Primary Care Coding Alert

Question: Should I use work-related code 99455 each time my family physician sees a workers' compensation (WC) patient, as long as the FP fills out the Accounting Policy Statements form?

Ohio Subscriber

Answer: No, you should instead report an office visit code (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...).

Use 99455 (Work-related or medical disability examination by the treating physician that includes 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) or 99456 (Work-related or medical disability examination by other than the treating physician ...) if a patient's employer or insurance company requires a physical for employment or medical-disability purposes. You should record 99455-99456 when your FP evaluates a patient to establish baseline information. The FP doesn't actively manage any patient problems during this encounter, according to CPT.

But if your FP treats a WC patient, bill 99201-99205 for a new patient or 99212-99215 for an established patient.

-- Answers to You Be the Coder and Reader Questions provided by Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare  consulting firm based in Landsdale, Pa.; Karlene Lockard, CPC, clinic compliance director at Stormont Vail HealthCare in Topeka, Kansas; and Amy S. McCreight, CPC, compliance research analyst at Ohio Health with 300-plus family physicians in Columbus, Ohio.