E78.5 | 99214 | ⬜ | | Type 2 diabetes + CKD | E11.22 + N18.x | 99214/99215 | ⬜ | | Obesity + Prediabetes + Hypertension | E66.9 + R73.03 + I10 | 99214 | ⬜ | | COPD + Hypertension | J44.9 + I10 | 99214 | ⬜ | | Depression + Anxiety | F32.9 + F41.9 | 99214 | ✅ | | Annual physical + an acute problem (mod -25) | Z00.00 + acute dx | 99396 + 99213-25 | ✅ | ## 4 · PREVENTIVE / WELLNESS & screenings (covered-in-plan recommendations) | Service | Code(s) | Cadence | Plan/Receipt? | | -------------------------------- | ------------------ | ------------------ | ------------- | | Annual wellness / preventive | 99395–99397 | yearly | ✅ (receipt) | | Medicare Annual Wellness Visit | G0438 / G0439 | yearly | ⬜ | | Well-woman exam | 99395 + Q0091/G0101| yearly | ⬜ | | Well-child / immunizations | 99391–99394 | per schedule | ⬜ (prenatal ✅) | | Colorectal screening | 45378 / 81528 FIT | colonoscopy q10y | ✅ (prep) | | Mammogram | 77067 | q1–2y, 40+ | ⬜ | | Cervical (Pap / HPV) | 88175 / 87624 | q3–5y | ⬜ | | Diabetic eye exam | 92250 / 2022F | yearly (diabetics) | ✅ (receipt) | | Diabetic foot exam | G0247 / 2028F | yearly | ⬜ | | Bone density (DEXA) | 77080 | per risk | ⬜ | | AAA ultrasound (men 65–75 smk) | 76706 | once | ⬜ | | Lung cancer LDCT | 71271 | yearly (eligible) | ⬜ | | Lipid panel | 80061 | per risk | ✅ (lab plan) | | Immunizations (flu/pneumo/etc.) | 90686 / 90677 … | per schedule | ✅ (receipt) | | Depression / anxiety screen | 96127 (PHQ/GAD) | per visit | ✅ | ## 5 · Bill / Receipt variations to support - **Copay-only** visit (most common): "what you owe = $copay." - **Deductible-not-met**: coinsurance owed; show progress bar + remaining. - **Preventive (covered 100%)**: "$0 owed — covered by your plan." - **Combined visit**: preventive covered + small problem-oriented copay (modifier -25). - **Procedure/lab add-on**: itemized line(s). - **Benefits/recommendations** block: eye, hearing, glasses allowance, colonoscopy, vaccines, with "it's been N years since…" nudges. --- ### Coverage summary Built today (gallery + care-docs engine): **~24** distinct conditions/combos + a receipt and a bill/benefits document. The ⬜ rows above are the prioritized backlog to reach full "most-common PCP" coverage (next tier: COVID-19, obesity, hypothyroidism, asthma/COPD, cellulitis, gastroenteritis, dermatitis, HTN+HLD and T2D+CKD combos, well-woman/well-child, mammogram/Pap/DEXA receipts).