Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 06, 2008 PDF

Medicare manual does not address same-day worker's comp visit, but you should ensure that you've got separate notes regarding both exams.

Question: Our billing company informed us that one of our longtime patients who we see for worker's comp disability and for personal (Medicare insured) issues cannot be seen for both personal and worker's comp. problems on the same day. The billing company said that the person should set up an appointment one day for worker's comp and another day for the Medicare visit. Would it be acceptable to have the patient leave and then come back in an hour or in the afternoon? Also, does the doctor need two charts for each insurance; therefore, two sets of progress notes?

Answer: Your best bet is to ask your outside billing company what its source was for its belief that you can't collect for both visits and that you have to ask the patient to return another time for the second visit. Neither Medicare's Internet Only Manual (IOM) nor the OIG Web site appears to substantiate these rumors.

It is true that you cannot bill a worker's compensation insurer for services that are rendered for non-work related claims, but many people do see their own family physicians for work-related injuries.

For example: Suppose the physician sees a patient for a back injury that occurred on the job, but during the same visit, also tweaks the patient's blood pressure medication. Because the different exams are separately identifiable, you should be able to report both to their respective insurers.

It is important that the two exams not overlap, and that the elements counted in one exam do not get counted toward the other.

Therefore, many coding analysts recommend that you maintain two completely separate chart notes --" one strictly devoted to the work injury, the other strictly devoted to non-work injury details/information.

In addition, the ICD-9 codes that you select for the different services must reflect the work the physicians did to treat the patient's separate problems.