Anesthesia Coding Alert

Question: Our physician orders functional testing as a precaution for prescribing controlled substances. In our state, you must provide objective functional testing to document positive patient response for workers’ compensation cases. We use an independent company to fulfil the objectivity requirement; they send a technologist (MD, DC, or PT) to our office to perform the functional assessment and follow up with a report. Our physician spends about 55 minutes reviewing and interpreting the report, developing a treatment plan, and consulting with the patient. What code or codes should I bill for the time spent? 

New York Subscriber

Answer: Providers often perform functional capacity evaluations (FCE) on patients covered under workers’ compensation. 

CPT® code 97750 (Physical performance test or measurement [e.g., musculoskeletal, functional capacity], with written report, each 15 minutes) is often used to report performance of an FCE with the corresponding report of findings.

However, each state has its own workers’ compensation jurisdiction which sets the fee schedule rules, including the codes you should use. Workers’ compensation is not considered to be a covered entity under HIPPA and as such can create billing codes to meet their needs (such as codes not found in the CPT® or HCPCS code sets). It would be a good idea to verify if 97750 is the correct code for a FCE or if the workers’ compensation jurisdiction uses a different code for providers to report these services in your area.

Resource: To learn more about FCE, see this article from the American Occupational Therapy Association: http://www.aota.org/about-occupational-therapy/professionals/wi/capacity-eval.aspx.