# Workers compensation unrelated diagnosis?



## AR2728 (Jul 24, 2013)

I'd love feedback on the following scenario:

Workers Compensation patient being treated/referred for acute lymphadenitis related to insect bite received while on the job-by a general surgeon.  This general surgeon performs many GI scopes and it is common for every patient who presents for office visit to be queried on their GI system/bowel habits/scope history.  Physician documents IBS, heartburn, and diarrhea in the patients work comp note and orders H-Pylori testing and follow up to discuss those results.  I query further as it appears to me that the GI issues would not be related to lymphadenitis or tick bite, and therefore, not part of the patients work comp claim/visit. The physician states that the heartburn is related because the patient is not able to take his prilosec due to meds for the lymphadenitis and it is therefore acting up.  I still argue regarding the H-pylori because surely this would not be related to the tick bite, also knowing that this physician discusses GI issues with every patient and documents diarrhea even if the patient mentions they had a diarrhea episode once last month after eating salad.  The patients primary care physician (whom referred the patient for work comp) has stated that the heartburn is a personal issue and he has documented it as an ongoing condition for the patient.  How can this possibly be related to tick bite?  I just don't see work comp agreeing. I'm not a physician, and I know I am a bit biased in my opinion simply from my past experiences with this physician and problems I've noted with over documentation.  

Would love to hear from others......


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## teresabug (Jul 29, 2013)

In my experience, the claims adjuster is going to review the dr's office note for that visit anyway and more than likely will either deny the claim as non w/c related or they'll down code the E/M level. IMO it sounds fishy, this querying being done. It sounds like dr may be overcompensating to support the E/M level being billed....


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