Wiki School,Sport Physicals

[kimber3179]

I do the coding for a family practice clinic of 14 physicians, physician assistants and nurse practioners. All those administrative physicals with forms to be filled out have been been ongoing issue. What documentation is needed to bill these types of physicals, usually the physician makes a small note patient is here for camp physicial refer to form. Or the physician will mark on the superbill that the visit is their yearly annual exam with the diagnosis for well child exam but the documentation says school physical refer to form. Basically the scanned form is the documentation. So to me we should only bill for filling out the form. But the physicians want it billed how they marked it on the superbill, some physicians circle a E/M level others a preventative code. And we always bill it to insurance even though it is usually denied as non covered. How do some of you handle these physicals? Any help would be greatly appreciated as this is one of our major areas of patient complaints and phone calls, and also is a huge headache for me. Thank you

 

[sg**]

You would code based on documentation. Documentation will be your backup, always. They are based on age, gender, appropriate history and exam. For school and camp physicals ICD would be V70.3. You should still refer to a document and not just a superbill, you need that backup to support your coding.
Is the form being filled out based on the exam? Maybe refer to V68 for just filling form, but how can form be completed if physical is not. Please clarify more.
Insurance maybe denying due to pt having a phyical already. Most insurances only do 1 per year. May have to call to insurance to clarify though.

I hope this helps.