# 99080 Billing Guidelines Question



## moore509

Hello!  For a special project, I will be asking docs to fill out additional paperwork (above and beyond what is typically expected) for a few of their patients.  On the bill, I expect an E/M and the 99080, along with any additional codes as necessary.  I don't think a modifier for a separately identifiable E/M is necessary.  Can someone chime in and let me know what you think?
Thank you!!!


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## airart

*Cpt 99080*

My PCP charges $25 to fill out FMLA, payable upon drop off.  I have them filled out every year so I know when I take the form; I know to hand over the money with it.  The office doesn't even bill it to my insurance carrier.  As for these others to help you out on questions, I found these.  Some other articles I came across mentioned they used this code for adoption papers too.

(Workers Comp) Texas Dept of Ins Medical Fee Guideline for CPT 99080 (2009), For 2013, the modifier 73 must be added to 99080 for Work Status Report reimbursement is $15.  If an additional report is required from carrier attach modifiers 73 and RR, reimbursement is $15.  Lastly if an extra copy of a previously filed report requested by or through the carrier attach modifier 73 and EC reimbursable at $15.

Medical Association of Billers - 
99080 is reports/forms. It's billable for work comp, not billable for anyone else. For non-billable forms, we use pseudocodes, so we can see at a glance that it is patient responsibility (and they have to pay for it when they drop off the form to be completed). We charge roughly $25 per page, depending on how much info is needed.

DMVFORM - DMV forms
DISFORM - Disability forms
FMLAFORM - FMLA forms
JURY - Jury duty excuse
FORM - Miscellaneous form

I like to use the descriptive codes instead of just "form" because, again, at a glance, we know what it is. 
Link: http://medicalassociationofbillers.yuku.com/topic/8904/code-for-forms

AAFP (American Academy of Family Physicians) Q&As had this - 

Getting paid for FMLA paperwork
Q - Is there a code I can use to bill for completing paperwork related to the Family and Medical Leave Act?

A - Try code 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form.”

Coding forms completion
Q - Under what circumstances is it appropriate to submit 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form?”

A - Code 99080 is intended to be used when a physician fills out something other than a standard reporting form, such as paperwork related to the Family and Medical Leave Act. This code does not apply to the completion of routine forms, such as hospital-discharge summaries. Also note that it would not be appropriate to submit 99080 in conjunction with 99455 or 99456, which are the codes for work-related or medical disability evaluation services. The descriptors for these codes explicitly state that they include “completion of necessary documentation/certificates and reports.”

This doctor's website actually lists all they bill with 99080.
http://www.drkalin.com/HP CPT coding.htm
Initial Insurance Narrative	99080
Narrative Report- Brief	99080
Narrative Report- Complete	99080
Medical Records- Copy & Transfer    99080
Complete Itemized Bill	      99080
Medical Data Review	99080

Here is another AAPC positing on this code, looks like only WC reimburses for this besides private pay. (2-23-2010)

Topic: 99080 - Special Reports - Is anyone using this? 

Q: My office is wanting to start charging insurance companies for CPT 99080 (Special Reports) because of all the time spent on filling out forms above and beyond. Though I would love to see my docs get extra $ I believe this code falls into the billing rule "Just Because There's a Code, Doesn't Mean it's Reimburseable". 
Is anyone else attempting or have attempted to get insurance companies to pay for this code? If so, are you successful? Any tips?

A: we are in the same dilemma. Paperwork for disability carriers and work comp carriers as well as meetings/visits with work comp nurse case managers.

A: I've never tried to bill this code to an insurance, but I'd be very surprised if they pay for it. You can always bill the patient....

A: I do bill this code, but only to W/C carriers when doing a PR-4 form to release the patient as permanent and stationary and/or quantify their percentage of future medical need. 

A: BTW, I DID bounce this question off of a Work Comp adjuster that I have been working with - and he said that as an adjuster, he realizes that a nurse case manager wanting to meet with the doctor is or can be important - as the NCM is working on behalf of the carrier - he would have no problem paying the doc for the time spent - but, does not know of an appropriate code - and would rather simply receive an invoice for services provided. Our issue is - if we can't bill someone for the doc's time, we can't justify reserving an appointment time slot for the meeting - therefore, we've been scheduling these individuals at the end of the day after clinic has finished - which then basically a) takes the doc away from the necessary end of day activities (i.e. dictating, answering questions, phone calls) or b) is being held on his own time ... Work Comp and Disability Carriers are the biggest time consumers of them all!!! I feel for these patients - there are a lot of providers who refuse to see these individuals - so, I feel strongly that SOMEONE has to be willing to treat them - but dealing with the paper/meeting requirements is such a nightmare!! 

A: We bill this code all the time for all workers comp. cases. Initial we charge 8 pages (8 units) and 2 for follow up. more than 50% of the time we get paid. 

A: I work in an Internal Medicine practice and we, too, bill this code out to Work Comp Carriers and it gets paid without question. We also charge patients who come into the office to have FMLA, Disability Papers, etc filled out. They pay for the services up front then rec the paperwork.

A: I coded for a Physical Medicine/Rehabilitation clinic, and we too used this all the time with the Work Comp cases; especially for their long, long forms! The base charge was $350/hour; but of course, they told the WC carriers about this up front. 
Some even mentioned they use this code for Adoption papers too.


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## moore509

Thank you!


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## kayba89

I literally had this same question as I am also in charge of our practices master fee schedule presently. Thank you for the detailed response!!


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## SharonCollachi

I am amused that my response from the Medical Association of Billers was quoted in the original response seven years ago!  Right now we are only using 99080 for Federal Work Comp patients (we stopped seeing other types of work comp), AND for legal cases for which we can use any code we like (insurance isn't involved).  The link is no longer valid, as they went to a paid-only forum some time after I resigned, as far as I can tell.


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