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Thread: physicals - can somebody tell me

  1. #1

    Default physicals - can somebody tell me

    AAPC: Back to School
    can somebody tell me how to code if a patient comes in only to have forms filled out for the dmv or a child coming in for a school physical or sports physical?

    I need CPT and ICD-9

    Thank You,
    Brenda Amaro, CPC

  2. #2
    Join Date
    Apr 2007
    Capital Coders, Columbia, SC


    For the longest time, I had quite a time figuring out the proper billing of physicals, too. My providers wanted to use the preventive medicine codes 99381-99397. But after some research, I learned that official CPT instructions make clear that the preventive medicine services codes (99381-99429) are to be used to report such preventive visits only when the patient history and physical are comprehensive. For insurance billing of physicals, we have begun using 99212 or 99213, depending on which two of the three key components are met, OR using the time spent face to face with the patient as the determining factor. We report the service with ICD-9 code V70.3 Other medical examination for administrative purposes (including school admission).

    For the completion of special forms, look to code 99080 special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form.

    Bill Hale, CPC

  3. #3


    Thank you very much... This is very helpful.
    Brenda Amaro, CPC

  4. #4


    The above is true, but you have to be careful because I've ran into insurance companies that have pd for the V70.3 DX w/ an E/M used to do these physicals and then when the pt comes in at a later date for a Well child exam or wellness exam the insurance denies because only 1 physical is payable for that pt's benefit period. When I've called on these they tell me it's because the DX V70.? that they go off of and the pt is only allowed 1 of these visits per yr regardless of the situation.
    Stephanie, CPC, HCS-D

  5. #5


    Per CPT® Assistant, July 1996, sports physicals should only be reported with a preventative medicine code if the provider performs a comprehensive history and exam. If the provider performs a brief, detailed, or extended history and exam, report the appropriate office/outpatient E/M code (99201-99215)
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  6. #6


    Can you bill medicare patients for filling out forms, i.e. disability forms???

  7. #7


    What my providers want to do is just specify that if patient needs special form filled out, they want to charge 20.00 to fill it out depending on the type of form and collect that up front. I'm not sure if that's ok to do or not but they are insistent on this. Any other suggestions would be great.
    Stephanie, CPC, HCS-D

  8. #8


    we also do that we charge $25.00 to have forms filled out. We do it across the board with all the patients.

    Unless the patient has not been seen recently or the for what ever reason the patient may need an H&P to have the forms filled out then we bill 99213 with the dx of v70...?

    Brenda Amaro, CPC

  9. #9


    some clinics don't bill the insurance company for a school physical. The patient pay up to $35 that includes completing the forms. So they code it as 99211-v70.5.


  10. #10
    Join Date
    Apr 2007
    Fayetteville, North Carolina


    Why can't you bill the preventive code for sports physicial with a 52 modifier and discount the price?

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