If you’re the primary treating physician (PTP) for an injured worker, you already know the Treating Physician’s Progress Report (on Form PR-2 or the narrative equivalent thereof) is reimbursable documentation. But the importance of this report goes beyond the $12.46 current reimbursement for billing code WC002.
The PR-2 justifies every other charge in the entire bill — making reimbursement for all services rendered dependent on the accuracy of this report.
In workers’ comp, documentation is everything. To avoid unnecessary disputes with the employer or insurer’s claims administrator, it’s crucial to document every service from the outset. Every billing code and modifier must be validated in the all-encompassing Primary Treating Physician’s Progress Report, which providers should issue at least every 45 days, or more often depending on the patient’s progress.
Too often, we see what may seem like minor omissions from PR-2 reports, including documentation of peripheral services that justify the application of modifiers.
For example, services that justify modifier 59 (for a Distinct Procedural Service), or modifier 25 (for significant, separately identifiable E/M service on the same day of another procedure or service), must be included in the PR-2 — or the provider risks denial of payment. To protect revenue, the PR-2 must reflect every billable service performed, however incidental.
For their part, medical billers need the full scope of treatment in order to bill correctly. By completing the PR-2 with all the relevant information, physicians empower administrative staff to keep the revenue stream flowing.
Getting PR-2 Reports Right
To ensure that your office’s billers have what they need to bill completely and compliantly, follow these guidelines for PR-2 reports:
- Avoid handwritten notes or forms. Type the report, so there’s no ambiguity about its contents.
- Be sure to use the correct, most recent version of form PR-2, available on our FAQ page.
- If issuing the narrative equivalent to (in lieu of) Form PR-2, be sure to follow the guidelines prescribed by California Code of Regulations (CCR) Section 9785:
If a narrative report is used, it must be entitled “Primary Treating Physician's Progress Report” in bold-faced type, must indicate clearly the reason the report is being submitted, and must contain the same information using the same subject headings in the same order as Form PR-2
With thorough, complete required documentation, administrative staff has the information they need to bill correctly, ensuring full reimbursement. Think of PR-2 reports as the keystone documents upon which the rest of your revenue cycle management depends.