Sports Physicals

July 27th, 2015 - Codapedia Editor
Categories:   Coding   Preventive Medicine Service  
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Sports or camp or college physicals are exams requested by a parent or patient as a screening prior to going to camp or college or playing a sport. They vary in their scope.

If the patient presents for a well child visit, and also needs their camp physical filled out, it is pretty easy.  Perform the preventive medicine service, and complete the form at the same time.  But, that's rare.  More typically, the patient presents a few months later for the sports physical, or the form arrives with a request for completion.

After two years old, most insurance companies will only pay for one preventive medicine service for kids each year.  So, how do you bill it?  CPT® tells us to use an office visit code for the billing code, and report a code in the 99201--99205 series for a new patient, or in the 99211-99215 series of codes for an established patient.  (In all likelihood, the patient would be established.  If the patient were new, many practitioners would do a complete well child visit at that first visit.)  Base the level of service on the level of history, exam and MDM performed. The problem is what diagnosis code should you use? In ICD-9, the only code available are the V codes describing exams: well child exams, or V70.3, an exam for administrative purposes. In ICD-10, See Chapter 21. The insurance company may very well deny this.   Warn the patient ahead of time that the visit may be non-covered, so that you can bill them for it later.

Parents may request that the clinician complete the form without seeing the patient. That is  a clinical decision, of course, based on how recently the patient was seen.  Most clinicians want to see the patient if the form has physical exam components to report.

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