Question Sports Physicals w/ diagnositic studies

Krissy01

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Our office provides sports physicals for a flat fee and it is not submitted to the insurance company for payment. However, one of our providers is inquiring if he could bill the insurance when providing a more detailed sports physical and what the criteria for reimbursement/billing would be. All we can find is the E/M code + 99381-99429 *if the patient has an abnormality or a preexisting problem is addressed in the process of performing this preventive medicine service can the E/M code be billed.” Is this the appropriate code? We are an orthopedic group and this is not the “well/annual” visit and don’t want to cause a billing issue for the primary care physician if this counts as an annual well visit for the year.

1. 97169-97172 (z02.5) standard sports physical $50.00 flat fee

2. 99384 (12-17 y.o) PMS (z00.129 w/o presenting problem with x-ray or labs ordered) bill the insurance

3. E/M.25 + 99384 PMS (z00.121 w/ presenting problem new patient) bill the insurance

4. E/M.25 + 99394 PMS (z00.121 w/ presenting problem est patient) bill the insurance
 

rthomas@impcna.com

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In our practice the way we handle sports physicals regardless of why it's need is if the patient is due for their yearly wellness exam we will schedule and perform a wellness exam and fill out the required clearance form during the visit. If the child is not due for a wellness exam we schedule a sports physical (using CPT 99429) and charge the patient $25.00 upfront. If there are problems that end up being addressed the will then charge the appropriate E/M visit. Our providers feel that a patient should have a through exam when it comes to participating in sports. There are some place that just have a set time and rush the kids in and out.
 
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