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Thread: Workman's comp 99455

  1. #1
    Join Date
    Apr 2007

    Default Workman's comp 99455

    AAPC: Back to School
    Need some help / advice: A patient comes in with workman's comp claim paperwork - patient was injured on the job. He comes in with a laceration requiring sutures (simple repair). Can I bill the repair and 99455 with mod 25 -- or is the repair included in the 99455? I have searched the AAPC website and other threads regarding 99455 but can not find any discussion on this type of scenario.

  2. #2
    Join Date
    Apr 2007
    Capital Coders, Columbia, SC


    This initial visit should be coded accordingly, just as any other visit. Code 99455 is typically used for the MMI, maximum medical improvement exam, (typically the last visit for the injury) at which time additional paperwork may need to be completed by the physician to return to the WKC carrier.

    Bill Hale, CPC

  3. #3

    Default IME's Help with Codes

    I have never coded these before and my manager has proposed this to me, we are in Maryland. This is what she sent to me:

    "Dr Rod completed his first IME on 05/09/14; pt: Jason Benjamin. Besides the face to face, Dr Rod told me that we spent 6 hours on this IME.

    I just wanted to confirm that this is being billed correctly.

    99456 x 1 - IME by nontreating physician
    99358 x 1 - medical records review 1st hour
    99359 x 9 - medical records review each additional 30min

    1 - Are those codes correct?
    2 - Is there supposed to be any modifiers?
    3 - The actual office visit is not to be billed as that is already included under 99456, correct?"

    I told her that it looked correct and the -25 could be used after the first code.
    Also, that the office visit was inclusive of the 99456. Am I correct?
    Everything that I've read suggested it.

    I also told hr that you can't code 99358/99359 for Medicare.

    Any advise would be greatly appreciated!

    Thank you,

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