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Camp Pe

  1. #1
    Default Camp Pe
    Medical Coding Books
    PATIENT PRESENTS WITH CHEIF COMPLAINT DOCUMENTED AS "4H CAMP PE", NO ROS, NO HPI, REVIEWED PERSONAL AND FAMILY HISTORY, EXPANDED PROBLEM FOCUSED EXAM, ASSESSMENT IS "IN GOOD HEALTH", PLAN "CLEAR FOR CAMP".

    WOULD I CODE THIS AS A 99212?

    I HAVE REVIEWED THE ARTICLE BELOW AND THE FOLLOWING IS AN EXCERPT FROM THAT ARTICLE:

    The matter of physicals for drivers licenses and camp and school physicals seems fairly comparable to "sports physicals." The AMA has officially addressed the issue of such "sports physicals" on three separate occasions: the first was in the July 1996 issue of The CPT Assistant, the second was in the August 1997 issue of The CPT Assistant, and the third was in the 1999 edition of The CPT Companion book. Although this topic appears in the 1999 edition of this book, interestingly, it does not appear in the 2000 and 2001 editions of this book.
    Here is the exact verbiage from these three citations:
    From the July 1996 issue of The CPT Assistant:
    Question: What code should I use to report a "sports" physical?
    AMA Comment: If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the Preventive Medicine series. If the physician performs a brief, detailed, or extended history and examination, then report the appropriate level office or other outpatient evaluation and management visit code.
    From the August 1997 issue of The CPT Assistant:
    Question: What code should I use to report a "sports physical" or a "school physical?"
    If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the preventive medicine series. If the physician performs a problem focused, expanded problem focused or detailed history and examination, then report the appropriate level office or other outpatient evaluation and management visit code.
    From the 1999 edition of The CPT Companion book:
    Question: What code should I use to report a "sports" physical?
    AMA Comment: If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the preventive medicine series. If the physician performs a problem focused, expanded problem focused or detailed history and examination, then report the appropriate level office or other outpatient evaluation and management visit code.
    Coders often suggest an alternate coding method of appending the -52 modifier to an otherwise appropriate "Preventive Medicine Services" code. While this is, indeed, a common-sense solution to this coding problem (and indeed, this is exactly how some payers prefer to have such services reported), the AMA makes clear that such a coding strategy is inappropriate from a strict CPT coding standpoint. Fortunately (or unfortunately as the case may be), the AMA's CPT Information Services has provided the following response, dated April 13, 2001, regarding the alternate coding method of appending the -52 modifier to an otherwise appropriate Preventive Medicine Visit code:
    From a coding perspective, it would not be appropriate to append Modifier -52 Reduced Services to a Preventive Medicine Evaluation and Management (E/M) Service code when only a brief history and examination is performed. Instead, the appropriate Office or Other Outpatient E/M Service code should be reported based upon the key components that are met (i.e., history, physical exam, medical decision making).
    Having a clear method, such as this official coding instruction provided by the AMA, to report such less-than-comprehensive Preventive Services is especially important since more and more payers offer coverage of such limited physicals as a covered policy benefit.
    If billing such a less-than-comprehensive Preventive Services visit to Medicare to get a denial from them so that you may then bill the patient or secondary payer, it may be important to consider using the -GY modifier, lest your carrier think you provided a covered E/M visit. Using the -GY in conjunction with an appropriate screening ICD-9-CM code should be all the information the Medicare carrier would need to make the correct determination that the service is a preventive, screening service.
    Greg Schnitzer, CodeRyte, Inc.

    http://www.coderyte.com/resources/wh...-purposes.html
    Heather Winters, CPC, CFPC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default 99212
    Based on exam and MDM I'd use 99212.

    However it would be interesting to hear from the AMA as to what would constitute an HPI for such a visit. How can you cover Location, Quality, Severity, Timing/Duration, Context, Modifying Factors, Associated Signs & Symptoms when there is basically no illness/injury/disease/comlaint?

    F Tessa Bartels, CPC-E/M

  3. #3
    Default Camp PE
    Exactly, thank you for your response
    Heather Winters, CPC, CFPC

  4. Default
    I am not sure if this is something anybody else would agree with, but for years we have been billing 99429 on our camp physicals. Most of the time, they don't really get a good eval, the doc pretty much just fills out their camp forms and signs it. We have a very low price on our 99429, but it does seem to get paid on our patients. I don't ever like using unlisted codes, but for some reason a group of people a while back decided to give it a shot. You may want to look a little further into that and see if you can find anybody else that is using a 99429 and see if it is justified.
    Jaime CPC, NCP, EMR Specialist

  5. #5
    Default Pediatric GURU
    According to today's audio conference, the presenter recommended coding all camp/school/sports physicals as preventative. I have sent a question to AAPC regarding this and am waiting for a response back from them. Recently when I attended a conference with Mary Jo Bowie, she indicated these would be coded as e/m unless a comprehensive physical and exam was done. I wish we could get the same response from everyone on this.
    Heather Winters, CPC, CFPC

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    for us, we've always used the preventive codes for sports px, camp px, DOT's, etc.... some are done at a lower rate (determined by the facility) because they aren't really a full complete px - however, we still use the preventive codes. We use V-codes - V70.3 - V70.5 for these types of things.
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  7. #7
    Default
    We also use the preventive codes for sports px, camp px, DOT px, etc. with V70.3 or V70.5 depending on the circumstance. We bill them at a lower rate than a full physical exam, like Donna was referring to.

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