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Pediatric Coding Alert

You Be the Coder:

School Physicals Can Be Tricky

Published on Wed Jun 11, 2014

Question: I have searched for a CPT® code to use with V70.3 for a school physical, but I am having trouble understanding whether or not to use 99213, 99401 or 99393. This patient had a physical during the year, but the college will not accept that visit since it requires a physical within two months prior to attending college. Can you advise on which code to report?

Answer: The answer depends on the documentation, but in general you can report 99213 or 99214 if the doctor found a separate problem during the physical (such as scoliosis or allergies). If it’s purely a well child visit and you know the insurer won’t pay for it because the child had a physical already this year, you may need to bill the parent directly for the charges for this non-covered service. You might also consider having the parent sign an advance beneficiary notice (ABN) recognizing that their insurer typically won’t pay for a second wellness visit during the year. 

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