Coding Consult: Answers to your questions about . . .


Preventive exams with vision screening, Sports physicals and checkups, Reciprocal billing arrangements


Coding Consult

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Choose article section...Preventive exams with vision screening Sports physicals and checkups Reciprocal billing arrangements

Preventive exams with vision screening

Q:When a patient comes in for a preventive exam and I do a vision screening too, can I bill for them separately?

A: CPT states under the Preventive Medicine section, "Immunizations and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately." Because vision screening now has its own code (99173, screening test of visual acuity, quantitative, bilateral), you can report it in addition to the preventive exam (99381-99397).

Some carriers are still not reimbursing these services separately, though. And others consider the vision screening as part of the preventive exam and will only reimburse for the E&M. Check with your local carriers to determine billing.

Sports physicals and checkups

Q: When a child comes in for a sports physical and a well visit at the same time, can I code the encounter as a preventive visit with V70.3? What about when the child comes in just for the sports physical—should I use an E&M code?

A: If the child comes in for an annual checkup, which would also clear him to play sports, code it as a preventive visit (e.g., 99383, initial comprehensive preventive medicine evaluation and management of an individual . . . late childhood [age 5 through 11]). Link it with V70.3 (other medical examination for administrative purposes).

From a CPT perspective, if the child comes in just for the sports physical and you perform a comprehensive history and examination, you should still report the age-appropriate code from the preventive medicine series (99381-99397).

If you perform a brief, detailed, or extended history and examination, report the appropriate office or other outpatient E&M visit code only.

Reciprocal billing arrangements

Q:I've arranged for another physician to cover my patients while I recover from a recent illness. How should I code for the substitute physician's services?

A: Medicare allows reciprocal billing if: the arrangement is only occasional and lasts no longer than 60 days; the regular physician is unavailable; and the patient has requested the service from her regular physician.

You code for the substitute physician, (who can't be in your group), as you would for yourself. Patients who are established with your practice would still be billed as established patients.

Modifier –Q5 (service furnished by a substitute physician under a reciprocal billing arrangement) must be attached to each service billed. There is no requirement to identify the name or UPIN of the substitute physician on the claim form, but the billing physician is required to keep a record of the substitute physician's UPIN and all services he renders. You may have reciprocal arrangements with more than one physician, and the arrangements need not be in writing.

Ask your commercial payers if they follow Medicare's rules. You can refer to the Medicare Carriers Manual section 3060.6.


This information provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Rd. South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit


Coding Consult: Answers to your questions about . . .. Medical Economics 2002;16:16.

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