Eli's Rehab Report

Question: Another practice asked us to perform an independent medical exam (IME) for a patient. Is there a code for this?

Illinois Subscriber

Answer: IMEs, most often performed as a baseline for life or disability certification or to establish the patient's percentage of disability related to body injuries or disease, should be coded with 99450-99456 (the E/M codes for special evaluation and management services). Use 99450 for basic life or disability exams, 99455 for a work-related or medical disability examination by the treating physician, and 99456 for a work-related or medical disability examination by other than the treating physician.

CPT says these codes are billable for new or established patients but do not include actively managing any problems undertaken during the encounter. However, if other evaluation and management services or procedures are performed during the same visit, you can report those services in addition to these codes using modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

You Be the Coder and Reader Questions were reviewed by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J.