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Thread: Codes 99455/99456

  1. #1

    Default Codes 99455/99456

    AAPC: Back to School
    Can someone please explain the correct use of these E/M codes, please?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2
    Join Date
    Apr 2007
    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,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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