Pulmonology Coding Alert

Question: My pulmonologist performs a lot of work for patients on disability. How should I report the E/M services?

Idaho Subscriber  
Answer: There is no specific ICD-9 code that represents a disability evaluation. Providers may consider reporting the E codes (external cause of injuries) in addition to the primary diagnosis code to illustrate clearly why the service was provided and what caused the signs and symptoms or conditions. The E code will identify the cause of the illness or injury being treated (e.g., auto accident), but it cannot be used alone. 
 
CPT provides a specific series of service codes describing two types of disability: basic life and/or disability evaluation services (99450), and work-related or medical disability evaluation services (99455-99456). 
 
The disability codes that are selected (from the codes listed above) represent the E/M of a patient to determine if the patient meets (or continues to meet) the requirements for being certified as disabled. These services include a basic life insurance and/or disability exam (99450) work-related or medical disability exam by the treating physician (99455), and work-related or medical disability exam by other than the treating physician (99456). Once the treatment plan is developed, the ongoing care is reported with the established patient codes (99211-99215). Periodically, the physician may have to recertify the patients disabling condition. This service is best reported with the disability codes, not the established patient codes.
 
When the appropriate codes have been selected, the insurer needs to be considered. These codes should be reported only to the entity responsible for covering the patients disability claim.  For example, if a patient is involved in a car accident, the auto insurer (of the patient or the other involved party) may be responsible for covering the medical costs for the injuries (depending on the terms of the insurance). When in doubt, check with the patients primary insurer to determine if it is handling the cost of the care.