Pediatric Coding Alert

Question: Does a code exist for reporting forms, such as sports or school forms? Will insurers cover the service?

New York Subscriber Answer: CPT contains the code 99080 (Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form) for filling out extensive reports, such as accident and injury forms as appropriate. But you should not use this code for completing brief standard reports, states CPT Assistant, Winter 1994.

Sports and school forms are generally simple. Most pediatricians consider completing the activity forms usual medical communications or standard reporting forms and part of the postencounter E/M work.

In Coding for Pediatrics 2003, the American Academy of Pediatrics indicates that you can try reporting 99080 for common forms. But insurers will probably not reimburse for it. If you report 99080 and the carrier rejects the code as a noncovered service, you may bill the patient. Even so, you must previously obtain a waiver from the parent agreeing to pay for the noncovered service.