Our physicians receive referrals of patients who have been injured on the job and who are covered by workman's compensation. We usually use the Consultation or New Patient Evaluation and Management codes for these visits. Should we be using the 99455 - 99456 codes instead? ...
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Article Overview
This article discusses coding questions that arise when physicians evaluate patients injured on the job and covered by workers’ compensation. It focuses on the difference between disability-oriented evaluation services and routine evaluation and management visits, and it clarifies the general circumstances under which the article’s referenced E/M and evaluation codes are relevant. The content is aimed at physicians, coders, and billing staff who handle occupational injury and disability-related encounters.
Why This Topic Matters
Properly categorizing these visits affects whether the encounter is treated as a disability evaluation or as a standard clinical service. That distinction matters for coding accuracy, claim submission, and avoiding miscoding of occupational injury visits.
What You Will Learn
- How work-related injury referrals can differ from disability-oriented evaluation encounters
- What kinds of visit purposes are addressed in disability evaluation guidance
- How the article frames the relationship between routine E/M services and evaluation services tied to disability forms
- What kinds of encounters are generally included in workers’ compensation-related evaluation questions
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice administrators
- Workers’ compensation billers
Codes Discussed
Code Ranges Discussed
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