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Dot Physicals

  1. #1
    Default Dot Physicals
    Medical Coding Books
    Can any please help. I am tring to bill for a D.O.T. physical. If an examination is done on a pt. and the forms are completed, the dx used is physical exam/dot physical (v70.5) which CPT is being used.
    Any advice would be appreciated. ??new/est. pt 99381-99387,or 9391-99397????
    thanks for your suggestions.
    New "B"

  2. #2
    Seacoast- Dover New Hampshire
    Default Dot Pe
    I find this a very interesting question as it has caused heated discussions in my billing office...In a family practice I used to bill at, I would have the Pt. pay up front. It would be an internal code "DOT PE" w/V70.5. Most insurances do not pay for the "DOT PE" but they will pay for annual PE. At the billing office I am at now, the providers are to bill ins w/age appropriate code and V70.5. I am interested to see what other discussions follow.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Regarding DOT physicals.... generally the CPT codes of new/est patients do not fit the criteria. Remember, with a "sick visit" CPT (99201-99215), their must be a chief complaint and the visit must meet criteria for the presenting problem, PFSH, Exam, and Medical Decision Making. There is an option to use one of the preventive medicine codes, but again, be sure the history and exam are meeting the criteria. In my experience, generally DOT physicals are self pay or paid by the employer and there is currently not a CPT code that accurately describes the services.

  4. #4
    Lansing, Michigan
    We have been using 99455 which is a "Work related or medical disability examination". It pretty much describes the process and we also make the patient responsible for payment (unless their employer is paying).

  5. #5
    Hi Kathymoon
    i didnt realize 99455 existed and i am so glad you shared! i think that is the exact code we should be billing for workers comp and pre-employment exams. one question, what does 'by the treating physician' in 99455 and 'by other than the treating physician' in 99456 refer to? are they stating if its the pts own provider, use 99455 and if its the employers provider use 99456? i am researching it but not having too much luck and thought i would tap in to your brain again!

    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  6. #6
    in response to the 99455 and 99456 codes. 99455 would be considered the patients physican or the treating physician for the work related injury and 99456 is for a physican other than the one treating the patient. If the patient was to be seen by the employers provider they are generally sent to a worker compensation clinic to be evaluated and unless the patient was coming in for a disability evaluation which to my understanding is if the patient is to be on perminant restrictions then would you use this code.
    Last edited by pachurch; 11-28-2007 at 08:22 PM.

  7. #7
    99455 and 99456 are for determining the disability of the patient you would use these codes for IME's not for DOT. You would use the Preventative visit codes according to the patients age and these would also be self pay. In previous organizations our practice management system allowed us to created a modifier DT to add to the Preventative code to let us know it was a DOT Physical.
    TJ Smith, CPC
    Cheyenne Physicians Group
    Cheyenne, WY

  8. #8
    Overland Park, KS
    I will offer my opinion here.

    I would not use the preventative medicine E/M codes for a DOT physical. I don't think a DOT exam meets the criteria for a preventative. This is more administrative in nature.

    I would report code 99499 (unlisted E/M) and ICD-9-CM code of V70.3 or V70.5 depending on what the physicial is for.

    I am not aware that payers reimburse for these types of encounters, so I would recommend making these a self-pay.

    Hope this helps and again this is my opinion.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  9. #9
    To add to my previous post DOT Physicals are paid by the employer or the employee and are never billed to the Insurance.
    TJ Smith, CPC
    Cheyenne Physicians Group
    Cheyenne, WY

  10. Default
    In our office we use the age appropriate preventative exam code with v70.0; my understanding is since it goes to the company they do not really care about which code we use since they have a set rate anyhow. the drug screen part of the DOT is different, if it is federal we indicate NIDA and if it is not it is either billed at NON NIDA or collection. I am reading some great responses, on how to bill.

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