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Sports Physicals

  1. #1
    Question Sports Physicals
    Medical Coding Books
    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!

  2. #2
    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.


  3. #3
    North Carolina
    I agree with Jen. If the visit is just for a sports PE, not a yearly exam, code from the appropriate office visit code. I have seen other practices do this differently but I prefer to stay with the AMA's view...

    Rebecca CPC, CPMA, CEMC

    Your click COUNTS...


    CLICK to give FREE mammograms!

  4. #4
    Overland Park, KS
    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).
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  5. #5
    Thanks for the help!

  6. #6
    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?

    Kristie Stokes, CPC, CPMA, CCS, CMDP, ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

  7. #7
    Kansas City, MO
    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.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  8. #8
    Santa Rosa
    Default $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.

  9. #9
    Thank you all very much... I think we will continue to charge the patient as we have been...


    Kristie Stokes, CPC, CPMA, CCS, CMDP, ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

  10. #10
    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

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