Results 1 to 5 of 5

Thread: CPT code for Independent Medical Examination?

  1. #1
    Join Date
    Apr 2007
    Location
    St Joseph
    Posts
    15

    Question CPT code for Independent Medical Examination?

    Promo: Code Books
    Help! I was just informed that our Ortho doctor is going to be doing IME's or Independent Medical Examinations. The code they have told me to use is 99456, Work related or medical disability examination. But to use it as a hourly rate. I can't find anything that says to use it as hourly. It is my understanding that this is one flat fee. The examination is a very thorough review of a entire chart and then a 5-10 page report.
    Does anyone of any other information on this exam? CPT codes? Billing?
    Your help would be greatly appreciated. Thanks!!

  2. #2

    Default

    99455 & 99456 are the codes to use. When I billed these I would bill the Comp rate for Comp claims, (those are set by WC) and bill others for whatever the Dr. wanted to charge since each case was different. If your Dr. wants, you can come up with an hourly rate and multiply it by the time spent doing the service.
    Bruce Crandall, CPC
    North Carolina Specialty Hospital
    Durham, NC
    www.ncspecialty.com

  3. #3
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,126

    Default

    I agree with Bruce. I also reside in NC and these are the codes we use. I'm sure you're in another state but here are the guidelines for our WC carrier.

    The Commission, in review of the Committee’s recommendation, and upon further discussion, has decided to adopt the following codes, to be used for all independent medical evaluations, effective March 1, 1996, and to set the following fees based upon time expended for review of medical records. If a physical examination is performed, additional CPT codes may be used.

    Code Time Fee
    IME 01 1 hour $100.00
    IME 02 2 hours $200.00
    IME 03 3 hours or more $400.00

    http://www.comp.state.nc.us/ncic/pages/feesec03.htm

  4. #4

    Default Maryland, Wash. DC, Virginia

    Does anyone out there know what the rules and regulations are for Maryland, DC and Virginia? (Standards for fees and how one charges for record review)

    So, are you saying that you would use the 99455 for record review and the consult or new patient e/m codes for the exam????

  5. #5

    Default

    Quote Originally Posted by janiceccs View Post
    Does anyone out there know what the rules and regulations are for Maryland, DC and Virginia? (Standards for fees and how one charges for record review)

    So, are you saying that you would use the 99455 for record review and the consult or new patient e/m codes for the exam????
    The thing about using these codes in the state of Virginia (where there is no WC fee schedule) is you are subjecting yourself to UCR rates for these codes. IME's are very comprehensive and since no code represents this accurately, I advise to set your rates and collect them prior to the visit. Our particular rates are set and we send the rate sheet to the carrier requesting the IME. So for example

    If your rate is $100 per hour and UCR is set for $435 for 99456 you short yourself revenue if it took you say 3hrs for the IME...

    In contrast, if your rate is $1500 and u bill it as a 99456, the UCR is $435 and you severely discount the hard work perfomed by the physician. This is the downside for using a CPT-code for a service that doesn't have an accurate CPT code.

Similar Threads

  1. CPT code 76140 Consultation on X-ray examination made elsewhere,writen report
    By dyates in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 03-16-2015, 02:16 PM
  2. Medical Coding and Billing Independent Contractor Available For Hire
    By natashabarnes in forum Employment General Discussion
    Replies: 0
    Last Post: 01-05-2014, 04:42 PM
  3. Replies: 1
    Last Post: 08-30-2012, 07:00 AM
  4. Replies: 1
    Last Post: 03-30-2011, 12:34 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.