khristinelouise
Networker
I really need some help. The urgent care clinic that I work for uses a national billing company. This company is billing all of our new L&I claims as new patients even if they are established patients with us. When I objected they took it to the person who is the head of their entire billing department who reviewed the L&I policy and said each new L&I claim can be billed as a new patient even if we have seen them before. But when I look on L&I's website what I find seems to contradict this. This is taken directly from the L&I payment policy on their website:
A new patient, then a new patient E/M should be billed, or
•An established patient, then an established patient E/M service should be billed, even if the provider is treating a new work related condition for the first time.
•Per WAC 296-20-051 providers may not bill consultation codes for established patients.
Note: L&I uses the CPT® definitions of new patient and established patient. Also, see definitions of both terms in Definitions at the beginning of this chapter.
Is there anybody out there who can clear this up for me?
A new patient, then a new patient E/M should be billed, or
•An established patient, then an established patient E/M service should be billed, even if the provider is treating a new work related condition for the first time.
•Per WAC 296-20-051 providers may not bill consultation codes for established patients.
Note: L&I uses the CPT® definitions of new patient and established patient. Also, see definitions of both terms in Definitions at the beginning of this chapter.
Is there anybody out there who can clear this up for me?