How to Bill for a Pre-Employment Exam - NOT a Physical

[nicoleysmith]

I am trying to determine how to correctly code for a pre-employment exam and I have been unable to find a clear answer on the forum or in the CPT book. My practice is currently using an e/m level visit (99201-99205, 99211-99215), but this seems incorrect since there is no problem to evaluate and manage. My administrator has informed me they are not physicals, so we cannot use a preventative code (99385-99387, 99395-99397). They are just a visit for the provider to confirm the patient is fit for the job description and complete the employer's paperwork. Since the company is the one usually paying for these, we are not concerned with insurance denials - but I still want to make sure I am coding them correctly. Is anyone able to offer more information? Please and thank you!

 

[Pam Warren]

What you're performing is a service that won't be submitted to payers, might be a self-pay option, and isn't represented well in CPT. So there is really no hard and fast coding rule for such a service. We set up a separate charge line called DOTEX (Department of Transportation Exam), which we priced at $75, I believe. It's not linked to a CPT and is always billed to 'self pay'.

 

[nicoleysmith]

Thank you very much, Ms. Brooks. Does that mean the leveling requirements are not applicable?

 

[Pam Warren]

Thank you very much, Ms. Brooks. Does that mean the leveling requirements are not applicable?
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E&M and/or preventive care levels aren't required when you set up a self-pay service that you won't submit to payers.

 

[nicoleysmith]

Thank you very much!