Medical Coding Tutorial — How to Code Sports Physical

Alicia: Sports Physical

Q: If a provider has coded a V70.3 sports physical & throughout document states and supports the well child check V20.2 and he has charged out an (regular E&M 99213 with V70.3) is a coder allowed the change the codes to preventative code 99383 with V20.2 as long as documentation is there?

A: Could you do this? Yes, you could. You got the documentation and everything. But would you want to do this? Probably not. I can give you a reason why. Some insurance [Ed. Note: companies] are not going to pay for sports physicals. And so again, you might have a reason to do a well-visit but if you make a change and there is a well-visit scheduled there's going to be a major conflict because you can only do a well-visit from insurance companies once a year. At least I don't know of any that will let you do more than once a year unless the baby is under one and they have to do a 6-month check-up and a 9-month check-up.

I went out and I found the example of the yearly well-visit exam versus sports physical only that a clinic actually put out to the patients to let them kind of pick and choose and why, and it just seems like I could explain it so much better than I could have. What they're saying is: "A YEARLY WELLNESS EXAM includes a comprehensive exam along with teen education, self-screening instructions, a urinalysis, complete blood count and completion of the sport's physical form." For a young woman who needs a pap as well, they can schedule that and it can all be done at the same time for the yearly wellness. But, they make a note here that said: "the yearly wellness exam at the same time as most insurance plans only pay ONE yearly wellness exam in a year." In other words, if you want to combine all of that for a girl, she had the pap; because if she had to come back and have pap, they may not pay for it.

[Little_shoe]

I don't know of any insurance that will pay a sick visit e/m (99205-15) code with a screening diagnosis. The 99213 will error out because of a screening diagnosis. You will need to change CPT to the a preventative CPT code or the primary ICD needs to be changed.