Well Child Exam vs. Sports Physical Exam | March 2022 | Clinical Corner

March 15, 2022

Well Child Exam vs Sports Physical Exam


Many students and their parents believe that a Sports Physical is equivalent to a Well Child Exam, but this couldn’t be further from the truth. The Sports Physical is designed to clear an athlete for participation in sports while the Well Exam includes much more.


Both a well-child visit and a sport physical are not needed. The child’s annual well visit covers everything he or she needs for a sport physical. A sports physical does not cover everything for a well-child visit. Only a well-child visit will let you take care of both at once.


Benefits of a Well Child Exam:

Well-child visits cover a lot of important health information such as:
• Overall health and development.
• Body mass index (BMI) percentile.
• Immunizations.
• Current medicines.
• Counseling for nutrition.
• Counseling for physical activity.
• Chlamydia screening urine test (16 and older).
• Depression Screening.
• Tobacco and alcohol use.


Billing for Sports Physical vs Well Child Exam:

Because the requirements for office visit codes are problem-oriented, many payers’ claims processing systems automatically reject claims that list problem-oriented visit codes (99211-99215) with preventive-oriented diagnosis codes (Sports Physical).


If the patient has not had a full preventive service in the last 12 months, the scheduler should inform the parent when he or she calls for an appointment that a full preventive service is recommended and that the sports physical form can be filled out in conjunction with the preventive visit.  Otherwise, perform a sports physical and bill the patient a standard fee. Most computerized billing systems allow you to set up service codes that are not billed to insurance (i.e., 99080), to track utilization data and to generate itemized statements.


In Conclusion:

A Sports Physical and a Well Child Exam are not interchangeable.  A Sports Physical focuses on an athlete’s health history and physical exam only as it relates to sports and is much more limited than a regular physical, and therefore does not take the place of a regular preventative exam. The Sports Physical can be incorporated into the Well Child Exam, but not vice versa, or it can be billed to the patient directly as a separate standard charge. Well Child Exam should be performed yearly.