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News, data, & insights about workers' comp billing

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More Work Comp Questions Answered

January 21, 2014 by Catherine Montgomery

We are cruising through January and still collecting questions from providers.  We’re happy to answer them and here are a few more of our most common ones.

1) Our office has always billed dispensed medication with CPT 99070 and the medication NDC number and units.  Should we continue to bill this way?

Although the current regulations do state that dispensed pharmaceuticals are payable, nothing specifically outlines how they are to be billed.  The code 99070 is a status code B, which means it’s bundled and has no reimbursement associated with it. Because we are not the DWC and do not know of an alternative code to use, we do not have an official recommendation.  We have been in contact with the DWC for clarification and do not yet have an update on how they want billing submitted. As soon as we receive clarification from the DWC, we’ll send out an update to those on our mailing list, and update this blog.

2) Several of our patient’s have a primary language other than English and require an interpreter at their appointment that we bill with a modifier 93, can we still do that?

Unfortunately, no.  As of 1/1/14 modifier 93 is no longer a valid modifier for workers compensation billing in California and nothing has been designated to take its place.

3) The code we used to use to bill for XYZ is no longer valid.  What do we do?

Just because a code is no longer valid, doesn’t necessarily mean the service(s) aren’t reimbursable. It may just mean another code needs to be used. The regulation change adopted use of the 2014 CPT codes. Your first step is looking for the up-to-date code in the 2014 edition of the American Medical Association CPT manual.  The next step is determining if that code is reimbursable per the new reimbursement methodology.

4) Have med-legals (coding or reimbursement) changed?

Med-legals (AME/QME/Panel QME) billing operates on a different fee schedule and set of regulations than regular physician billing.  The med-legal regs and reimbursement did not change on 1/1/14 and currently remain the same as they were last year.

5) What can we expect from carriers post 1/1/14?

Initially we prepared our clients to be patient with carriers while they, too, navigated the new regs and reimbursements.  We are still recommending patience but initial returns on our clients’ 2014 dates of service have given us some hope that carriers took the time to prepare for RBRVS ahead of time.  Our very, very, preliminary report is positive with multiple big name carriers not only adjudicating claims correctly, but doing so in a timely and compliant fashion.

Division of Workers' Compensation (DWC)

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

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