Significant changes to the Work Comp Fee Schedule 2009

  1. Employer must give employee a choice of at least three health care providers in which to seek treatment. In the past, employees have been instructed to a work comp clinic, now the employee has a choice. The primary treating doctor must complete and file the WC 164, not every single provider.
  2. If a payer does not give a prior auth, and a claim is sent in without dispute within 7 days of the claim it is automatically deemed authorized unless the payer request a hearing and notifies the treating provider.
  3. Rule 18 is based on the 2008 RVP’s and CPT codes. If a code has been deleted in 2009, it needs to be back walked to the 2008 CPT code.
  4. Any nurse case managers, PT, OT, Physician can now bill for Telephone or Online services. Physicians would still bill under the E/M codes and all other under the medicine codes.
  5. Physical Therapy: Pt cannot bill eval with every single therapy session. If patient presents with new problem or complain, or the therapist needs to do an eval to reestablish treatment protocol, that is fine, but cannot be billed on every single therapy session.
  6. PT can now bill for telephone calls for the purpose of coordination of care based on the RVP telephone codes in the Medicine Section of the CPT book.
  7. E/M-Medical record documentation shall follow CPT guidelines.
  8. Documented telephonic or on-line communication time with the patient or other healthcare provider can be billed as an E/M visit if NOvisit scheduled within 1-7 days. If visit is scheduled or is scheduled as result of telephonic communication, must be included in the E/M visit for the face to face encounter with the patient, but the time may be included.
  9. Provider must be specific in addressing the 7 elements of an E/M visit and documenting the extent he went to in all 7 areas, with specific detail to time. A chief complain must be documented on every visit, even if it is just a med check. Must also be very specific about the plan of treatment and coordination of care.
  10. Physician Team Conference: can be billed if all criteria met. At least 3 qualified health care professionals from different specialties who are actively involved in patient care. All team members must have performed a face to face with the patient within the last 60 days.
  11. Face to Face or telephonic meeting by physician with the employer claims rep or attorney can be billed if written report generated. Must be minimum of 15 minutes. Code used would be Z701 and is paid at $75.00 per 15 minutes. Fees include travel, mileage and cost of report.
  12. Depositions: Preparation time Z730, Deposition time Z734
  13. Deposition cancelation <7 days Z731, 5-6 days Z732 and > 5 days Z733
  14. Testimony: Preparation time:Z730, Testimony is Z738
  15. Testimony cancelation: <7 days Z735, 5-6 days Z736 >5 days Z737.
  16. Report preparation: If requested for a physician to complete additional forms sent to them by a payer or employer, may be billed according to time. If less than 15 minutes use code Z754 and maximum of $42.00 per form. If more than 15 minutes treat as a special report and use corresponding codes.
  17. If an injection is provided in office as part of an E/M visit, the drug will be paid at cost. Would be prudent to include an invoice with bill.
  18. SI Joint injections back on list of approved CPT codes to be done in ASC for 2009. Reimburses same as regular joint injection $763.88, which is up from 2008 which was $703.71.

Terri Craig, CPC-H

01/27/2009