Laureen Jandroep asked:
For pre screening sports of high school kids we use Z02.5. If the Provider does comprehensive exam then it is preventive exam or wellness. But if brief/detailed then it is E& M office/established visit.
So if made office visit some part of fees will come on patients head. So who decides what typr of exam provider does.
I thought it is 100% covered by insurance. Please help me to make more clear. Thanks
Answer:
Office visits that involve sports exams are considered preventive/screening exams so you would use the preventive visit codes 99381-99397 . You can not bill a regular E/M visit 99201-99215 for a screening examination. The keyword here is screening. Patients should sign a form stating they understand their insurance may not pay for this screening / preventive visit. In some instances; if the patient already had a regular annual exam; this most definitely will not be covered. There are carriers that do not like the Z02.5 linked to a prevention E/M. If the patient had prior knee surgery or other health issue and was being followed up on for knee pain (for example) after knee surgery to determine if he could play football this season; you could use an E/M medical necessity visit. However; in most cases these exams are comprehensive and preventive so obtain a signed form indicating the patient might be liable.
For pre screening sports of high school kids we use Z02.5. If the Provider does comprehensive exam then it is preventive exam or wellness. But if brief/detailed then it is E& M office/established visit.
So if made office visit some part of fees will come on patients head. So who decides what typr of exam provider does.
I thought it is 100% covered by insurance. Please help me to make more clear. Thanks
Answer:
Office visits that involve sports exams are considered preventive/screening exams so you would use the preventive visit codes 99381-99397 . You can not bill a regular E/M visit 99201-99215 for a screening examination. The keyword here is screening. Patients should sign a form stating they understand their insurance may not pay for this screening / preventive visit. In some instances; if the patient already had a regular annual exam; this most definitely will not be covered. There are carriers that do not like the Z02.5 linked to a prevention E/M. If the patient had prior knee surgery or other health issue and was being followed up on for knee pain (for example) after knee surgery to determine if he could play football this season; you could use an E/M medical necessity visit. However; in most cases these exams are comprehensive and preventive so obtain a signed form indicating the patient might be liable.
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