Primary Care Coding Alert

Question: A patient came in for medical illness diagnosis and had also hurt his finger. A Workers- Compensation employee later called and advised the coder to submit the finger claim to them. I have separate charts with documentation that reflects both tinea corporis as primary diagnosis and finger pain as secondary. For the same date of service, can I bill one office visit to the medical carrier and one to the Bureau of Workers- Compensation?

Ohio Subscriber

Answer: You-re on target with splitting the E/M portions. You can bill the non-work related sick visit to the commercial carrier and the work-caused injury evaluation to Workers- Compensation. Separate supporting documentation and super bills, as you indicate, are essential for correct coding and payment.

Treat the claims separately. For instance, you would use 99201-99215 (Office or other outpatient visit -) for the E/M portion that treated the tinea corporis (110.5, Dermatophytosis of the body). On a separate superbill you would then report 99201-99215 with 959.5 (Other and unspecified injury to finger) based on the performed and documented history, examination, and medical decision making that the finger injury required. You may also want to add an appropriate "E" diagnosis code to indicate the cause of the injury (such as E919.x, Accidents caused by machinery).