Primary Care Coding Alert

Question: When a child comes to the office for a sports physical and a well visit at the same time, can I code it as a preventive visit with V70.3? What about when the child comes in just for the sports physical should I use an E/M code?

Texas Subscriber

 
Answer:  If the child comes in for an annual checkup and this examination would also clear him or her to play sports, coding it as a preventive visit is appropriate (e.g., 99383, Initial comprehensive preventive medicine evaluation and management of an individual late childhood [age 5 through 11 years]). Link it with V70.3 (Other medical examination for administrative purposes). From a CPT perspective, if the child comes in just for the sports physical and the physician performs a comprehensive history and examination, you should still report the age-appropriate code from the preventive medicine series (99381-99397). However, if the physician performs a brief, detailed or extended history and examination, report the appropriate office or other outpatient E/M visit code only. Because most payers deny sports physicals, billing only for the E/M will ensure reimbursement.