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Work Comp Coding

  1. Question Work Comp Coding
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    Need help w/ Work Comp and PPD's and Impairment Ratings.
    My question is, for cpt code 99455 is this only billable during a "physical" E/M, Does the W/C carrier have to have requested the PPD be done before it can be done. Example: Can a patient be seen in follow up and Charged for that visit (if they are outside any global period) then a month later when the W/C asks for the PPD can the physician charge 99455 for supplying the PPD without seeing the patient on the date of service for the PPD. Or in this case should the Dr charge for 99080 for the PPD without bringing the patient back in? Any assistance would be appreciated!

  2. #2
    If this patient was sent for the PPD and Impairment Ratings then you would bill 99455. If this patient comes back under the work comp carrier for the use follow-up visit. I hope that this helps

  3. Default
    Thank-you for your reply, However I still have questions?? The issue here is that the Dr. last see the W/C patient in Sept. then in Jan. the W/C carrier requested a PPD. The Dr gave the Impairment and PPD rating by reviewing his previous visit notes, (from sept) and other op reports and such. Can he charge the 99455 for the PPD without bringing the patient in for the exam? Can he base his PPD on an exam that was done before the W/C carrier requested the PPD? If he can not charge 99455 in this situation, can he charge for 99080-Special Reports and base his Impairment/PPD on the last visit?

  4. #4
    I would then bill the 99080 - Special Reports and your physician can base his impairment on the previous visit.

  5. Default
    Thank-you much for your Help

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