Wiki DOT/sports/Employer E/M coding

[MelissaL]

Can someone give me some input? How would you code a DOT physical or Sports or Employer Physical? Patient has already had a well physical for the year so that would not be appropriate to code the well codes.

 

[dballard2004]

We use 99499 (unlisted E/M) for these types of visits. The exception is sports physicals. If the sports physical meets the criteria for a preventative medicine encounter, we report these as well-child checks using the preventative medicine E/M code based on the patient's age and new vs. established patient criteria. If the sports physical does not meet the criteria for a preventative medicine encounter, we report 99499. These types of encounters are not usually reimbursed by payers, so for sports physicals, if we report 99499, we make these cash visits; for DOT or employer physicals, they are either cash visits as well or we invoice them back to the employer.

 

[pineapplelvr]

our facility bills a cheaper preventive code (we use internal modifiers to change the price) for example 99396.01 and then 81003.02 for a DOT because it usually requires a UA along with it and we use dx V70.3, but usually this are billed to the employer. If it's the patients own insurance, they still get billed, but it's up to them to get their employer to reimburse them.

for sports pxs we use 99294.sp (another internal mod to just change the price)

anyways, that's just how our facility has chosen to do these.
hope that helps