Wiki Sports Physicals

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
G
Code: Z02.5

Code Name: ICD-10 Code for Encounter for examination for participation in sport

Block: Encounter for examination for participation in sport


Excludes 1:blood-alcohol and blood-drug test (Z02.83)

Details: Persons encountering health services for examinations (Z00-Z13)

Note: Nonspecific abnormal findings disclosed at the time of these examinations are classified to categories R70-R94.

Excludes 1:examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Guidelines: Factors influencing health status and contact with health services (Z00-Z99)

Note: Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y99 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
(a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
(b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

For more details on Z02.5 , ICD-10 Code for Encounter for examination for participation in sport , visit: https://coder.aapc.com/icd-10-codes/

crystalm

Contributor
Messages
15
Best answers
0
Hi! I am wondering how others code sports physicals when they come through. Our office uses a preventative med code along with diagnosis of
V70.3. There aren't very many payors that will cover this, and we are having angry patients to deal with. I am also wondering if there is something out there that specifically would address this? Any help is appreciated!
 

jek521

Networker
Messages
60
Best answers
0
If a comprehensive well-child check is performed, with the sports physical paperwork completed, our pediatricians & FPs use 9938x-3396x with diagnosis code V20.2. If only if a limited service is provided to evaluate the patient in order to fill out the form, then 99201-99215 with diagnosis V70.3 is billed.

NASBHC--National Assembly on School-Based Health Care--advises using
V20.2 in this way, stating that an administrative exam usually doesn't meet the criteria of a preventive medicine CPT code.

Jen
 

dballard2004

True Blue
Messages
1,168
Location
Gower, MO
Best answers
0
I agree. CPT Assistant says that if a sports PE is perfromed, not the yearly exam, use the E/M office visit codes (99201-99215).
 
Messages
296
Location
Pensacola, FL
Best answers
0
We charge the patient $20.00 for sports physicals. Prior to my arrival at this practice, they told me they never got paid so they always charge. But you guys are saying that we can bill the insurance at the E/M visit with code V70.3? Can we do this for school and work physicals?
 

amjordan

True Blue
Messages
751
Location
Kansas City, MO
Best answers
0
Yes, you can bill the patients insurance for this service. However, from my experience this is not covered service because it is an administrative physical requested by the school. In order to provide this service in a more affordable manor the family practice group I worked with did the same thing. They offered sports physicals for $20. The stayed open a couple evenings a week and a couple of Saturday mornings during the peak school PE season to accommodate our patients. As an added benefit, the practice grew because new families started to utilize our office because of this service.
 

dentfam

Networker
Messages
64
Location
Santa Rosa
Best answers
0
$25 not billed to insurance

The FP I worked for would not bill to insurance as it really was a "school requested" thing and did not really meet the requirements of an E/M code.
We would schedule a block of time for Sports Physicals only and charge $25 for the limited exam and paperwork involved to clear for sports.
 

LLovett

Guest
Messages
1,722
Best answers
0
After a lot of research we ended up using the unlisted preventive medicine code 99429 and charged the patient a set fee.

The E/M codes 99212-99215 are problem visits and shouldn't be used as well care, which is what a sports pe is. The problem with well care codes we ran into was with medicaid. They have very specific requirements in order to use those codes, if all elements are not done you can't bill them and you can't bill a patient for a service that is covered by medicaid. That left us with an the option of using the unlisted code which is not covered by medicaid or most insurances.

Just my experience, hope it is helpful.

Laura, CPC
 

ESORENSEN

Guest
Messages
9
Best answers
0
Sports px

How 'bout age appropriate preventive med code with modifier 52 to show that service is reduced. Use v20.2 so insurance may pay but reduce fee in case they don't.

Eva sorensen, cpc
 

mmorningstarcpc

True Blue
Messages
643
Location
Charleston, South Carolina
Best answers
0
My former FP office wasnt getting paid either, so when I got there, we changed the way we handled sports physicals. We told the patient up front we did not submit to insurance and that is was a set fee. We use the preventative medicine code that fit the age of the patient, and all sports physicals were a set price. I dont remember the exact price now but think it was about $25-35 dollars.
 

mitchellde

True Blue
Messages
13,390
Location
Columbia, MO
Best answers
1
I am in agreement with Laura, these are well visits, and I agree with the unlisted preventive code I think it simplifies everything.
 
Messages
22
Best answers
0
Paperwork

do you guys have them sign a consent and fill out a seperate demographics form when your physician does these in the office, or do you just keep a copy of the physical form?
 
Top