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.