Coding Consult: Answers to your questions about. . .


Choosing V-codes; doing sports physicals; fluorescein staining


Coding Consult

Answers to your questions about . . .

• 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.

Choosing V-codes

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.

Doing sports physicals

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.

Fluorescein staining

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.


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 Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit


Coding Consult: Answers to your questions about. . ..

Medical Economics

May 23, 2003;80:19.

Related Videos
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Robert E. Oshel, PhD
Gary Price, MD, MBA
Gary Price, MD, MBA
Related Content
© 2023 MJH Life Sciences

All rights reserved.