Precision Critical to Get Workers' Comp Visits Paid
Published on Sat Jul 01, 2000
Neurosurgeons who bill for workers compensation claims can avoid reimbursement delays by using caution when billing for evaluation and management (E/M) services that do not relate to the workers comp evaluation, and by determining how the patients job affects their health, says Sylvia Albert, CPC, president of the Tidewater AAPC Chapter and a customer support manager at the AcSel Corporation, a healthcare reimbursement consulting firm in Virginia Beach, Va.
Defining Work-related Conditions
Some neurosurgery billers are under the misconception that workers compensation insurance only covers patients suffering from work-related injuries, but the Medicare Carriers Manual (MCM) 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 neurosurgeons, says Eric Sandham, CPC, 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, a coder who specializes in surgical and neurosurgical procedures.
Head or spine trauma, however, as a result of automobile accidents also may fall under this category. Many people work on the road in sales, repair, transportation, delivery and more. 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, Sandham says.
Using E/M Codes for Workers Comp Evaluations
Coders should be aware that they cannot bill for a standard evaluation and management (E/M) service on the same day they bill for a work-related evaluation code unless a separate condition is being evaluated. CPT 2000 states, If other evaluation and management service and/or procedures are performed on the same date, the appropriate E/M or procedure code(s) should be reported in addition to codes 99455 and 99456, which are designed specifically to report work-related or medical disability evaluations:
99455 work-related or medical disability examination by the treating physician that includes:
completion of a medical history commensurate with the patients condition;
performance of an examination commensurate with the patients condition;
formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment;
development of future medical treatment plan;
and completion of necessary documentation/certificates and report
99456 work-related or medical disability examination by other than the treating physician
Section 2370.2 of the MCM outlines Medicares policy on paying for separate E/M services during workers compensation services. It states, If workers compensation 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. A [...]
