When it comes to student health and athletic performance, school physicals serve as a cornerstone, ensuring the well-being and readiness of young individuals to participate in various physical activities.
However, the significance of these assessments extends beyond clearance to participate in sports; they encompass comprehensive evaluations of a student’s physical health, identifying potential issues and offering preventive measures. Because of the crucial importance of school physicals, let’s advocate for the inclusion of DCs as sports specialists and explore effective billing practices for their services.
School physicals are important
Preventive health measures: School physicals serve as proactive interventions, aiming to detect underlying health issues before they escalate. These assessments encompass not only musculoskeletal evaluations, such as scoliosis screenings, but also screenings for cardiovascular health, vision and hearing. DCs are well-equipped and perhaps best-equipped to perform these preventive evaluations.
Enhanced athletic performance: For students engaged in sports activities, physical fitness is paramount. School physicals ensure athletes are in optimal condition to participate safely, minimizing the risk of injuries and maximizing their performance potential. For students taking part in activities that require running and jumping, optimal spinal health takes on a new meaning.
Identification of musculoskeletal issues: Musculoskeletal injuries are common among athletes, often stemming from underlying biomechanical imbalances or structural abnormalities. Conditions like Osgood-Schlatter disease (OSD) is a common cause of knee pain, for example, in adolescents during growth spurts. It’s an overuse injury that occurs when a child repeatedly performs the same movements, such as running or jumping. Through thorough assessments, school physicals can detect such issues early on, enabling timely intervention and rehabilitation.
Promotion of overall well-being: Beyond the realm of sports, school physicals contribute to the overall health and well-being of students. By addressing any health concerns and providing guidance on nutrition, exercise and lifestyle habits, these assessments foster healthy habits that extend beyond the school environment. Often, DCs who are active with a school’s physicals are asked to present in the classroom on these healthy habits, furthering education about chiropractic care.
Compliance with regulations: Many school districts and athletic associations mandate pre-participation physical examinations to ensure compliance with safety standards and liability concerns. School physicals facilitate adherence to these regulations, ensuring a safe and conducive environment for student athletes. DCs are uniquely qualified to lead the charge with these examinations.
Why DCs are best-suited for these evaluations
Expertise in musculoskeletal health: Because DCs are trained extensively in diagnosing and treating musculoskeletal disorders, they are an asset in assessing athletes’ physical readiness. This expertise extends beyond traditional medical evaluations, encompassing holistic approaches to injury prevention and performance enhancement. Often, they take a more holistic approach to healthcare, which is especially important in youth.
Focus on functional movement: DCs are uniquely trained in and emphasize functional movement assessments, identifying biomechanical imbalances and movement dysfunctions that may predispose athletes to injuries. By addressing these issues through tailored interventions, DCs optimize athletes’ performance while mitigating injury risks.
Noninvasive treatment modalities: Chiropractic care offers noninvasive treatment modalities, such as spinal manipulation, soft tissue therapy and rehabilitative exercises. These interventions align with the principles of conservative management, prioritizing natural healing processes and minimizing reliance on pharmacological interventions. Once again, critical when dealing with young individuals.
Collaborative care approach: Integrating DCs into the school physicals process fosters a collaborative care approach wherein multiple healthcare professionals work synergistically to optimize students’ health outcomes. By leveraging the expertise of DCs alongside other medical professionals, schools can provide comprehensive and holistic care for student athletes.
Educational outreach opportunities: DCs can also contribute to educational outreach programs, promoting injury prevention strategies, proper ergonomics and wellness practices within the school community. Through workshops, seminars and individual consultations, DCs empower students to take proactive measures toward their health and performance goals.
Best practices when charging and billing for student physicals
When DCs offer school physicals, establishing a transparent fee structure is essential. This structure may include a base fee for the physical examination, additional charges for specialized assessments or treatments, and bundled packages for comprehensive services. And the services may be billable to insurance. School physicals fall under the heading of “preventive services” and very often, those are not covered when ordered or delivered by a DC. It’s critical to set the proper tone up front for fees and payment expectations.
Billing for sports physicals is applicable whether the patient is being seen in the office or in a group setting, where multiple physicals are taking place at one time. Sometimes, a DC will be invited to visit a team’s practice session and offer physicals for all involved, one at a time. Sometimes, the parent brings the individual into the office for the evaluation.
Coding for student physicals
Most often, physicals are a cash-based service, vs. an insurance-eligible service. Well-child examinations, reimbursable to allopathic physicians, can include a sports physical, and in those instances, they may be reimbursed. Outside of that well-child exam, it’s unlikely insurance would cover the visit for DCs when only a sports physical is performed.
That said, if the student is being seen in the chiropractic office, with valid complaints and findings along with the physical, it may be appropriate to code an Evaluation and Management (E/M) service (9920X – 9921X). During this typical E/M service, the components of the sports physical may be performed and the physical form completed. In these instances, medical necessity may be established, making the visit reimbursable. The diagnosis for this visit would be appropriate based on the complaint and findings.
When the sports physical is stand-alone, with no stated complaints, it’s more likely to be a cash-based visit and must be coded as such. Yes, you can code the appropriate E/M code as noted above, but many practices like to set a different fee specifically for this service. In those instances, you may choose to use an internal code for your ledger, such as 99499 Unlisted Evaluation and Management Service. In these circumstances, it’s also critical to assign an ICD-10 code, even with no complaint. We suggest using code Z02.5, encounter for examination for participation in sport.
Final thoughts
In conclusion, school physicals play a pivotal role in safeguarding the health and well-being of student athletes, offering preventive measures and promoting optimal performance. By integrating DCs as sports specialists, schools can leverage their expertise in musculoskeletal health, functional movement and collaborative care approaches. Implementing transparent charging and billing practices ensures accessibility and equity in healthcare delivery, empowering students to thrive both on and off the field.
KATHY (KMC) WEIDNER, MCS-P, CCPC, CPCO, CCCA, better known professionally as Kathy Mills Chang, is a Certified Medical Compliance Specialist (MCS-P), a Certified Professional Compliance Officer (CPCO) and a Certified Chiropractic Professional Coder. Since 1983, she has been providing DCs with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Celebrating serving this profession for more than 40 years, Weidner leads the largest team of certified specialists under one roof in the profession, at KMC University, and is known as one of our profession’s foremost experts on Medicare and documentation. She or any of her team members can be reached at (855) TEAM-KMC or info@KMCUniversity.com.