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Sports Physicals - diagnosis code

  1. #1
    Default Sports Physicals - diagnosis code
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    I have a question to throw out there. What diagnosis code do you put on sports physicals? Our office routinely uses V70.3 (other medical examination for administrative purposes; sports competition). Our state medicaid office will not pay with this diagnosis, and has come back and said if we use diagnosis code V70.5 (health examination of defined subpopulation; students) that they would pay. I don't think I agree with that, as the description for V70.3 fits what we are doing better. Any thoughts?

  2. #2
    Overland Park, KS
    I'll wager an opinion here.

    Sports physicals are indeed administrative in nature and should be reported with ICD-9-CM code V70.3. There really is no CPT code for these types of physicials, so I recommend reporting 99499 (unlisted E/M).

    Hope this helps and again this is my opinion.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  3. Default
    I agree it should be coded V70.3 and no insurance company is going to pay for a sports or a CDL physical. I never listen to the insurance companies when they say code it this way and it will get paid, but you have to code by what is in the chart.

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