Internal Medicine Coding Alert

Question: Which CPT code should I use for a patient who was referred by his employer for a Department of Transportation (DOT) physical exam?

New York Subscriber

Answer: Use either 99499 (Unlisted evaluation and management service) or no CPT code.

These exams are never billed to an insurance company. They are either billed to the employer or paid for at the time of service by the patient. Therefore, they can be priced at the provider's discretion, and it is not necessary to use a CPT code. You can bill this to the employer the old-fashioned way by invoice through a prearranged agreement with the employer or, if you prefer to keep things uniform in your practice, use 99499. The diagnosis code is V70.5 (Health examination of defined subpopulations).

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.