Choosing V-codes; doing sports physicals; fluorescein staining
Use appropriate V-codes when you order lab tests as part of a screening exam, such as 85025 or 80061.
Use diagnosis code V70.3 for sports physicals.
You can't code separately for fluorescein staining; it's included in the E&M service.
Q: Would I use a V-code to bill Medicare for preventive screening along with CPT codes 85025 and 80061?
A: ICD-9-CM V-codes describe patient-physician encounters that are related to health status but may not involve an illness, injury, or disease process. Codes 85025 (blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) and 80061 (lipid panel) are for lab tests you might order as part of a preventive or screening exam. When you order such a test, use the appropriate V-code.
If you're screening for high cholesterol, for example, the most specific and appropriate V-code is V77.91 (screening for lipid disorders). Other V-codes are appropriate with other lab codes, depending on the reason for the screening:
V20.2 (routine infant or child health check) for screening during a well-infant or child exam
V70.0 (routine general medical examination at a health care facility) for screening performed as part of a routine check-up
V72.3 (gynecological examination) for screening during an annual well-woman exam.
Q:Our practice has been having trouble getting reimbursed for school sports physicals. I just discovered 97005 and 97006. Are they appropriate for this type of visit?
A: No, codes 97005 (athletic training evaluation) and 97006 (athletic training re-evaluation) should not be used for the physicals you're asking about. From a CPT perspective, athletics training codes are generally problem-oriented, and they include recognition and evaluation of an athletic injury; management and recommendations for treatment; and educational training related to the specific injury. Athletic trainers most commonly provide these services.
In contrast, a sports physical is typically a nonproblem-oriented encounter in which you evaluate and certify a patient's involvement in organized sports, such as high school football. If you perform a comprehensive history and physical examination, report the age-appropriate code from the preventive medicine series. If you perform less than a comprehensive history and exam, report the appropriate-level office or other outpatient E&M visit code.
Typically, you'd use diagnosis code V70.3 (general medical examination; other medical examination for administrative purposes), which includes general medical exams for sports competition, for a sports physical.
Because some payers will not accept this code in conjunction with an office or other outpatient visit code, such as 99213, you could code a less-than-comprehensive sports physical using the appropriate preventive medicine code and attach a 52 modifier (reduced services) to indicate that it was less than comprehensive.
Q:When a patient presents with an eye injury, I use fluorescein staining to detect foreign bodies or corneal damage. Is there a specific code for that in addition to the E&M code? The codes in the ophthalmology section seem to apply to more complex procedures than those I perform.
A: No, there's no additional CPT code for fluorescein staining. It's included in the E&M service you provide. The fluorescein codes in CPT's Special Ophthalmological Services section (92230, 92235, and 92287) are for procedures performed by ophthalmologists.
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Coding Consult: Answers to your questions about. . ..
May 23, 2003;80:19.