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Thread: Help!!!

  1. #1

    Default Help!!!

    AAPC: Back to School
    We treat alot of Workers Comp patients and State Fund is always requesting the physician to fill out medical necessity forms regarding the medication the patient is taking. Because we are always getting requests we were wondering if we can start charging for these forms and what CPT code do we use?????? Does anybody know?

  2. #2



    I request you to see CPT codes 99455-99456 or 99080


  3. #3



    I request you to see CPT codes 99455-99456 or 99080


  4. #4
    Join Date
    Apr 2007
    Lubbock, TX


    I believe that we use 99080, Special Report. You should check the carrier's website and your state's department of insurance website to see if there are any codes mandated for payment, or specified as the way to get reimbursed for reports, when eligible. If your physician prescribes certain medications frequently, (for example: Dr. A sees a lot of patients with pain, and he usually prescribes hydrocodone to relieve the pain, in dosages appropriate for for the situation); chances are, the fundamental function he's expecting to achieve each time he prescribes it, remains constant. For frequently prescribed medications that are subject to review, I suggest creating a report template, that allows the doctor to fill in the information as it pertains to each patient. Here's how Dr. A's might look (with hypothetical effects.).


    Hydrocodone products are indicated for the relief of moderate to severe pain. They in a class of medications called opiate (narcotic) analgesics, which relieve pain by changing the way the brain and nervous system respond to it.
    [___Patient X____]'s injuries, as they are pertinent to this case, consist of [___Dr. lists patient's injuries that are causing significant pain, in clinical terminology____]. It is my professional opinion that the level of pain associated with this patient's injuries, is severe enough to have a detrimental impact on their quality of life, and that hydrocodone has been safe and effective in achieving optimal relief of persisting pain, with minimal side effects. As such, I have prescribed the patient [dosage of hydrocodone], which is currently necessary to achieve the desired pain-relief result, and is within clinical practice standards. [Patient] will undergo periodic evaluations to assess the need for, and the effectiveness of their hydrocodone medication, and I will continue to prescribe it when I believe that it's needed, within the scope of my practice.


    It will save them time, with a lot of requests. Hope that helps!

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