Results 1 to 2 of 2

Codes 99455/99456

  1. #1
    Overland Park, KS
    Default Codes 99455/99456
    New Call-to-action
    Can someone please explain the correct use of these E/M codes, please?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Sioux Falls South Dakota
    Quote Originally Posted by dballard2004 View Post
    Can someone please explain the correct use of these E/M codes, please?

    These codes are used for work related or disability examinations. The CPT book does contain complete descriptions of what needs to be done to bill for these. 99455 is used if the physician is the treating physician for the problem (either work comp or the condition causing the possible disability), while 99456 is used if they are not the treating physician but are asked to evaluate the patient and their records.

    These are usually requested by the work comp carrier or the agency that needs a disability rating. The physician should be experienced with work comp and disability ratings, based on the newest guidelines. I can't remember off-hand the book/standard used for disability ratings, but the physician should have whichever edition their state mandates. (I no longer code for the PM & R doc, but he did a ton of these!)

    Your primary diagnosis will be V68.01.

    I hope this helps,

Similar Threads

  1. cpt 99456/need rvu or another code
    By ddebbied in forum Modifiers
    Replies: 2
    Last Post: 11-05-2013, 09:43 AM
  2. 99455 - We have this code
    By kbarron in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-30-2011, 08:12 AM
  3. Cpt 99455 & 99456
    By valleycoder in forum Billing/Reimbursement
    Replies: 1
    Last Post: 04-06-2011, 09:06 AM
  4. 99455, 99456 Help
    By NURJAN1 in forum E/M
    Replies: 1
    Last Post: 10-14-2010, 02:13 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.