General Surgery Coding Alert

However, you may report a standard E/M service and a workers' compensation evaluation on the same day, as long as the physician provides E/M services for a condition unrelated to the workers' compensation claim, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center.
 
"If workers' compensation does not pay all of the charges because only a portion of the services is compensable (i.e., the patient received services for a condition which was not work-related concurrently with services which were work-related), Medicare benefits may be paid to the extent that the services are not covered by any other source which is primary to Medicare," according to Section 2370.2 of the Medicare Carriers Manual.
 
Commercial payers also recognize their obligation to pay benefits for non-workers'-compensation conditions.
 
Example: An established patient may present for a workers' compensation evaluation following on on-the-job lifting accident. At the same time, the patient has ongoing complaints of chest pain. The surgeon evaluates the patient for possible hernia (caused by the on-the-job lifting accident) and chest pain (the ongoing problem not related to workers' compensation).
 
In this case, you may report 99455 and an appropriate-level E/M service, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...). To allow for separate payment of the E/M service, you must also append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.