Author Topic: Sports Physical  (Read 1432 times)

djk

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Sports Physical
« on: January 22, 2015, 09:00:10 AM »
I am billing for upstate Ny for Medicare and the provider did a sports physical for a patient to  participate in special olympics.. V70.3. I didnt think i should use the Go439 because it wasnt a complete AVW if i used it  he couldnt have a AWV another 12 months according to Medicare guidelines so I used the 99213 and it was denied for non-covered with that dx.  so what are your thoughts and suggestions

kristin

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Re: Sports Physical
« Reply #1 on: January 22, 2015, 09:15:22 PM »
Because the patient is Medicare, I don't really see how this can be billed out. I would have done an ABN and made it self-pay. It really isn't an AVW, or a 9921xx visit.

Any other thoughts from someone else?

PMRNC

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Re: Sports Physical
« Reply #2 on: January 23, 2015, 02:59:30 PM »
You might be out of luck if you didn't have patient sign an ABN.
Linda Walker
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djk

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Re: Sports Physical
« Reply #3 on: January 27, 2015, 01:24:14 PM »
these patients are developmental disability and have medicaid so they dont sign ABN's

kristin

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Re: Sports Physical
« Reply #4 on: January 27, 2015, 07:20:53 PM »
The more I think about it, I realize that because Medicare would never pay for a sports physical in the first place, it wouldn't need an ABN. Therefore, Medicaid has nothing to do with it, if I am not mistaken, because no claim is being submitted. This is strictly a self-pay service, and should be billed as such. While I understand that the patients in this situation are developmentally disabled, if Medicare is their primary insurance, you follow Medicare's rules about whether or not an ABN needs to be issued, or not, and if not, then you handle it like any other service that is never covered by an insurance company.