Orthopedic Coding Alert

Question: In your July issue, you recommended using 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) when the orthopedist fills out disability forms. Couldn't 99450-99456 also be used for this?

Washington, D.C., Subscriber

Answer: According to CPT, 99450 (Basic life and/or disability examination) should be used when the orthopedist performs a baseline evaluation prior to the issuance of life or disability insurance certificates. Codes 99455-99456 refer to work-related or medical disability evaluations, normally requested by workers' compensation or automobile insurers and billed directly to them. If the orthopedist performs this type of evaluation and fills out forms related to the exam, then these codes should be billed instead of 99080 because these evaluations include filling out paperwork, and it cannot be billed separately.

If the patient presents to the orthopedist for a different reason (such as a series of injections) and subsequently asks the orthopedist to fill out disability forms, the practice cannot bill 99450-99456. In this case, bill for the service performed (such as the injections) in addition to 99080 for the form completion.