Q&A Sports, DOT Physicals vs EPSDT's (preventative)

[Dolores Soliz]

Three questions?
1. What is the difference in the three above?
2. If a provider has coded a V70.3 sports physical & throughout document states and supports the well child check V20.2 and he has charged out an (regular E & M 99213 with V70.3) is a coder allowed to change the codes to preventative code 99383 w/V20.2 as long as documentation is there?
3. Are we allowed to make a recommendation to provider... i.e. documentation supports this code instead of what they charged out?

 

[Ruth Sheets]

Question 1: Requirements of sports physicals can vary by state and sport. DOT physicals are determined by the Dept. of Transportation. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. Here is a link: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-Periodic-Screening-Diagnosis-and-Treatment.html

Question 2: was covered in the November 2013 Q&A Webinar. Laureen explained that it is not a good idea to change the code to a well care visit. Most insurances will pay for a well care visit once a year, but if a coder makes a change, and later that same year the patient schedules a well care visit, then that creates a problem. The patient will expect to be able to use the well care visit and they won't be able to do so.

Question 3: In general, yes, depending on your work environment. Make sure you do your research first, and be aware of problems such as that mentioned in above.

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