Since it is sports physical time again, Blue Cross Blue Shield of North Dakota (BCBSND) would like to highlight some details to assist in differentiating between a sports physical and well child checkup/preventive medical exam. These details ensure all members receive the appropriate coding and billing for services provided. In turn, this ensures member benefits are applied correctly. We understand and respect efforts to perform full well child checks when appropriate. BCBSND prefers this as well.
However, we do understand that this cannot always be accommodated and therefore would support different coding. Below we summarized scenarios and highlighted coding and billing guidelines to ensure benefits are applied correctly.
- When the main purpose of the appointment is for a sports physical and the practitioner does not complete a full preventive Evaluation and Management (E/M), an appropriate office/outpatient E/M should be billed with the sports physical diagnosis.
- When the patient received a sports physical and annual preventive E/M on the same day, an appropriate preventive E/M would be billed with the appropriate encounter for examination diagnosis code and the sports physical diagnosis code.
Referenced below are some key factors as well as our current policy to consider when billing for these services.
Please review the Sports Physical policy and references below:
- Sports physicals are often needed when a child or teen wants to participate in an extracurricular sports activity.
- Practitioners will review the current fitness level and preexisting injuries to assess if the child or teen can participate in the sport.
- Areas of focus
- Height and weight
- Vision and hearing
- Heart health
- Blood pressure
- Muscle and bone health, flexibility, and strength
Questions?
Contact the appropriate providers service center number listed on the back of the members' insurance card.
