Work Comp Questions Answered: Code 99358, Conversion Factors, and More

Work Comp Questions Answered: Code 99358, Conversion Factors, and More

Today I continue to answer questions from our recent webinar about the March 1st changes to the Physician fee schedule.

If procedure code 99358 is not reimbursable, what code should I use?

Per the current fee schedule code 99358, previously used for record review bills, is not reimbursable because it is one of the codes that is considered bundled. Bundled codes are not separately payable even if they have RVU values associated with them.

However, Labor Code 5307.11 allows claims administrators and providers to engage in a contract agreeing to pay amounts that differ from the fee schedule. Providers can negotiate for 99358 payment by entering into 5307.11 contracts. Remember that you need to negotiate a separate contract with each claims administrator that includes the price per unit of work.

Consult our workers’ comp FAQ for more information on 5307.11 contracts.

I’m confused about Conversion Factors. Why does DaisyBill use different Conversion Factors than the ones shown in the DWC regulations?

Remember, don't look at the body of the regulations for current Conversion Factors--those numbers are the unadjusted Conversion Factors. Conversion Factors change every year for the next several years. Instead, you must look at the update table by the date of service for the proper conversion factors.

As of March 1st, the DWC adopted completely new Conversion Factors.

Find these new values in the regulations in Section 9789.19 Update Table in subsection B.

Who is the Administrative Director?

Destie Overpeck is the AD or Administrative Director of the DWC. She was appointed April 20th of 2015 after having served as the interim AD for several years. Congratulations to Ms. Overpeck!!!

For purposes of workers’ comp reimbursement calculations, what is the difference between facility and non-facility?

The DWC uses the concept of “point of service” to determine which work comp formula applies when calculating reimbursement. To determine whether a service location is a facility (F) or a non-facility (NF), you must look up the point of service on a chart found in regulation Section 9789.12.2 (d). For specific directions on where to find this chart, refer to our FAQ about Facility and Non-Facility RVUs.

Two of the most common locations are an office and an ASC or outpatient surgery center. An office is a place of service 11, and if you look at the chart it's a Non-Facility. In contrast, ASCs and outpatient hospitals are Facilities. Make sure to use the correct formula if you're calculating these rates manually.

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