Eli's Rehab Report

Published on Sun Oct 01, 2000 PDF

Question: A patient presented to the physiatrist with whiplash and back pain resulting from a car accident. During the visit, the patient asked the doctor to look at her foot because shes had heel spurs for years and wanted to see if the doctor could do anything for her. Can the doctor bill an evaluation and management code to the auto insurer for the whiplash, and another to her personal insurer for the heel spurs?

Janice Grimm
Abington, Pa.

Answer: First, you should determine whether there is coordination of benefits between automobile insurance and health insurance carriers in your area or state. This fact will be crucial if one of the two carriers denies the submitted claim.
In this case, there are two distinct diagnoses for the two services rendered, and you must be able to link the correct diagnosis appropriately with the appropriate service rendered. The automobile insurance will be responsible only for the portion of the bill that involved treating the patient for the whiplash (847.0, sprains and strains of other and unspecified parts of back, neck) and back pain (724.5, backache, unspecified) caused by the motor vehicle accident, not for treating the heel spurs (726.73). The claim for the heel spurs should be sent separately to the patients health insurance carrier.