# Work related physical



## shanhockyfan

What would be the appropriate code be for work related physical? Thank you for your time and thoughts


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## RebeccaWoodward*

shanhockyfan said:


> What would be the appropriate code be for work related physical? Thank you for your time and thoughts



Look at 99455/99456


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## Mojo

99455/99456 codes are for disability services. Are you asking about disability or pre-employment exams?


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## RebeccaWoodward*

*Disagree*



Mojo said:


> 99455/99456 codes are for disability services. Are you asking about disability or pre-employment exams?




No...CPT clearly indicates that 99455/99456 can be reported for *WORK RELATED* *OR* Medical disability eval services.  We have an occupational/WC clinic and we use these for these very purposes.


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## Mojo

RebeccaWoodward* said:


> No...CPT clearly indicates that 99455/99456 can be reported for *WORK RELATED* *OR* Medical disability eval services.  We have an occupational/WC clinic and we use these for these very purposes.



The CPT descriptor is "The following codes are used to report evaluations performed to establish baseline information prior to life or disability insurance certificates being issued."  In addition, doesn't the Work Related or Medical Disablity actually mean Work Related Disability or Medical Disability since the descriptors mention "treating physician" and "other than treating physician" as well as "condition" and "formulation of a diagnosis... calculation of impairment." The terminology describes a patient with a disability, not a pre-employment exam and is the reason I asked the OP for clarification.

Rebecca, what are your thoughts? Does CPT Assistant offer guidance on these codes?


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## RebeccaWoodward*

What code should I use for a workers' compensation examination?

CPT codes 99455 and 99456 are both designated to cover work-related or medical disability exams. The first covers an exam provided by the treating physician, and the second covers an exam provided by someone other than the treating physician. *According to CPT, both codes should be used to report “evaluations performed to establish baseline information,” when “no active management of the problem(s) is undertaken during the encounter*.” If other evaluation and management (E/M) services or procedures are performed for the patient on the same date, you should also report the appropriate E/M or procedure code. Attaching a -25 modifier might help ensure that both services are reimbursed

http://www.aafp.org/fpm/2000/0100/p17.html

How does a physician report performing a Department of Transportation physical?  With CPT® code 99455 and ICD-9 code V70.5,  99455 is for a work related or medical disability examination by the treating physician.  (9945 is for this examination by other than the treating physician.)  See the CPT® book for the complete description of the code.  
It is incorrect to bill a preventive medicine code for this service, in the 99381-99397 series of codes.  This service is not payable by the patient's insurance company, which does not cover employment related expenses.  Billing with a preventive medicine service, and a general exam diagnosis code, V70.0, so that the insurance company pays the service, is incorrect

http://codapedia.com/~article_317_Department of Transportation DOT exams.cfm

99455 -- Disability examination

Q. When is it appropriate to bill CPT code 99455 -- work-related or medical disability examination? I have been told only on initial exam and release exam. Others have said every date of service, as long as the physician fills out the impairment (APS) rating. 

A. *According to the AMA's CPT Assistant, these codes are used to create a "baseline" evaluation and do not involve management of any problems*. Management of problems other than those related to the disability are reported using E&M codes (99201-99215) with a -25 modifier. If the physician is managing the work-related condition, then subsequent care is reported using the appropriate level of E&M code (99211-99215). 

http://www.physicianspractice.com/coding/content/article/1462168/1589695

(CPT Assistant 95-emphasis added by me)


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## Mojo

Thanks for the links, Rebecca.

And Supercoder.com reports:
Sometimes coders try to assign the codes for work-related or medical-disability evaluation services (99455-99456) to DOT exams, but those codes are for evaluations related to workers’ compensation claims. The DOT exam also does not meet the criteria for a preventive medicine service (99381-99397) because the physician does not perform the comprehensive age-and gender-appropriate history/exam specified in CPT for these codes.


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## wanda muhammad

*99455 or not?*

So what would be used for pre-employment examinations?


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## kathy a

On the DOT physical I use the 99455 as the procedure code and V70.5-occupational .
Kathy Albert,CPC


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## AshleyTohill

*Confusion over the type of evaluation*

It seems there are a few responders that are getting the actual question confused. A pre-employment physical is not the same as a W/C physical. A W/C physical is when an employee has been hurt on the job and should be coded with the codes that were suggested above. But if this is a pre-employment PE then it is totally different. At our CAH's (Critical Access Hospital) clinic we perform pre-employment PE's for the school district and for other companies. Our DOT PE's we have assigned a EM level that reflects the work done in the eval. For our school district we have a specific contracted price and we use the unlisted preventive code 99429. It just depends on how your facility has it set up, but I do know that the codes mentioned above should not be use for a pre-employment PE. Even the sources cited say its for W/C, not pre-employment. Thank you!


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## cduzan

*Cindy Duzan, Occupational Medicine Specialist,CPC*

You can only code a V code, V70.5 Health Examination of defined subpopulations (Occupational Health Examinations and Pre-placement screenings)

You are not treating anything, so you cannot code a diagnosis.

Most private insurance carriers will not cover this service. We always make the employee or the employer (if they authorize) pay for these exams.


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## dballard2004

For pre-employment or DOT exams, we report code 99499 (unlisted E/M) and ICD-9-CM code V70.3 or V70.5 depending on the type of exam.  Many carriers will not reimburse for these types of exams, so these are either payed out of pocket by the patient, or in the case of DOT exams, we invoice the employer.


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