Internal Medicine Coding Alert
Receive Reimbursement for Sports Physicals
Confused about whether the preventive medicine codes can be used to report a sports physical? Not after you hear what our experts have to say. If the physician completes and documents both a comprehensive history and exam, the preventive care codes are an option for reporting a sports physical. But often the physician performs only a limited physical exam when a patient presents for a sports physical, says Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif. In those cases the preventive medicine codes are no longer a suitable option. When a physician obtains a comprehensive history as part of a preventive medicine service, it is not problem-oriented and does not involve a chief complaint or present illness, according to Principles. But it does include the following: Many insurance companies will only allow one preventive care exam per year, so if the patient has already received a preventive care service you must report the unlisted-procedure code for the sports physical. "But if the timing is good enough to get both the preventive care exam and the sports physical done at the same time, you should report the appropriate preventive care code," Pride says.
According to Principles of CPT Coding, preventive medicine codes 99381-99397 include "a comprehensive history and a comprehensive examination." But "comprehensive," when used to describe the history and exam components of a preventive medicine service, has different requirements than when it is used to describe a standard E/M service. For codes 99381-99397, comprehensive means that the history and exam components reflect an age- and gender-appropriate history/exam.
Report the age-specific preventive medicine code if the physician completes all of the history and exam requirements and meets the requirements in the basic preventive medicine code descriptor "periodic comprehensive preventive medicine re-evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/ diagnostic procedures." Remember, codes 99381-99397 cannot be reported if a patient has received any professional
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