Wiki Pre-employment physical

[tholcomb]

Good afternoon fellow Coders,

Patient came in for pre-employment physical for the police department the physician billed 99215 with diagnosis V70.5 Blue Cross is denying stating that the services do not fall within the scope of provider license this patient has seen the physician before and is the patient's PCP any thoughts?



Thank you,
TH

 

[dclark7]

The denial code may be incorrect. But most insurance companies will not pay for a pre-employment physical. Either the town/police department should have been billed or the patient. Services required/requested by a third party are not usually covered by the insurance company.

 

[MarcusM]

You should use the well check CPT codes like 99384, 99385. The V code told BCBS this was a well check and not for an acute visit. Also, if this patient had a prior well check, usually insurance only allows one per year that may or may not coincide with birth date and not calendar or fiscal year or insurance plan year. Medicaid in Texas is real bad about this one. For example, birth date is July 1 and last physical was July 2nd of the year before, then Medicaid will not allow another physical until August 1 or after.

 

[tholcomb]

Thank you for the infomation.

TH