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SCCL5558

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Hi there. As most of you (California) billers know, the CA Workers Compensation Fee Schedule changed effective 1/1/2014. I was caught off guard with this change and have been trying to find out as much info as possible relating to the new codes being used and the payment amounts??? So far I was told by SCIF (State Compensation Insurance Fund) that consult codes (99241-99245) are no longer payable. Review of records (99358) is no longer payable as well as Peer to Peers. The report codes were changed as well (eg: 99081 is now WC002).

Anyone have any info as to where or what fee schedule they are going off of??

Any information would be so helpful!

Thanks!!
 
Ca workers comp changes

Hi, I think a lot of us are a bit in the dark when it comes to the changes. I don't know what fee schedule they are using but I do know that the new P&S report codes are WC003 and WC004. And I wasn't aware of the review of records (99358) not payable anymore or the peer to peer. And worst of all, my doc doesn't make it any easier by trying to bill for reports that are NOT reimbursable and the code has been deleted. I do have a question, when are doctors first injury reports supposed to be completed? Is it only at initial treatment of the injured worker or is it at every initial doctor visit that worker encounters?
 
This is what I have in regards to the "First Report." I'm not positive if anything has changed with this either.....

Within 5 working days following initial examination, a primary treating physician shall submit a written report to the claims administrator on the form entitled ?Doctor's First Report of Occupational Injury or Illness,? Form DLSR 5021. Emergency and urgent care physicians shall also submit a Form DLSR 5021 to the claims administrator following the initial visit to the treatment facility. On line 24 of the Doctor's First Report, or on the reverse side of the form, the physician shall (A) list methods, frequency, and duration of planned treatment(s), (B) specify planned consultations or referrals, surgery or hospitalization and (C) specify the type, frequency and duration of planned physical medicine services (e.g., physical therapy, manipulation, acupuncture).

-Normally when we bill for a consult, we would bill for the 99244 and then 99080 by how many pages of the report. Since consult codes are no longer, I am assuming that 99080 is no longer?? So lost!!!
 
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