by Wyn Staheli, Director of Content - innoviHealth
Mar 13th, 2018 - Reviewed/Updated Jan 31st
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.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.
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