How To Use CPT Code 99075

CPT 99075 describes the process of providing medical testimony by a healthcare provider in a legal proceeding. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99075?

CPT 99075 can be used to describe the provision of medical testimony by a healthcare provider in a legal setting. This code is used when the provider reviews medical records and testifies under oath, providing their expert medical opinion based on the available facts.

2. Official Description

The official description of CPT code 99075 is: ‘The provider reviews medical records and renders his medical opinion under oath on the basis of the facts made available to him.’

3. Procedure

1. The healthcare provider reviews the relevant medical records and familiarizes themselves with the case.
2. If required, the provider may travel to a different location, such as a courtroom, to give their testimony, or they may provide their expert opinion in a deposition in their own office.
3. The provider testifies under oath, providing their expert medical opinion based on the facts presented to them.
4. They may be required to answer questions from attorneys or provide clarification on their testimony.
5. The provider’s testimony may be used to support or refute claims in a legal proceeding.

4. Qualifying circumstances

Healthcare providers eligible to provide medical testimony using CPT 99075 are those who have the expertise and qualifications to offer an expert medical opinion in a legal setting. This may include physicians, specialists, or other healthcare professionals with relevant knowledge and experience. The testimony must be given under oath and based on the facts available in the medical records.

5. When to use CPT code 99075

CPT code 99075 should be used when a healthcare provider is called upon to provide their expert medical opinion in a legal proceeding. This code is appropriate when the provider reviews medical records, testifies under oath, and renders their medical opinion based on the facts presented to them. It should not be used for routine patient care or other non-legal situations.

6. Documentation requirements

To support a claim for CPT 99075, the healthcare provider must document the following information:

• Details of the legal proceeding, including the case number and the court or deposition location
• Medical records reviewed and any additional materials considered
• Date and duration of the testimony
• Summary of the provider’s expert medical opinion
• Signature of the healthcare provider providing the testimony

7. Billing guidelines

When billing for CPT 99075, ensure that the healthcare provider is qualified and authorized to provide expert medical testimony. The code should be used specifically for the provision of medical testimony in a legal proceeding. It should not be reported with other codes unless there are additional services provided that are separately billable. It is important to follow any specific billing guidelines provided by the payer or legal entity requesting the testimony.

8. Historical information

CPT 99075 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician reviewing medical records and providing expert medical testimony in a malpractice lawsuit.
2. A specialist testifying in a personal injury case, offering their expert opinion on the extent of the plaintiff’s injuries.
3. A healthcare provider providing their medical opinion in a workers’ compensation hearing, assessing the impact of an injury on the individual’s ability to work.
4. A physician giving testimony in a disability claim, evaluating the individual’s medical condition and its impact on their ability to perform daily activities.
5. A healthcare provider providing expert medical testimony in a child custody case, assessing the child’s medical needs and the ability of each parent to meet those needs.
6. A specialist testifying in a criminal trial, providing their expert opinion on the cause of death or the presence of injuries.
7. A physician giving testimony in a medical malpractice case, offering their expert opinion on whether the standard of care was met.
8. A healthcare provider providing their medical opinion in a social security disability hearing, evaluating the individual’s ability to work and the severity of their medical condition.
9. A specialist testifying in a product liability case, offering their expert opinion on the safety and effectiveness of a medical device or medication.
10. A physician giving testimony in a personal injury lawsuit, providing their expert opinion on the long-term prognosis and potential future medical needs of the plaintiff.