Meet the Challenge of Workers Compensation Claims
Published on Sun Jul 01, 2001
Neurosurgeons should not dread billing for work-related diseases just because the coding can be challenging. The Medicare Carriers Manual (MCM) explicitly notes that workers' compensation insurance covers occupational diseases in addition to work-related injuries. Comprehensive documentation of the disease will help obtain compensation in these cases, as will education about your particular state or carrier requirements for reimbursement.
Work-Related Versus Not Work-Related
Section 2370.1 of the MCM notes that Medicare policy requires compensation for injury or disease suffered in connection with employment, "whether or not the injury was the fault of the employer." Therefore, chronicling any occupational environmental cause of the illness is crucial. Codes 99455 (work-related or medical-disability examination by the treating physician that includes: completion of a medical history commensurate with the patient's condition; performance of an examination commensurate with the patient's condition; formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; development of future medical treatment plan; and completion of necessary documentation/certificates and report) and 99456 (work-related or medical-disability examination by other than the treating physician) are designed specifically to report work-related or medical-disability evaluations.
Billers must know when a condition can be considered work-related for reimbursement purposes. Carpal tunnel syndrome (354.0) is a fairly common occupational injury treated by neurosurgeons, but less common neurologic conditions should also be billed when they are related to the patient's work. For instance, toxic encephalopathy (349.82) due to exposure to organic solvents and organophosphate pesticides can occur in workers performing automobile body repair or applying pesticides. Those patients whose work entails considerable travel should also be considered for workers' compensation claims for chronic conditions.
"Truck drivers have back injuries a lot because of the constant bouncing of the truck," says Sharon Tucker, CPC, president of Seminars Plus, a healthcare consulting firm in Fountain Valley, Calif. "A back injury can hide itself for a long time, and many are progressive for someone doing a lot of lifting. Lower-back injuries are probably one of the hardest to prove, however, and the employer has to accept this as a work injury."
When dealing with occupational diseases, practices should be especially careful to record documentation of the patients' job duties and when symptoms began. That clinical documentation must justify diagnoses, admissions, treatments performed and continued care. The information in the operative report must be comprehensive and readable.
Because occupational illnesses do not have a first report of injury -- which the insurance companies typically like to see -- sending the patient's medical records with the first billing can expedite payment. These records likewise should document the progressive nature of the patient's injuries during the duration of the job.
For patients with multiple conditions, only one of which is related to a work injury, the neurosurgeon should [...]
