Internal Medicine Coding Alert

Question: A patient came in to have papers completed for Social Security benefits. The physician completed the papers and wants to charge for this. When we do this for the Social Security office, we normally don't charge. But the request for the information came from an attorney. How should we bill? Is it appropriate to use the disability evaluation code, 99450?

Ohio Subscriber

Answer: Physicians are often asked to complete paperwork to assist patients in qualifying for benefits or for other activities such as employment, school, life insurance and so on. The physician may use his or her discretion in charging for this service. Some physicians charge a nominal fee of $25-30 every time they perform this service. Others will charge only when the amount of paperwork completed is burdensome or if they know the patient can afford to pay. Only when the insurance company has contacted the physician directly to provide the information should the insurance company be charged for this service. In most instances, the patient will pay out of pocket for this.

Most physicians, however, elect to charge for this service when an attorney is involved. When billing attorneys for this type of service, it is not necessary to use codes. If you want to track this service on your billing software, the appropriate code is 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form). It is inappropriate to use 99450 (Basic life and/or disability examination) only if paperwork is completed and no examination is performed. This code is for medical examinations for life insurance companies or for serving as an independent examiner for a casualty insurer in accident or trauma cases. No active management of the patient's problem is described in these codes. However, the completion of paperwork is a component of these codes and would not be billed separately when reporting this service.

Answers for You Be the Coder and Reader Questions were reviewed by Linda Bishop, CPC,CCS, corporate compliance officer, Pediatric Management Group at Children's Hospital, Los Angeles; and Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.