CPT code for Independent Medical Examination?

LLinville

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Burlington Jct, MO
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:confused: 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!!:confused:
 

BCrandall

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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.
 

RebeccaWoodward*

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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

http://www.comp.state.nc.us/ncic/pages/feesec03.htm
 

janiceccs

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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????
 

Khargrove

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Encino, California
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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????
The thing about using these codes in the state of Virginia (where there is no WC fee schedule) is you are subjecting yourself to UCR rates for these codes. IME's are very comprehensive and since no code represents this accurately, I advise to set your rates and collect them prior to the visit. Our particular rates are set and we send the rate sheet to the carrier requesting the IME. So for example

If your rate is $100 per hour and UCR is set for $435 for 99456 you short yourself revenue if it took you say 3hrs for the IME...

In contrast, if your rate is $1500 and u bill it as a 99456, the UCR is $435 and you severely discount the hard work perfomed by the physician. This is the downside for using a CPT-code for a service that doesn't have an accurate CPT code.
 
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