EM Coding Alert

Question: What code should I use to submit a claim for a disability exam that our physician performed? We are not able to provide this service under WC for this patient.

Indiana Subscriber

Answer: Since workers’ compensation (WC) won’t cover this service, you should submit 99455 (Work related or medical disability examination by the treating physician that includes: completion of a medical history commensurate with the patient’s condition; performance of an examination commensurate with the patient’s condition; formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; development of future medical treatment plan; and completion of necessary documentation/certificates and report). If another physician provided the treatment, you would report 99456 (Work related or medical disability examination by other than the treating physician that includes …).

General rule: Coverage for 99455-99456 is rare. Most payers assume these forms are being completed at the time the patients are seen in the office. Forms completion is part of doing business. You are certainly able to charge the patient for forms completion as long as the patients are aware you are doing this and what the expectations are.