Orthopedic Coding Alert

Question: Should I use work-related code 99455 each time my orthopedist sees a workers'compensation (WC) patient, as long as the physician 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 ...), depending on whether your physician treated 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 orthopedist evaluates a patient to establish baseline information.

The physician doesn't actively manage any patient problems during this encounter, according to CPT. But if your orthopedist treats a WC patient, bill 99201-99205 for a new patient or 99212-99215 for an established patient.