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annual physical/school physical

  1. #1
    Question annual physical/school physical
    Medical Coding Books
    Patient came in for an Annual Physical and Physician billed

    99395 with dx v70.0

    Patient came in 1 week later for school physical and Physician billed

    99395 with dx V70.5

    Should the Physician have used to preventive codes within 1 weeks time or how should the school physical have been billed. Can't you transfer the information and lab results from the annual physical onto the school form.

  2. #2
    Default
    I believe one of those annuals will be denied. Was there anything found ie sign or symptom that one of those services be charged for an established E&M? Even though the diagnosis can be utilized as primary dx's, the insurance is going to look at why the annuals were done a week a part. May throw a red flag, you know what I mean?
    Kiana CPC, CPC-H, BCS-M, BCS-R

  3. #3
    Default
    Oops, and I forgot, if it was just for form filling, you are correct. The information he collected at the annual could have been transferred to the school physical form.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  4. #4
    Default physical
    Quote Originally Posted by kimb View Post
    Patient came in for an Annual Physical and Physician billed

    99395 with dx v70.0

    Patient came in 1 week later for school physical and Physician billed

    99395 with dx V70.5

    Should the Physician have used to preventive codes within 1 weeks time or how should the school physical have been billed. Can't you transfer the information and lab results from the annual physical onto the school form.
    What I have found is that these codes should only be used once in a 12 month period. They are usually not paid more than that.
    What we have been telling the offices is that if the patient is due for their annual physical and need a school/sports physical etc to do the paper work at that time and then do the annual physical. Just incorporate the paperwork into this one visit. Otherwise we have been using the 99429 preventive visit, but it's never paid and then these extra visits become patient responsibility.
    Anyone else? I'm curious to see how others are billing these things also.

  5. #5
    Default
    most of the time, school physicals or any other at the request of the patient is a self pay .. they sign a waiver and pay up front

    some of my practices do it that way

  6. #6
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    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 07:30 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  7. #7
    Location
    Ft. Myers, FL
    Posts
    11
    Default Sports Physicals
    I work in a family practice office and when we do sports physicals, we give the parents two options. The first option is we can have a nurse transfer the information from the previous preventative exam to the sports physical form and have the doctor sign it, but it has to be dated with the date of the actual exam since the findings were as of that date. The second option is to bring the patient back in and self pay for another exam since only one preventative exam is usually covered in a 12 mos period by most insurers. If the last exam was greater than 12 months, then they have to come into the office for another physical regardless. In your particular case, my office would have just transfered the info to the sports physical form(s) at no charge to the patient.

    Noell, CPC

  8. #8
    Default
    Our office would also use the previous physical to fill out the forms as long as the physical was within the last 12 months. Some offices charge a nominal fee to fill out forms. I would find it suspicious if I were the payor that two complete physicals were actually done so close together... did the doctor actually document two complete physicals?
    Barbara Haskins CPC

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