Wiki Billing Work Comp and Sick Visit

[namedcare]

Patient presents for work comp treatment and during evaluation/exam other issues are noted, (i.e. rapid heart rate), what steps need to be taken with documentation and billing. If issues were non-urgent, would bring her back tomorrow, but heart rate is excessive. We have a paper chart, so physician drew a line down the middle of page and is documenting work comp on one side and sick visit on the other. Can two E/M be billed, etc? FYI Patient is uninsured for sick visits.

 

[deenakrause]

I was a work comp adjuster for more than eleven years. I have since moved to processing and auditing both work comp and PIP bills for my insurance company. Work comp will not pay for anything not related to the work injury. They could even downcode to pay for injury treatment only. We have often seen split medical records. I am not sure how they bill for the non-related treatment.

 

[debrakae]

In most cases the provider would document two separate encounter notes, one for the work comp and a problem focused exam for the sick problem. One would get billed to the work comp carrier and the problem focused exam to the insurance carrier.

The problem is since the patient is uninsured for sick visits, it would be considered a cash patient. You may want to consider only charging the patient for services that are required, that don't fall under the work comp claim (ie EKG, blood work, x-rays, etc) and not charging a separate office visit.