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sports pe

Lori Posted Wed 29th of August, 2012 12:57:52 PM

we have a patient coming in for a sports pe ONLY... what dx and cpt can we use?? thks

SuperCoder Answered Wed 29th of August, 2012 13:58:23 PM

1. Know Your CPT® Code Choices

CPT® does not include a specific code for completing camp or sports forms. Instead, you have a few options when considering how to code the service.

Option 1: If you fill out a camp or sports form at the time of an E/M service, such as a preventive medicine service, you won’t code anything additional for the form. That’s because the form’s completion is typically considered included in the E/M service (for instance, 99394, Periodic comprehensive preventive medicine reevaluation and management of an individual … adolescent [age 12 through 17 years]).

Option 2: If you’ve already given the prospective camper her preventive medicine service, you might not need to have her come into the office. Many practices maintain a policy indicating that if the patient has been seen within a particular timeframe (such as 12 months), the practice will use that information to fill out the form, precluding the need for the child to present for another exam. In these cases, some practices charge a fee to cover the work involved in looking up the patient’s most recent physical and completing the form.

Option 3: Sometimes parents aren’t able to coordinate their child’s well check with a sports or camp exam, making it necessary for the child to come in specifically for a sports or camp exam. In this situation, CPT® Assistant advises that if the physician performs a comprehensive history and examination, you should report the age appropriate code from the Preventive Medicine series (e.g., 99394). If the physician performs a brief, detailed, or extended history and examination, then CPT® Assistant advises that you report the appropriate level office or other outpatient evaluation and management visit code (e.g., 99212). In this case, you should inform parents that sports and camp physicals are often noncovered services and that you may charge them up-front for the service.

When applying a forms charge, some practices use an internal code for tracking purposes. Othes may use the special reports code (99080, Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form), which is for completing forms that involve more work than that usually required for a standard insurance form.

Caution: Bear in mind that CPT® does not consider code 99080 a standalone code, advises Kent J. Moore, manager of healthcare delivery and financing systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. Instead, CPT® intends for you to report 99080 as an adjunct to another service (e.g., an E/M service). Also keep in mind that insurers most likely won’t pay for this charge, and the cost would typically be the parent’s responsibility.

2. Check Age, Exam Purpose for Best Diagnosis

If you perform a camp exam for a healthy patient, you’ll use V70.3, Other medical examination for administrative purposes, as your diagnosis code.

If, however, you fill out the patient’s camp or sports form during his regular annual physical, you’ll use the routine general medical examination code V20.2 (Routine infant or child health check) for children under age 18 or V70.0 (Routine general medical examination at a health care facility) for children age 18 or older. Link the diagnosis to your preventive medicine CPT® code.

3. Prepare a Patient Notification Sign

If you decide to charge for forms completion and you’re unsure of how to let patients know about your camp form policy, consider including a statement on your financial forms notification, which you give to new patients and ask patients to sign annually. You should also keep it in your waiting room, examination rooms, and on your Web site.

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