Pulmonology Coding Alert

Question: My pulmonologist frequently treats patients on disability. How should I report the E/M services?

Idaho Subscriber

Answer: 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 your pulmonologist develops the treatment plan, you should report the ongoing care with the established patient codes (99211-99215). Periodically, the physician may have to "recertify" the patient's disabling condition. Bill this service with the disability codes, not the established patient codes.

The ICD-9 code that you report for these services will include the condition that causes the patient to be "disabled," such as black lung disease (500).