Wiki Sports/School Physical Coding

[masprague319]

I am needing some direction on coding for sports/school physicals. I know the dx would be V70.3, but should the appropriate age related preventative CPT be used or do we submit with an office visit code and append a modifier 33? If the preventative CPT is used it could be denied since the child has probably already had their annual exam. I have heard that some pediatricians set a cash price for physicals since this can be an issue with insurance. Thanks for any advice.

 

[caseef]

Most insurances will not pay the V70.3 even if you use the 33 modifier and you also have to take in the fact that most school physicals do not require the same information that is required for the preventative exams.

 

[Kisalyn]

Caseef is right... a lot of insurances won't reimburse for V70.3. Our providers will perform routine physicals if the patient is due for one and fill out their forms.

If the patient is not due for a physical, the providers just fill out the form with the patient and we bill out preventative with V70.3 and reduce the charge.