Wiki 99245 consultations for workers comp permanency

[mnuhfer04]

Our office does workers comp, we are in NY. When an established patient comes in for a Permanency appt, the providers do an extensive amount of work, they document their note as well as filling out a C-4.3 form which they upload into the comp board.
We have always billed a 99245 consultation code for this visit. But I’m wondering if this is correct or not.
If anyone has any insight on this, I’d appreciate any on this matter.

 

[amyjph]

Check the NYS work comp rules/fee schedule. There should be direction for what to bill.

Example (this is old year, but example) https://www.optumcoding.com/upload/...L4dVy1MiSgpGbbdD-bWqWp5v-06x149icWV24-1uF7OzZ
20. Non-Schedule and Schedule Permanency Evaluations Non-schedule: Code 99245 is used for examinations and reports of non-schedule permanency evaluations performed by an authorized physician. Schedule: Code 99243 is used for examinations and reports of schedule permanency evaluations performed by an authorized physician.

 

[mnuhfer04]

Check the NYS work comp rules/fee schedule. There should be direction for what to bill.

Example (this is old year, but example) https://www.optumcoding.com/upload/...L4dVy1MiSgpGbbdD-bWqWp5v-06x149icWV24-1uF7OzZ
20. Non-Schedule and Schedule Permanency Evaluations Non-schedule: Code 99245 is used for examinations and reports of non-schedule permanency evaluations performed by an authorized physician. Schedule: Code 99243 is used for examinations and reports of schedule permanency evaluations performed by an authorized physician.

Thank you! I will definitely do some more digging. (=

 

[amyjph]

WC should be an easier animal to handle because it should be all spelled out as to what is billed for the forms and certain procedures in the fee schedule (for most states).
For example, in CO: https://cdle.colorado.gov/dwc/workers-compensation-rules-of-procedure