Encounter for disability determination

This code signifies a patient's visit specifically for the purpose of a medical evaluation to determine their eligibility for disability benefits or services. It indicates that the primary reason for the encounter is the assessment of their functional limitations and health status in relation to disability criteria.

Use this code when a physician or other healthcare provider performs an examination or completes documentation required by a disability agency (e.g., Social Security Administration, workers' compensation board). This includes initial assessments, re-evaluations, or appeals related to disability claims.

• Always sequence this code as the primary diagnosis when it is the sole reason for the encounter.
• Report additional codes for any underlying medical conditions or diagnoses that are being evaluated for disability.
• Ensure documentation clearly supports the purpose of the visit as a disability determination.