Wiki Billing both Medical and Workers Comp for same surgery

[massa2005]

We have a case where the whole performing surgery approved by WC found a tumor that needed to be removed in the same area. Tumor was not found till surgery and provided removed it.

Case denied for not related to case.

Would the provider been able to write 2 separate notes, and billed WC for their portion of the surgery and Medical Ins for the discovery and removal of the Non work related issue?
If so.. how is this coded?

 

[SharonCollachi]

Did they deny everything or just the extra procedure for the tumor removal? If they denied everything, I would call the adjustor and have a little chat.

Now, on the the surgery. My first thought is, would it be considered incidental to the surgery that was being done? The surgeon is already in the same area - was it extensive work? If you were billing everything to regular insurance, would both procedures be paid?

My second thought is, I would bill everything to workers comp, with a very carefully worded report, stating what happened. I would also expect them to deny the second procedure. I would then write a letter to the regular insurance, explaining what happened, and ask them to process and pay for the tumor-related procedure. They may decide that it was included in the main procedure and pay nothing.

Good luck. This one is a tough one!