Wiki Sports Physicals - diagnosis code

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crystalm

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I have a question to throw out there. What diagnosis code do you put on sports physicals? Our office routinely uses V70.3 (other medical examination for administrative purposes; sports competition). Our state medicaid office will not pay with this diagnosis, and has come back and said if we use diagnosis code V70.5 (health examination of defined subpopulation; students) that they would pay. I don't think I agree with that, as the description for V70.3 fits what we are doing better. Any thoughts?
 
I'll wager an opinion here.

Sports physicals are indeed administrative in nature and should be reported with ICD-9-CM code V70.3. There really is no CPT code for these types of physicials, so I recommend reporting 99499 (unlisted E/M).

Hope this helps and again this is my opinion.
 
I agree it should be coded V70.3 and no insurance company is going to pay for a sports or a CDL physical. I never listen to the insurance companies when they say code it this way and it will get paid, but you have to code by what is in the chart.
 
Hello , I am a bit confused , I have billed ICT Z02.5 with CPT 99213 for sports physicals . Some insurances have paid and some do not
 
Ithiel05 said:
Hello , I am a bit confused , I have billed ICT Z02.5 with CPT 99213 for sports physicals . Some insurances have paid and some do not
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In my opinion, 99213 would be incorrect for this service because that code represents a problem-oriented visit. In order to code 99213, you need to have a chief complaint, which would be some kind of symptom or condition that requires evaluation by the provider. A sports physical does not meet this definition and I agree with the post above that recommends coding this with 99499.

As for payment, some insurance plans might cover a sports physical, and others might not - you'd have to check the patient's benefits to know. If it's not covered, then it would be the patient's responsibility. If you're billing it with 99213, it's also quite possible that these are being paid or denied in error because the coding may be causing the payer's claim system to apply an incorrect benefit.
 
There is alot of information out there about it. Some payers actually want codes for athletic training eval or PT depending on the extent and documentation like 97169, 97161. You have to look up payer rules on it. I think some actually do accept E/M codes but you have to check the plan.
Like Thomas said, some payers will cover and some won't.

 
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