Medicare Compliance & Reimbursement - 2018 Issue 7
Specialty Spotlight: Primary Care: Get Physical with These Preventive E/M Codes
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Article Overview
This article explains how primary care practices may document and bill common physical exams tied to school, sports, employment, and similar administrative needs. It is aimed at coders, billers, and primary care staff who need a practical overview of the relevant CPT and diagnosis code sets, the related administrative encounter codes, and common situations where alternative E/M or therapy-related codes are not appropriate. The discussion also covers general payer considerations and when a less common unlisted E/M option may come into play.
Why This Topic Matters
Physical exams are frequent in primary care, but the billing approach can vary depending on the type of visit and the patient’s prior preventive care. Understanding the applicable code families and documentation expectations helps practices reduce denials and avoid improper code selection.
Article Sections
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Know the Codes You Can Use
Introduces the broad coding families discussed for school, sports, and work physicals and explains the general billing context for preventive and administrative encounters.
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... Those You Can’t ...
Reviews categories of codes that are not used for these types of physicals and explains the broader distinction between preventive administrative visits and problem-oriented services.
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... And One to Use with Caution
Covers an additional unlisted E/M option discussed in the article, along with general payer and documentation considerations.
What You Will Learn
- Which code families the article discusses for routine school, sports, and work physicals
- How the article frames administrative encounter coding alongside preventive medicine visits
- Which broader categories of codes the article says are not appropriate for these visits
- What general considerations are raised for using an unlisted E/M service in this context
Who Should Read This
- Primary care physicians
- Family medicine practices
- Medical coders
- Medical billers
- Practice managers
- Reimbursement staff
Codes Discussed
Code Ranges Discussed
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