CPT Code for DOT exams

March 13th, 2018 - Wyn Staheli, Director of Research
Categories:   CPT® Coding   Diagnosis Coding   Evaluation & Management (E/M)   Modifiers  
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Question

I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?

Answer

It would be inappropriate to use E/M office visit codes as these require all the components of a 'sick' visit (e.g., chief complaint, PFSH, Exam, and Medical Decision Making) which do NOT fit the DOT exam. We have heard that some people use the preventive medicine codes (99381-99387, 99391-99397), but those too have specific E/M requirements. The Unlisted E/M Visit (99499) is the safest code to use.
 
However, if you do happen to perform a regular E/M visit at the same time, use the unlisted code and bill the E/M service with modifier 25.
 
One thing to note is that DOT exams should not be billed to the medical insurance. Some employers may pay for them, but in most cases, it is paid for by the patient.

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