Internal Medicine Coding Alert

Question: One of our physicians wants to bill an E/M code for a commercial driver’s license (CDL) physical. How should we handle this coding dilemma?

Illinois Subscriber

Answer:  CPT^® doesn’t include a code specifically for a CDL physical. All of the existing preventive medicine E/M codes 99381-99387 (Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient …) or 99391-99397 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient …), go beyond the work typically involved for a CDL physical.

Potential solution: Some physician offices set up a special “dummy” code to use internally for CDL physicals. Many of the patients are self-pay, so this approach allows offices to get appropriate production credit and charge a reasonable amount for the service. If you or your physician is determined to use an actual E/M code for these encounters, you will need to use 99499 (Unlisted evaluation and management service), since no other E/M code accurately describes this service.