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School, sports, camp physicals

  1. Default School, sports, camp physicals
    Medical Coding Books
    Can anyone tell me how they bill school, sports or camp physicals? The office visit does not see to be appropriate since the patient's visit is not problem focused. Would you use the preventive medicine codes?

  2. #2
    Overland Park, KS
    Per CPT® Assistant, July 2006, 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)

    This has been a hotly contested issue on these forums. Some coders disagree and think that a preventative medicine code should be used instead since the patient has no complaints. Many payers also may not reimburse for an office/outpatient E/M code (99201-99215) with ICD-9-CM code V70.3, so while the above is CPT's directive, you may want to consult with your payers for their recommendation.
    Last edited by dballard2004; 06-17-2010 at 06:31 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  3. #3
    Little Rock Arkansas
    Default School, camp, and sports physicals
    Considering the type of examination that is performed for these physicals, usually there is not any CPT that fits. The physician performs a basic exam of HEENT, lungs, and heart and that's about it. This limited exam does not fit the documentation requirements for any preventative exam CPT. Using a 99201-99215 E & M with the V70.3 will not get paid by the payor either. At our family practice office we usually would charge $20 up front for these types of exams and set up a dummy code in the system that would not be billed to insurance.

  4. #4
    Ellenville, New York
    A new twist on this question, because I have been asked to verify the proper number of RVU's have been assigned to the physician who performs a sports, school, or pre-employment physical. It is not a billing question, because these are paid by contracts. However, a claim was never generated, so these have not been coded. Without clear guidance on the codes used, how do you determing RVU's?

  5. #5
    Our offices for example created codes specific to each situation with set prices eg. (school pe 99429 $35.00) we collect money up front because codes are created by our company we don't bill insurances. Most insurance will deny this type of physicals.

    Hope this may help!
    Mildred Nieves, CPC

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