Maximize Payment of Workers' Compensation
Published on Thu Jun 01, 2000
Each of the 50 states and the District of Columbia has its own Workers Compensation program. This means that when it comes to coding and reimbursement, there is no one set of rules upon which providers can rely.
With orthopedics comprising such a big part of work-related injuries, its no surprise that orthopedic practices have their share of Workers Compensation claim denials. Though the only consistency from state to state seems to be the lack of consistency, the variety of problems ortho coders face is indicative of the variety of rules for Workers Compensation.
Billie Jo McCrary, CPC, CCS-P, CMPC, is practice manager of Wellington Orthopaedic and Sports Medicine in Cincinnati, a six-office practice with 18 physicians. Her practice sees enough Workers Compensation patients to warrant a staff position devoted entirely to handling those claims. While I oversee all of the billing and reimbursement for our offices, we have one person whose sole responsibility is to process Workers Compensation, says McCrary. She keeps me informed as to what gets denied and what gets paid and where we are in the appeals process on certain claims, so I am familiar with some of our challenges.
For Some, Unusual Procedural Services Usually Dont Get Paid
Our (Ohio) policy manual has a list of modifiers they consider acceptable, but they dont pay any additional for them, says McCrary. Modifier -22 (unusual procedural services) is one that we use frequently. Quite often, our physicians want to use -22 on patients requiring a 27134 (revision of total hip arthroplasty; both components, with or without autograft or allograft.) We use this modifier a lot for a variety of orthopedic scenarios, including massive bone grafting and the extra preparation and surgery time that goes with that, placement of a custom device requiring extensive surgical deliberation, osteotomies on either side of the joint to correct a preoperative deformity, revision of a revision surgery and morbidly obese patients, etc.
Regardless of the procedure, the Ohio Bureau (of Workers Compensation) says we get the fee scheduled for that procedure, and not any more regardless of the -22 modifier, says McCrary.
Casting Supplies Are Not Always Covered
We bill for casting supplies using 99070 (supplies and materials provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]), says Kim Davis, McCrarys Workers Compensation Specialist at Wellington Orthopaedic. The Bureau just says supplies are not covered and we have to write off the cost, which we do quite often, since we cannot balance-bill the patient with Workers Compensation. This is either a $35 or $90 write-off for us, depending on the amount of supplies used for casting. The only [...]
