Neurology & Pain Management Coding Alert

Question: I have a patient who is applying for early disability retirement. I have spent four hours filling out forms and reviewing 20 years of medical records to offer supporting medical information about her disability, in addition to seeing the patient weekly. Can I bill for this extra time, and if so, how should I code it?


West Virginia subscriber

Answer: Yes, you can bill for the additional time. The code you need to use depends on where the disability determination request came from. Because this isn't a disability determination for workers- compensation, you can exclude the work-related or medical disability evaluation services codes 99455 (Work-related or medical disability examination by the treating physician ...) and 99456 (... by other than the treating physician ...).

Option 1: If a third party sent you a letter requesting the disability determination, you can report 99450 (Basic life and/or disability examination that includes: measurement of height, weight and blood pressure; completion of a medical history following a life insurance pro forma; collection of blood sample and/or urinalysis complying with -chain of custody- protocols; and completion of necessary documentation/certificates).

Option 2: If you did not receive a letter of disability determination from a third party, but your patient presented a determination request to you, report 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form).