# physicals - can somebody tell me



## BRENDA28

can somebody tell me how to code if a patient comes in only to have forms filled out for the dmv or a child coming in for a school physical or sports physical?

I need CPT and ICD-9

Thank You,


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## halebill

For the longest time, I had quite a time figuring out the proper billing of physicals, too. My providers wanted to use the preventive medicine codes 99381-99397. But after some research, I learned that official CPT instructions make clear that the preventive medicine services codes (99381-99429) are to be used to report such preventive visits only when the patient history and physical are comprehensive. For insurance billing of physicals, we have begun using 99212 or 99213, depending on which two of the three key components are met, OR using the time spent face to face with the patient as the determining factor. We report the service with ICD-9 code V70.3 _Other medical examination for administrative purposes (including school admission)._ 

For the completion of special forms, look to code 99080 _special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form._ 


Bill Hale, CPC


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## BRENDA28

Thank you very much... This is very helpful.


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## raidaste

The above is true, but you have to be careful because I've ran into insurance companies that have pd for the V70.3 DX w/ an E/M used to do these physicals and then when the pt comes in at a later date for a Well child exam or wellness exam the insurance denies because only 1 physical is payable for that pt's benefit period. When I've called on these they tell me it's because the DX V70.? that they go off of and the pt is only allowed 1 of these visits per yr regardless of the situation.


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## dballard2004

Per CPT® Assistant, July 1996,  sports physicals should only be reported with a preventative medicine code if the provider performs a comprehensive history and exam.  If the provider performs a brief, detailed, or extended history and exam, report the appropriate office/outpatient E/M code (99201-99215)


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## susanhoule

Can you bill medicare patients for filling out forms, i.e. disability forms???


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## raidaste

What my providers want to do is just specify that if patient needs special form filled out, they want to charge 20.00 to fill it out depending on the type of form and collect that up front. I'm not sure if that's ok to do or not but they are insistent on this. Any other suggestions would be great.


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## BRENDA28

we also do that we charge $25.00 to have forms filled out. We do it across the board with all the patients.

Unless the patient has not been seen recently or the for what ever reason the patient may need an H&P to have the forms filled out then we bill 99213 with the dx of v70...?


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## trep72

some clinics don't bill the insurance company for a school physical.  The patient pay up to $35 that includes completing the forms.  So they code it as 99211-v70.5.

Vontressa


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## Stefanie

Why can't you bill the preventive code for sports physicial with a 52 modifier and discount the price?


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## thegranddiva1

To the question about billing MCare pt's for filling out forms. Yes you can bill the pt, because MCare does not cover this service. But the pt must sign an ABN acknowledging that they have been made aware that MCare will not pay for this service and that they (the pt) are responsible for payment. 

To the question of billing the preventative with a 52 modifier, I am a collector and the rule of thumb is to never give an insurance company a chance to reduce your payment if another code will allow you receive full contracted payment, use modifier 52 only when you absolutely, positively have no other choice. The doctors that I have worked for will usually bill using 99213, because they are not the pediatrician who would give the child their annual physical.

Roni Jones, CPC


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## mitchellde

Also per CR1776 a 52 modifer is never allowed to be used on E&M codes to include the preventive E&M.


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