tci E/M Coding Alert - 2019 Issue Q4

You Be the Coder: Examine Payer Policy in This Coding Conundrum

Question: We have a patient who is a pilot, and per Federal Aviation Administration (FAA) guidelines, he is periodically required to undergo an exam to evaluate his physical ability to fly. The patient’s insurance company notified us that they will cover such work-related exams providing they are billed using CPT® code 99455. However, the code’s descriptor states that it is to be used for a “work related or medical disability examination.” My questions are these: first, does the “or” in the descriptor mean that the code can be used for a work-related disability or...

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