Primary Care Coding Alert

Question: Most of our insurance companies won't pay for a sports physical after the patient has already had a yearly physical. Once the parents learn they'll have to pay, they want to count their child's general physical in the sports physical's place. Are there certain services other than filling out paperwork (such as an EKG) that distinguish a sports physical? We'd also like to establish a fixed amount to charge for physicals that insurance won't cover. Do you have any advice?Answer: Sports physicals are distinguished from yearly preventive medicine physicals both in their scope and their focus. A sports physical lacks many of the elements of an age- and genderappropriate comprehensive history, examination, counseling and anticipatory guidance, which are otherwise required elements of an annual preventive medicine visit (i.e., yearly physical) represented by codes 99383-99385 and 99393-99395. Also, a sports physical is focused on determining whether the patient is physically [...]