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."