Internal Medicine Coding Alert

Reader Question:

Contact Payer to Nail Down Sports Physicals Coding

Published on Thu Oct 20, 2016

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Question: I am new to internal medicine coding, and I was looking at reporting sports physicals and came across the CPT® code 97005, which mentions “Athletic training evaluation.” Can this be used to report a sports physical?

Indiana Subscriber

Answer: You won’t find any straightforward means to report a sports physical. You do not have any specific codes to report the evaluation your physician provides to certify that the person can take part in sporting activities.

You should use codes 97005 (Athletic training evaluation) and 97006 (Athletic training re-evaluation) when an athlete or a sportsperson visits your physician to get evaluated for a sporting-related injury. Since these are problem-oriented codes, you cannot use these CPT® codes for a sports physical, which is more of an administrative or preventive evaluation to inform the sporting authority that the person is fit to take part in the particular sport.

Instead, to report a sports physical, you can opt to report a preventive medicine services code (99381-99397) if your clinician performs the physical as part of an annual wellness visit. Alternatively, some payers might allow you to report another appropriate E/M code (99212-99215) for the visit, although many payers will not allow this, because these other E/M codes are also used to report problem-oriented visits.

If the payer does not accept a preventive services code or another E/M code for reporting a sports physical, you may want to check with the payer regarding how it wants the service reported, or even if it covers sports physicals. If it does not, you will have to inform the patient undergoing the physical that the service is not covered under his or her insurance and that he or she will be responsible for paying for the visit.