ED Coding and Reimbursement Alert

Question: We saw a workers' compensation patient who presented with asthma due to inhaling wood dust at his job. During the examination, the physician performed a chest x-ray and saw an aortic aneurysm. He performed a limited examination to ensure that the patient wasn't in immediate danger and then filled out a referral to a cardiologist to address that. He wants to bill for the aortic aneurysm exam as well as a separate one for the asthma. Can we bill these to workers' compensation or do we send them to Medicare?

Codify Subscriber

Answer: You can potentially report both exams, but you can't bill both to workers' compensation.

If the ED physician documented separate exams - one for the asthma and one for the aortic aneurysm - you can bill the asthma exam to the workers' comp payer and report the aortic aneurysm visit to Medicare.

"If WC does not pay all of the charges because only a portion of the services is compensable, i.e., the patient received services for a condition which was not work related concurrently with services which were work-related, Medicare benefits may be paid to the extent that the services are not covered by any other source which is primary to Medicare," CMS says in Pub 100-05. "A physician/supplier is permitted under WC law to charge an individual or the individual's insurer for services that are not work related." If your patient isn't on Medicare, check his private insurer's rules before you split the workers comp visit with the aneurysm visit.

Make sure you link the asthma ICD-10 code to the workers' compensation exam and the aortic aneurysm diagnosis code to the Medicare claim.