Outpatient Facility Coding Alert

Question: How do you code for a work related exam?

Arkansas Subscriber

Answer: There are two CPT^® codes for a work related exam: one by the treating physician and another by the physician other than the treating physician. The first choice is 99455 (Work related or medical disability examination by the treating physician …) and the second is 99456 (Work related or medical disability examination by other than the treating physician …). Report the code that represents the physician you’re coding for.

• Both codes include the same elements related to the work involved:

• 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.