Pediatric Coding Alert

Question: One of our patients who visits our office yearly is severely physically and mentally disabled from a previous car accident. His mother often requests that our nurse fill out various service forms for him. In the past six months, the nurse has completed 12 forms for therapy, home health care, school and specialists' requests, some of which require more than an hour to complete. Is there a code that covers this service?


Texas Subscriber
Answer: Unfortunately, no CPT or HCPCS code represents nurse completion of forms. Insurance companies will not reimburse these services.

CPT does, however, include a physicians' form completion code (99080, Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form). "There are occasions when a physician must fill out other than a standard reporting form (e.g., detailed forms related to accidents, injuries, Worker's Compensation); code 99080 may be used to report the completion of these special reports," states the Winter 1994 CPT Assistant. Payers' policies vary on coverage for physicians comple-ting these forms.

Be careful: Don't use 99080 when a pediatrician fills out a brief standard form, such as a return-to-work form or hospital discharge summary. "Completion of these routine forms are not reported separately, including the forms described in the nursing facility assessment codes," according to CPT Assistant.

Strategy: When a pediatrician spends time filling out forms, consider charging patients for form comple-tion. Notify patients that if an insurer deems the service noncovered, the patient will be responsible for payment. Or simply inform patients up front that forms comple-tion is an elective, noncovered out-of-pocket expense to the patient.

Exception: When a third-party payer requires the form, you should charge the insurer the associated 99080 fee. Append modifier 32 (Mandated services) to the E/M service that the pediatrician performs. Code 99080 is an adjunct service that you must report in addition to the basic service, according to CPT's "Special Services, Procedures and Reports" introductory notes.