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School physical and problem visit on same day


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Can anyone tell me how they would bill if a patient came in for a school physical and problem visit on the same day?



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I would bill a Preventive Medicine Service code (99394) w a modifier 52, dx V70.3 with a reduced price and an appropriate E/M code w modifier 25 w prob. dx code.

I have heard many different ways to bill for Sports Physicals, I am not sure there are any concrete answers.

If there are, please let me know where to find them. This is an issue that comes up a lot through the year.


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Code the school physical as a preventive 9938x-9939x with DX V70.3 and code the problem as 9921x with mod -25 and the appropriate DX

I have not heard of using a mod -52 on the preventive E&M

The school physical is coded as a preventive only if preventive guidelines are met meaning with ROS, PFSH, appropriate level of exam, counseling etc. If not, then the school exam is coded as a 99201-99215 which means the school exam and the problem will all go under one E&M code

While a Comprehensive preventive is not the same as Comprehensive exam (see preventive section in CPT) and is supposed to be "as determined by the physician", it is expected that the preventive be comprehensive. So a preventive with no ROS with a 4 bullet exam just doesn't meet that. Payers can not downcode your preventive to a 99201-99215 but they can deny the preventive as "not meeting preventive guidelines" if the note/exam is so limited
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