Podiatry Coding & Billing Alert
Follow Medicare Rules Closely for Worker's Comp Consultation
Question: We are billing a consultation and treating physician’s progress report (WC002) for patients of Worker’s Comp. (Gallagher Bassett). We get paid for the report but the consultation code 99243 is denied. Any suggestions for a different consultation code?
New York Subscriber
Answer: According to the major changes brought in by the Official Medical Fee Schedule (OMFS), the consultation code 99241-99245 was discarded in 2010.
a statement stating from OWCP that “The US Department of Labor’s Office of Workers’ Compensation Programs (OWCP) will adhere to the recent decision by the Center for Medicare and Medicaid Services (CMS) that was announced in MLN Matters, #MM6740. Effective March 1, 2010 OWCP will no longer accept the use of the AMA/CPT® Consultation codes ranges 99241-99245 and 99251-99255 for inpatient/outpatient facilities and office settings. Any line items submitted with date of service on or after March 1, 2010 will be denied and returned stating ’The requested procedure is not a covered service.’”
The proposed new fee schedule for 2015 has stipulated that it will pay for consultations consistent with CMS Medicare’s policy for consultations. And as CMS Medicare no longer pays for consultations using codes 99241 to 99245 and 99251 to 99255, you will have to use these codes instead:
For the progress reports, you will continue to bill WC002 (Treating physician’s progress report).
For additional information please refer to CMS MLN Matters Number: MM6740 located at: http://www.cms.gov/MLNMattersArticles/downloads/MM6740.pdf.
Podiatry Coding & Billing Alert
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