Wiki yearly pe

[lmjd]

Is anyone running into the problem of PE's needed for college, sports, etc but the time period is within the year of the last PE. Insurance companies are not paying with diagnosis codes reflecting the reason-ie routine health check (V20.2) vs V70.3 with a preventative E&M-any ideas?
Thanks!

 

[dmaec]

we use the age appropriate preventive visit code - with V70.3 dx - it is a "lower" rate than regular preventive services - I don't believe insurance will cover it so it ends up self-pay.... sometimes we offer sports px clinics a couple nights a week for a couple weeks and only charge $40.00 for the visit. Regular office hour individual sports px visits are $70.00 around here.

 

[bhaskins1]

If the child has had a routine physical in the last 12 months we can usually just fill out the forms from that visit. If you are getting alot of these, some offices charge a nominal fee to the patient to fill out forms. If the school/sports team/camp requires something more recent, most commercial insurance companies will not cover it and we will advise the parent they will have to pay for the visit out of pocket. (after insurance has denied) Be careful, Most insurance contracts require that you file the claim with them first... if they deny for frequency limit or a service that is not covered you can then turn around and bill the patient.

Hope this helps!