Part of the job of the treating physician is to report on the patient's condition regularly via a PR-2 report (billed as WC0002).  However, per the DWC, the payment for this report is limited to once every 45 days unless one or more of the conditions listed in §9785(f) (1)-(7) are true. This may help to explain why sometimes you may be denied for billing a WC0002.

These conditions include a significant, unexpected change in the patient’s condition, the need for a new referral or consultation, a significant change in the treatment plan, a return to work or release from care, among others.  If one or more of these conditions is met the then the PR-2 (or equivalent) should be completed and billed for.  Remember to document in the PR-2 which of the conditions is being met ensure that reimbursement is made.

If none of these conditions are true but the patient is being seen more frequently than every 45 days, the provider should bill a regular E/M code without creating or billing a PR-2 report.  The E/M code will need to be submitted with some type of documentation from the provider indicating that the patient was seen (per the billing guidelines).  This criteria also applies to the global surgery period if one is in effect.

Here is the text of the regulations taken from the DIR website.

Read More:

• Sedgwick Incorrect Denials of PR-2 Reports

Originally published on Petal to the Metal and migrated to this blog upon the merger of the two blogs.