Evaluation and Management: Special E/M Services (Q&A) (August 2013)

August 2013 page 13d Evaluation and Management: Special E/M Services Question: What is the proper way to report evaluation services related to a worker's compensation injury for new and established patients? Answer: Code 99455, Work related or medical disability examination by the treating physician, and code 99456, Work related or medical disability examination by other than the treating physician, are used to report evaluations performed to establish baseline information prior to the issuance of life or disability insurance certificates. This service is performed in the office or other setting, and applies to both new and established patients. When using...

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Note:  The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article addresses a special evaluation and management topic from CPT Assistant, focusing on how certain work-related or disability examination services are discussed in relation to office-based patient encounters. It is relevant for coders, billers, and compliance staff who work with evaluation and management reporting, especially when distinguishing special service types from routine E/M services. The article also notes related code-set references and modifier usage in the context of same-day services.

Why This Topic Matters

Understanding the scope of this Q&A helps readers quickly determine whether it applies to claims involving work-related or disability examinations and related evaluation and management reporting considerations. It is useful for professionals seeking guidance from a CPT editorial source on how this topic is framed within special E/M services.

Article Sections

  1. Evaluation and Management: Special E/M Services

    Introduces the special E/M services topic and presents a question-and-answer format centered on work-related or disability examination reporting.

What You Will Learn

  • The general scope of special evaluation and management services addressed in the article.
  • How the article frames work-related and disability examination reporting within an E/M context.
  • Which code sets and modifier references are mentioned in connection with the discussion.
  • What broad situations the article says are relevant to this Q&A topic.

Who Should Read This

  • Medical coders
  • Medical billers
  • Compliance staff
  • Revenue cycle professionals
  • Physician practice administrators

Codes Discussed

Code Ranges Discussed

Modifiers Discussed


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