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Thread: How to code for a Medical Insurance Exam? (CPT)

  1. #1
    Join Date
    Apr 2007

    Default How to code for a Medical Insurance Exam? (CPT)

    AAPC: Back to School
    If a patient presents to the office for an insurance exam how do I code this? I have looked at the Preventive Medicine Services codes and I don't feel that it is a preventative exam since it is being requested by a third party it is more an administrative exam... I have also looked a the Basic Life/ and or Disability Evaluation Servies 99450. However, this code does not say for medical inurance evaluation is is only for Life or Disability Insurance... Any ideas?

  2. #2
    Join Date
    Apr 2007
    Greater Orlando

    Default How about querying the Med Ins Co?

    How does what the physician did/will do compare with the bullet points of 99450? You did not identify anything extra required in this instance, so, I'd be inclined to use this CPT even though "medical" is missing from the title.

    However, that said, why not just call the insurance company/plan and ask how they want this reported/billed (which CPT)? Am I wrong in assuming that they're paying for this exam?
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  3. #3
    Join Date
    Apr 2007
    Concord, NC or Rochester, NY


    This would be a consultation since it is requested by an insurance cararier.

  4. #4
    Join Date
    Apr 2007

    Default Patient requested

    You are correct the carrier would be paying this claim.

    I think from what I can gather this patient is applying for insurance hence, "Insurance Exam". I don't think that his current carrier would pay for something a Third Party Administrator is requesting. Especially, if he/she jumps ship to another carrier, for a better term...

    The practitioner did a complete exam with hx. and ancillary work up, cmet,lipid profile, cbc, etc

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