Wiki 99245 consult question

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mnuhfer04

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Our provider filled out and filed a C 4.3 form for a comp patient. The patient was not seen that day, but was seen the day before. Typically we bill a 99245 consult, but can we still bill that when the provider wasn't face to face with the patient the day he filled it out? And if not, can we bill anything for it?

Thanks!
 
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mnuhfer04 said:
Our provider filled out and filed a C 4.3 form for a comp patient. The patient was not seen that day, but was seen the day before. Typically we bill a 99245 consult, but can we still bill that when the provider wasn't face to face with the patient the day he filled it out? And if not, can we bill anything for it?

Thanks
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To bill an EM code, you will need to meet the code requirements. Most require the face to face visit (with very few exceptions).
 
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Does your state publish a WC fee schedule and/or have guidelines around forms? If the provider saw the patient the day before face to face, what was billed for the visit? The form has to be filled out within 48 hours. If the provider provided the service face to face with the patient and you have the medical record for it (progress note, etc.), just because the actual filling of the required form was the following day, seems to me, you would still bill normally on the day the service was provided. You don't bill anything on the day they write it up if it is different, you bill it on the date the patient was seen. You only have two options, 99243 or 99245 according to the link below.

Bottom of the form: "BILLING INFORMATION Complete all billing information contained on this form. Use additional forms or narrative, if necessary. The workers' compensation carrier has 45 days to pay the bill or to file an objection to it. Contact the workers' compensation carrier if neither payment nor an objection are received within this time period. After contacting the carrier, if necessary, file Health Provider's Request for Decision on Unpaid Medical Bill(s) (Form HP-1). If you have questions, please contact the NYS Workers' Compensation Board at1-800-781-2362."

"*The Form C-4.3 is not being replaced by the CMS-1500; however, the CMS-1500 form may be used to electronically submit medical bills for permanency evaluations using an XML submission partner. To do so, medical providers should: 1) Only use CPT codes 99243 or 99245; 2) Only use ONE CPT code (99243 or 99245) on the medical bill; 3) Attach a completed C-4.3 to the CMS-1500 form as the medical narrative; and 4) Do not separately send a C-4.3 to the Board."
 
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amyjph said:
Does your state publish a WC fee schedule and/or have guidelines around forms? If the provider saw the patient the day before face to face, what was billed for the visit? The form has to be filled out within 48 hours. If the provider provided the service face to face with the patient and you have the medical record for it (progress note, etc.), just because the actual filling of the required form was the following day, seems to me, you would still bill normally on the day the service was provided. You don't bill anything on the day they write it up if it is different, you bill it on the date the patient was seen. You only have two options, 99243 or 99245 according to the link below.

Bottom of the form: "BILLING INFORMATION Complete all billing information contained on this form. Use additional forms or narrative, if necessary. The workers' compensation carrier has 45 days to pay the bill or to file an objection to it. Contact the workers' compensation carrier if neither payment nor an objection are received within this time period. After contacting the carrier, if necessary, file Health Provider's Request for Decision on Unpaid Medical Bill(s) (Form HP-1). If you have questions, please contact the NYS Workers' Compensation Board at1-800-781-2362."

"*The Form C-4.3 is not being replaced by the CMS-1500; however, the CMS-1500 form may be used to electronically submit medical bills for permanency evaluations using an XML submission partner. To do so, medical providers should: 1) Only use CPT codes 99243 or 99245; 2) Only use ONE CPT code (99243 or 99245) on the medical bill; 3) Attach a completed C-4.3 to the CMS-1500 form as the medical narrative; and 4) Do not separately send a C-4.3 to the Board."
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Thank you so much! I will be looking into this.
 
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