Children need physicals to participate in their favorite sports year round, but the demand can grow with warm weather approaching. Ideally, the need for sports physicals should provide the opportunity to offer complete age-appropriate medical exams following the American Academy of Pediatrician’s Bright Futures Guidelines. If your practice runs into reimbursement obstacles for full-scale physicals, however, follow our experts’ advice to code correctly and still stay in the game.
Tackle Coverage Issues
Choosing the diagnosis code for a sports physical is fairly easy. You’ll use V70.3 (Other medical examination for administrative purposes).
Choosing the best CPT code for a sports physical is a bit trickier. “I struggle with this because the service rendered is preventive, but doesn’t meet the criteria (in my opinion) of the preventive medicine E/M codes,” says JoAnne M. Wolf, RHIT, CPC, coding manager for Children’s Physician Network in Minneapolis, Minn.
Here’s why: In most cases, a child coming for a sports physical doesn’t have a chief complaint, so it seems inappropriate to code from the 99201-99215 range (codes for an office or other outpatient visit for the evaluation and management of a new or established patient), Wolf points out.
Although the preventive medicine E/M codes 99381-99397 (codes for initial or periodic comprehensive preventive medicine evaluation and management of an individual) satisfy the requirements for sports physicals, they also seem inappropriate. When the patient only requests a sports physical, the service you provide doesn’t meet the codes’ comprehensive nature.
“Physicals are a very hard topic to discuss because some insurances will not cover them at all and some will cover them in different ways,” says Susie Stokes, CMC, CMOM, practice manager of Morgan Pediatric Group in Smyrna, Tenn.
Common guidelines can include:
- One per calendar
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers