Wiki Help

[01051184]

I need advice from WC billers. We have a patient being seen for 3 separate injuries with 3 different injury dates. Concerning the E & M charge, how would you handle this situation? The provider wants to charge an E&M for each injury. Can someone advise?

 

[Quaker]

E&M services

If the physician provided an E&M service on 3 separate dates of service for various injuries, then billing an E&M service for each date of service seen would be appropriate. However, if the physician saw a patient on one date of service for multiple injuries (acute or chronic), you can only bill one E&M service. Code it at the appropriate level.

 

[mitchellde]

If this were not WC I would agree only one E&M, however Look and see if WC has issue 3 different claim numbers or certs or whatever yours calls them. If that is the case, then each case number must be submitted as an independent claim so each injury must be documented as a separate encounter with no crossover. The you will submit a different e&m for each incident. Very much the same as if you have an injury and a medical encounter which is submitted to two different carriers.
Debra Mitchell, MSPH, CPC-H

 

[01051184]

Thanks so much for your help. They do have different claim numbers.

 

[NIC21]

Also, make sure the Provider has a separate note for each injury.