Precision Counts When Billing For Workers' Comp Visits
Published on Tue Aug 01, 2000
There are no national standards for coders to follow when processing workers compensation claims; the rules are determined on a state-by-state basis. This creates a challenge for billers, but handling such claims does not have to be a chore. First and foremost, the neurologist who wishes to treat a patient with a work-related illness or injury should acquire prior authorization from the patients insurance carrier, as this may avoid claim denials and delays in receiving appropriate reimbursement.
Neurologists who bill for workers compensation claims also can avoid delays in reimbursement by using caution when billing for evaluation and management (E/M) services that do not relate to the workers compensation evaluation, and by determining how the patients job affected his health, says Sylvia Albert, CPC, president of the Tidewater AAPC Chapter and a customer support manager at the AcSel Corp., a healthcare reimbursement consulting firm in Virginia Beach, Va.
Work-related Injuries and Diseases Are Covered
Some neurology billers are under the misconception that workers compensation insurance only covers patients suffering from work-related injuries, but the Medicare Carriers Manual notes, All states now provide compensation for at least some occupational diseases as well.
Carpal tunnel syndrome (354.0) is a very common occupational injury treated by neurologists, says Eric Sandham, CPC, a coder who specializes in neurological procedures and is compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno. Head or spine trauma as a result of automobile accidents also may fall under this category. Many people work on the road in sales, repair, transportation and delivery. Sandham says, If part of their job is on the road and theyre injured on the road, not at a work site, they should be eligible for workers compensation benefits.
Documentation Is Key for Workers Compensation
When dealing with occupational injuries, practices should be especially careful to record documentation of the patients job duties and when he began experiencing symptoms, says Sharon Tucker, CPC, president of Seminars Plus, a healthcare consulting firm in Fountain Valley, Calif. Since youre talking about an occupational illness, you wouldnt have the first report of injury that the insurance companies like to see from a patient with an occupational injury. Therefore, the doctor should always send all of the patients records to the insurance company to prove that the patients condition progressively worsened during the job. The workers compensation company usually asks for all of the records anyway, so its a good idea to just send them along with the first claim.
Another point to remember when dealing with workers compensation claims is to always add an E code whenever possible. The E codes are the Supplemental Classification of External [...]
