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Work Physical VS Yearly Physical

  1. #1
    Question Work Physical VS Yearly Physical
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    I work in an office that has an occupational health department. People can call and schedule pre employment physicals through this department. We have been having more and more companies(mostly schools) that require the employee to have a work physical at the cost to the employee.

    Recently there was a patient on the medical card that needed a preemployement physical but did not have any money and we are not able to bill the 99450 to public aide. We were able to schedule the person for a yearly physical, which they were due for, and have the Dr fill out forms while at the visit. Then the visit was billed out as a 99395. I know there is a FINE line doing this but now the Occupational Health person is kinda "coaching" self pay people to schedule a yearly physical and bring forms along so that the visit can be billed to insurance. I feel really uncomfortable with the whole thing and I wanted to know from some of you more experienced coders if this process is OK to do or if it would be considered fraudulant?

    I can understand that if they are due for a yearly physical anyways that the dr is doing basically the same stuff, just more indepth with history ands counciling BUT if the SOLE reason the patient is coming in is for a pre-employement physical then shouldn't we just leave it at that and not tamper with it anymore?

    Thanks for any insight! It is GREATLY appriciated!

  2. #2
    Columbia, MO
    Curious.. are you billing a 99450 for peremployment physicals?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Yes, the 99450 is what we use for the basic pre-employement physical.

  4. #4
    Columbia, MO
    The problem is that is the code for life insurance or disability insurance clearance/screening, it has nothing to do with a pre-employment status.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    I agree, 99450 should not be used in this case. I would suggest using 99429.

    I also agree with you that it is wrong to provide a non-covered service under the guise of a covered service. Blind billing like that is fraud.

    If that service is provided it should be charged in addition to the yearly. If all they are doing is filling out some additional paperwork, then I would say bill the yearly and then charge the patient a form completion fee.

    Just my take on the situation,

    Laura, CPC, CEMC

  6. #6
    The book states that for the 99450 the measurement of height,weight and blood pressure is taken. the complete medical history is taken, a blood sample or urinalysis is taken with chain of custody protocols and a completion of necessary documentation/certificates is done. All of this is done during a pre-employment and/or DOT physical. That is why we use that code.

  7. #7
    Columbia, MO
    Yes but the purpose of that code is to communicate that this was for life insuance or disability purposes. That is not what you are doing. Just because you feel the work performed is the same does not mean that is the correct code. Go back to what Laura said as she is correct. Charge the annual and the 99080 for filling out the forms. If the patient has already had an annual then just fill out the forms and charge the 99080. Bottom line is the 99450 is incorrect for the purpose you are using it for.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    I am not sure how I am going to get a whole organization to change their forms The only time we bill this code is to employers. We use to just use "OCH" and the dx V70.5 and bill employers or have patients self pay without using an actual CPT code. I am not sure why it was changed recently but that is what the new form says that was put together. All in all though I think I have the answer I was looking for.

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