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Eli's Rehab Report

Reader Question:

Coding for Fitness Physicals

Published on Sat Sep 01, 2001

Question: I perform many fitness physicals, and I write exercise prescriptions and order health profile labwork. Is there a specific code I can use to get paid by Medicare?

Maryland Subscriber
 
Answer: A physical is billed with the preventive-medicine codes (99381-99429), which include ordering the lab tests and writing the exercise prescription. As you probably know, the preventive E/M codes are not covered by Medicare and would need to be billed to the patient, with notification beforehand via an advance beneficiary notice.
 
The only time Medicare might reimburse for the physical is if the patient had an established medical condition that required the approval of a physician before the patient could begin an exercise program. In that case, you could use the ICD-9 code for the established condition, and use an established E/M visit. For instance, if one of your multiple sclerosis patients wanted to start an exercise program and you performed a full physical before clearing the patient for exercise, this may be covered by your carrier using a standard established-patient office visit code with the MS diagnosis.  
 
You might have trouble billing this type of scenario for a new patient, unless the patient were referred to you by another doctor. For instance, if a cardiologist referred a patient to you to determine whether the patient was fit enough to start an exercise program, you could code the consult (or office visit, if its a referral versus a consult) with the ICD-9 for the patients heart disease, and indicate that it was ordered by the referring physician. But if a new patient came in and said he just wants to ensure that he is fit enough to exercise and you had no supporting diagnosis code, you would have to bill the standard preventive-medicine codes, which would not be reimbursed.
   
-- Advice for Reader Questions and You Be the Coder was provided by Laureen Jandroep, OTR, CPC, CCS-P CPC-H, owner of A+ Medical Management and Education, a coding and reimbursement consulting firm and a national CPC training curriculum site in Egg Harbor City, N.J.

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