Here is what CPT Assisstant, August 1997 says regarding sports physicals:
If the physician performs a comprehensive history and exam, then you should report the appropriate code from the preventative medicine series. If the physician performs a problem focused, expanded problem focused or detailed history and exam, then report the appropriate level office or other outpatient E/M code. The key phrase here is “problem focused,” if the exam is not for a problem, you can’t code the new patient and established patient office visit codes. These codes have a chief complaint, the HPI describes the development of the patient’s present problem, the extent of the ROS is supposed to be “problem pertinent” the extent of the exam performed and documented is dependent upon the nature of the presenting problem, and the MDM is “medical decision making” which is dependent upon the number of possible diagnoses, and/or the number of management options that must be considered.
If the doctor documents that a patient is coming in to have a school form filled out and to check to see if he needs a PPD shot, 10 minutes was spent with the patient, vitals were taken, and he indicates that the patient is well with no symptoms, did a 4 system exam check and indicates that the patient did not need a PPD since results last year were negative, and did not do an annual physical, this is still not a 99211-99215 visit. These are for problems that need to be evaluated and managed by a physician. When a patient is well, with no symptoms and comes to have a form filled out, presumably stating for school that he/she is physically fit and up-to-date, this is a “preventative medicine” visit. The physician should do more than 10 minutes and 4 exam systems. If they don’t, it still does not meet the criteria for the sick visit codes.
Last edited by dballard2004; 10-23-2008 at 06:30 AM.
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P