The Secret to Sports Physical Coding

Sports Physical Coding Questions

There are many unanswered questions in this world. Why is the sky blue? Why is the grass green? Why does CPT (current procedural terminology) not have a sports physical code? If you find yourself stumped over the last question, you are not alone. With millions of students participating in school sports each year, and likely requiring physicals prior to the start of the season, doctors offices are left wondering how to correctly bill for these visits.

For offices who outsource their billing and coding to experts such as Applied Medical Systems (AMS), there is no need to stress over these billing issues. However, if you’re handling your billing in-house, you are certain to have experienced stress over the topic of sports physical billing.

We found that practices tend to make two main coding errors when submitting sports physical claims:

  • Preventive Medicine Codes: Many providers will use a preventive medicine code with a modifier to show reduced services. However, a sports physical does not meet all the guidelines for this code type and therefore is not appropriate to use in this manner.
  • Office and Other Outpatient Services Code: Although this may work in some cases, many times insurance companies will reject claims that use “problem” codes for “preventive” appointments. Before attempting this method, it is best to speak with the insurance company for approval.

Now that you know what codes not to use, you may be wondering what options you are left with. The simplest way to get around the lack of sports physical billing codes is to perform and bill for a full preventive service, such as an annual physical. Most insurance plans allow for one reimbursal for a preventive exam each year.

In the case that the patient has already taken advantage of the preventive exam allowance, setting a fee for the service and billing the patient directly is a smart choice. For example, setting a $25 fee for the service and collecting the payment from the patient at the time the sport physical is performed is a surefire way to collect. However, be sure to tell your patient ahead of time that there is a fee associated with the service. A great way to handle this is by sending a letter to patients indicating that if they need to schedule a sports physical and an annual physical has already been performed then a fee will apply.

Let Applied Medical Systems Help

We understand that medical billing can be a headache. At AMS we have experts that work diligently to reduce billing errors and get your claims paid the first time. WIth a 97% or greater accuracy rate, you are in great hands with you chose to work with AMS. To learn more about AMS coding services or to request a free quote, click here.