Wiki Physical for Police trainig - can we bill for it

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Missy13

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A patient came in fof Physical for police trainig. Also received a flu shot.
Doc is billing 99213 and flu shot. Can physical for police be billed and what code should be used? I think that physical for police training should be billed to patient as I am not finding any info on any insurance paying for it. Or should it be included in the office visit?:confused:

Thanks much!
 
Medically necessary services

Hi, The service that you describe, the exam for police academy, is not a medically necessary, billable to insurance, service. IF this should happen to be timed such that it can be combined with the patient's annual preventive service, it would be billed with the CPT code for the preventive service. Otherwise, it is billable to the patient or perhaps the patient's employer.
 
Missy13 said:
V70.3 attaching to OV?
Click to expand...

Yes, attached to the OV. There is no other dx code to use. It will not pay and it will deny for patient responsibility. Even though it is not medically necessary you still bill the insurance for the denial, as the EOB will indicate the patient responsible amount, the patient is still allowed any preferred discount. The V70.3 communicates the reason for the visit.
 
If a patient is receiving a service that beforehand is known to be not medically necessary, they should be paying for said service at the time of service... why should that patient be allowed any sort of "discount"? There is no CPT code for a police physical... The office should be templating a code calling it whatever they prefer and collecting at the time of service.
When children receive sports physicals I have always done the same. Told the parent its not a billable service to insurance and its twenty bucks, take it or leave it.
 
teresabug said:
If a patient is receiving a service that beforehand is known to be not medically necessary, they should be paying for said service at the time of service... why should that patient be allowed any sort of "discount"? There is no CPT code for a police physical... The office should be templating a code calling it whatever they prefer and collecting at the time of service.
When children receive sports physicals I have always done the same. Told the parent its not a billable service to insurance and its twenty bucks, take it or leave it.
Click to expand...

The patient is entitled to the discount negotiated between the insurance and the provider. Without billing the service you would not know the patient owed amount per the contract.
 
I agree in the aspect of the service provided being supported by an actual valid CPT code. what is the CPT code for "police physical"?
 
I've seen preventive CPT coding used with V70.5 (employment-related exam) as opposed to a 99213. I've seen some payers pay and others not.

Good luck!

Marlena
 
One of my providers asked about using code 99420 for a DOT or for a school/employment physical. Does anyone have any experience or knowledge of this code? I can't find any additonal info in EncoderPro and do not have access to CPT assistant.

Thank you,
Karen
 
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