Tag Archives: preventive
Face Off Against Common Sports Physical Coding Challenges
Posted on 15. Apr, 2010 by Editor.
Hint: Gathering upfront pay and watching E/Ms make a difference.
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
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Ensure Multi-Vaccine Payment With This Coding Advice
Posted on 09. Mar, 2010 by Editor.
You may need to append modifier 25, depending on payer policies.
Question: Our physician billed 90634, 90710, and 90606 for vaccines given to a 5-year-old patient. The insurance company denied payment and said they required a modifier. What should we have done differently?
New Hampshire Subscriber
Answer: According to standard CPT coding, vaccine codes do not require modifiers on the associated E/M code. However, you might need to include modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) if your insurance company requires it — which might be why you received a denial.
Well check: If your physician administered vaccines on the same day as a well visit, code the well visit with the appropriate code such as …
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3 Steps Win the Sports Physical Reimbursement Game
Posted on 24. Sep, 2009 by .
These useful strategies assure revenue despite scant insurer coverage.
Right now, a rush of young kids are looking to their family physicians for medical clearance to participate in sports. Commonly referred to as sports physicals, they present unique problems to coders, especially concerning their coverage by insurers. To avoid loss of revenue and to maximize the earning potential of your practice, here are some surefire tips on coding for sports physicals.
1. When Unsure of Coverage, Ask for Cash
To ensure revenue for your practice, you can ask patients, especially those with insurance that you know does not cover it, to pay cash for the sports physicals. “My suggestion is that these are treated as ‘self-pay’ services and offices should collect up front,” says Christy Neff, RMC, physicians billing specialist for Witham Health Services in Lebanon, Ind.
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No Code for Camp Exam? Here’s How You Handle Pay
Posted on 01. May, 2009 by .
Summer vacation is right around the corner, and you know what that means: Parents needing camp forms filled out, and your practice wanting to provide this service while getting paid for the pediatrician’s time.
Here’s how your peers do it: 100 percent* complete the form without a face-to-face encounter.
*Note: Figure based on respondents to a survey posted on Pediatric Coding911.com, not a scientific sampling.
But doing so comes with some hitches and additional options.
Tie Exam Into Preventive Medicine Service
Why is capturing pay for camp form services, which generally do not require the work involved in a preventive medicine exam (99381-99395, Preventive Medicine Services), problematic? “There is no code for a ‘camp physical exam,’” writes Richard Lander, MD, FAAP, pediatrician with Essex-Morris Pediatric Group in Livingston, N.J.
You can build the associated E/M service into forms completion for attending summer camp or playing summer sports. “We try to tie the sports exam into the patient’s preventive medicine service,” said Julia M. Pillsbury, DO, FAAP, FACOP, in “Give Your Preventive and Vaccine Services a Checkup” at The Coding Institute’s Pediatric Coding and Reimbursement Conference 2009 in Las Vegas.
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