Getting calls all year-round from parents requesting sports physicals for their children might be a common feature for your pediatric practice. Even though the physical may be fairly simple to carry out, it is not always straightforward to code.
If you are clueless about how to code a sports exam, think about these choices that will put your CPT coding on the right track while dodging non-payment issues.
Perform less and code office visit
When a pediatrician provides a true sports exam, CPT offers no direct match. Pediatricians may provide a shortened well-care visit, in which they assess the risks, perform an exam, and order vaccine and labs.
Encourage full well check
In order to avoid V70.3 non-coverage issues, try to schedule patients for preventive medicine services rather than for sports physicals. Sometimes parents misinterpret the sports physical as the child or adolescent’s complete annual physical examination. Having the patient come in for the annual ensures she gets the full service.
Consider forms policy
For patients who have received a recent preventive medicine service, think about using that information to complete a sports form. Few pediatric practices have a set fee the patient pays for this service such as a $ 20 forms fee.
Some practices will include completion of forms at the time of an E/M visit; however charge if the forms are brought in at another time. There’s additional office overhead involved if the chart must be pulled and reviewed, the form completed, mailed, or faxed, and the chart refiled.
Drawback: For liability reasons, your physician may not want to issue a form without checking the patient to see if his status has changed.
When a parent insists or the school calls for an abbreviated exam on a patient who has not had a well check in the previous half of the year, you might want to put into practice a financial plan. Physicals required for sports are normally the patient’s responsibility. Insurers normally do not cover the service.
Best practice: If you expect the insurer will not cover the sports physical, have the parent sign an advance beneficiary notice (ABN). Ensure the parent understands she will have to pay if the insurer does not cover the sports exam, and notify her of the price.
Tool: You can use a private payer version of Medicare’s form to educate the parent and ensure she is aware of her choices and responsibilities.
Check state scope of practice laws
Once you decide on the best strategy for your practice, confirm that your state allows you to use that technique. For instance, certain states publish guidelines indicating that a physical done within the last 12 months is enough and the patient does not require an updated form, whereas other states need children to bring in new forms for each individual sport they intend to play.
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