Wiki work comp seperate injuries

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cdnred1360

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What is correct way to bill work comp for a patient that has 2 separate claims #'s/2 different injuries with 2 different dates of injury but seen on same day? Patient seen in one encounter for 2 claims -would 2 claim forms need to be completed and what modifiers would be attached to E & M to accurately reflect this scenario? Thanks for any input.
 
Each PR2 reflects the injuries per case so technically your office was supposed to have seen and evaluated the patient once per case (claim). If that was so, then you can just bill for each case. Are both claims with the same adjustor/payor?

Peace
?_?
 
WC Injury

We bill these on separate claim forms as each injury has its own claim number and distinct injury date.

Some carriers have required the use of Modifier 25 on one of the EM services, as we are billing for two EM visits on the
same date, and they need the modifier to avoid having a denial for duplicate.

If billing on paper, I highlight the DOI as well as the claim number when submitting to clarify for the carrier that there
are two distinct separate injuries being treated on the same date.
 
cdnred1360 said:
What is correct way to bill work comp for a patient that has 2 separate claims #'s/2 different injuries with 2 different dates of injury but seen on same day? Patient seen in one encounter for 2 claims -would 2 claim forms need to be completed and what modifiers would be attached to E & M to accurately reflect this scenario? Thanks for any input.
Click to expand...

You'll need to file separate CMS-1500 forms, one for each claim number, even if seen on the same date. Since you'll be using 2 separate forms, I don't think the -25 modifier would be required on either form b/c they are under separate claim numbers.....like each one was a separate encounter.

***make sure you have the correct injuries w/each claim number.

I hope this info is helpful.
 
celticnurse said:
You'll need to file separate CMS-1500 forms, one for each claim number, even if seen on the same date. Since you'll be using 2 separate forms, I don't think the -25 modifier would be required on either form b/c they are under separate claim numbers.....like each one was a separate encounter.

***make sure you have the correct injuries w/each claim number.

I hope this info is helpful.
Click to expand...

I agree. For Department of Labor claims, they will automatically deny any multiple visits and you have to file an adjustment request form stating the reason why you had to file multiple bills on the same day. They are also particular about including all relevant control numbers. As long as the documentation is there to show each case (claim) was evaluated, you should be alright.

Peace
@_*
Good luck.
 
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