Internal Medicine Coding Alert

Question: A fellow coder recently suggested reporting codes 97005 and 97006 for sports physicals. Are these codes really applicable, and will we be reimbursed if we use them?

Arizona Subscriber

Answer: One crucial element of codes 97005 (Athletic training evaluation) and 97006 (Athletic training reevaluation) renders these codes inapplicable to sports physicals these codes represent problem-oriented services, i.e., recognition and evaluation of an athletic injury and educational training for a specific injury.

To report a sports physical, a nonproblem-oriented evaluation of a patient for certification for involvement in organized sports, you should use the age-appropriate preventive medicine code. To use the preventive medicine series of codes, 99381-99397, the physician must perform and document a comprehensive history and examination.

If the physician does not have documentation of a full comprehensive history and examination, you should report the appropriate-level office visit (E/M service) or other outpatient evaluation and management visit code.

Link the most appropriate CPT code to diagnosis code V70.3 (General medical examination; other medical examination for administrative purposes). If your carrier will not reimburse for an office or other outpatient visit code linked to V70.3, you may want to consult your carrier when choosing the CPT code you report to represent the service provided.