Optometry Coding & Billing Alert

Question: Should I code any differently for workers' comp claims? What if more than one state is involved in the case? Whose billing rules should I follow?

Arizona Subscriber
 
Answer: Generally, your coding should stay the same for workers' comp claims as for other claims. However, you should be aware that not every state uses current-year CPT codes. You may get denials or experience delays if you're using new codes and your workers' comp carrier isn't up-to-date. Each state has its own idiosyncrasies, so it's best to ask your state carrier or check the Web site for the appropriate CPT codes to use.

And it's important to use E codes. Of course these codes will never be the primary diagnosis, but they're important because they "complete the picture" of the patient's injury, treatment and claim. Patients may have more than one workers' comp claim open and in the system. An E code to indicate the external cause of injury, such as E849.3 (Place of occurrence; industrial place and premises), can help the carrier to differentiate between the claims and get them paid faster.

You need to follow the rules and fee schedule of the state in which the workers' comp claim was originally filed. This may or may not be the same as the patient's current state of residence. Billing can get complicated when you're dealing with truck drivers and other mobile professionals because a patient may initiate care for an injury in a state other than where he lives.

Remember: Focus on where the claim was first filed. That state will have jurisdiction over the claim. The only exception is workers' comp for federal employees, which has nationwide rules. Workers' comp for railroad workers is a mix -- most states abide by nationwide rules, but some states have their own.

Hint: Every state has a workers' comp Web page that outlines the rules and provisions of the program to some extent. Workers' comp programs are usually run by your state's Department of Labor, which may be able to help you locate a Web site or phone number. To search for state Web sites, go to www.workerscompensation.com/ or www.comp.state.nc.us/ncic/pages/all50.htm. For federal program information, go to www.dol.gov/esa/regs/compliance/owcp/fecacont.htm. For railroad program information, go to www.brs.org/felainfo.htm.

-- Reader Questions and You Be the Expert were answered by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas; Adrienne Rabinowitz, CPC, billing manager in Freehold, N.J.; and Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.