Practice Management Alert

Question: We have a longtime patient who we see for workers- comp disability and for personal (Medicare-insured) issues. Our billing company informed us that we cannot see this patient for both personal and workers- comp problems on the

same day. The billing company said that the person should set up an appointment one day for workers- comp and another day for the Medicare visit. Would it be acceptable to have the patient leave and then come back in an hour or in the

afternoon? Also, does the doctor need two charts for each insurance and, therefore, two sets of progress notes?

Arizona Subscriber

Answer: Your best bet is to ask your outside billing company what its source was for its belief that you can't collect for both visits and that you have to ask the patient to return another time for the second visit. Neither the Medicare Web site nor

the OIG Web site appears to substantiate these rumors. It is true that you cannot bill a workers- compensation insurer for services that are rendered for non-work related claims, but many people do see their own family physicians for

work-related injuries.

For example: Suppose the physician sees a patient for a back injury that occurred on the job, but during the same visit also tweaks the patient's blood pressure medication. Because the different exams are separately identifiable, you should be

able to report both to their respective insurers. It is important that the two services not overlap and that the elements counted in one service do not get counted toward the other.

Therefore, many coding and billing analysts recommend that you maintain two completely separate charts each with separate notes -- one strictly devoted to the work injury and the other strictly devoted to non-work injury details and information.

In addition, the ICD-9 codes that you select for the different services must reflect the work the physicians did to treat the patient's separate problems.