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Old 10-08-2008, 12:54 PM
LLinville LLinville is offline
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Question CPT code for Independent Medical Examination?

Help! I was just informed that our Ortho doctor is going to be doing IME's or Independent Medical Examinations. The code they have told me to use is 99456, Work related or medical disability examination. But to use it as a hourly rate. I can't find anything that says to use it as hourly. It is my understanding that this is one flat fee. The examination is a very thorough review of a entire chart and then a 5-10 page report.
Does anyone of any other information on this exam? CPT codes? Billing?
Your help would be greatly appreciated. Thanks!!
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Old 10-08-2008, 01:04 PM
BCrandall BCrandall is offline
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99455 & 99456 are the codes to use. When I billed these I would bill the Comp rate for Comp claims, (those are set by WC) and bill others for whatever the Dr. wanted to charge since each case was different. If your Dr. wants, you can come up with an hourly rate and multiply it by the time spent doing the service.
Bruce Crandall, CPC
North Carolina Specialty Hospital
Durham, NC
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Old 10-08-2008, 01:11 PM
RebeccaWoodward* RebeccaWoodward* is offline
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I agree with Bruce. I also reside in NC and these are the codes we use. I'm sure you're in another state but here are the guidelines for our WC carrier.

The Commission, in review of the Committee’s recommendation, and upon further discussion, has decided to adopt the following codes, to be used for all independent medical evaluations, effective March 1, 1996, and to set the following fees based upon time expended for review of medical records. If a physical examination is performed, additional CPT codes may be used.

Code Time Fee
IME 01 1 hour $100.00
IME 02 2 hours $200.00
IME 03 3 hours or more $400.00

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Old 04-14-2014, 09:32 AM
janiceccs janiceccs is offline
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Default Maryland, Wash. DC, Virginia

Does anyone out there know what the rules and regulations are for Maryland, DC and Virginia? (Standards for fees and how one charges for record review)

So, are you saying that you would use the 99455 for record review and the consult or new patient e/m codes for the exam????
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

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