Wiki How to bill E & M for same visit treating MVA injury follow-up and other Dx?

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janda9092

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PT was seen by physician for follow-up to injuries sustained in a car accident. At the same visit, the PT was also treated for Hypertension, seborrheic keratosis, and otitis media - all not accident related. Do we bill 2 separate E & M's - one to the Car Insurance Co and another to Medicare (& its' secondary insurer) for the respective ailments, or does everything get sent under 1 E & M code to the MVA Case Manager to decipher their portion and then, subsequently, get sent to MCR with it's secondary insurer?
 
janda9092 said:
PT was seen by physician for follow-up to injuries sustained in a car accident. At the same visit, the PT was also treated for Hypertension, seborrheic keratosis, and otitis media - all not accident related. Do we bill 2 separate E & M's - one to the Car Insurance Co and another to Medicare (& its' secondary insurer) for the respective ailments, or does everything get sent under 1 E & M code to the MVA Case Manager to decipher their portion and then, subsequently, get sent to MCR with it's secondary insurer?
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The most important thing to remember is that "Insurers providing only workers’ compensation, automobile insurance, and property and casualty insurance are not considered to be health plans." meaning they are not covered entities. Therefore, you cannot disclose any information to such a payer that isn't relevant to the injury.

In this case, the provider should have two completely separate visit notes; one for the exam and treatment directly related to the MVA, and the other for all non-MVA-related problems. Each document should be written as if that was the only encounter for that day. You would then use the MVA documentation to level and bill the appropriate E/M for those services only. And likewise for the non-MVA documentation. Because of the minimum necessary restrictions on the liability carrier, you have no alternative other than to bill two separate E/M charges, BUT they must be leveled separately.

If the provider intermingled the MVA-related and non-MVA-related conditions in one encounter note, you cannot submit that to the liability carrier. Even if you don't send the documentation, the fact that the non-MVA-related diagnoses are present on the claim is enough to violate the minimum necessary rule. Likewise, you can't submit a claim to Medicare when you know there is another insurer primary (the liability). If you try to bill Medicare for only the non-MVA conditions, it would be impossible to level that visit when the information is grouped together in one encounter note.

Bottom line here is that, if the provider created only one visit note that encompassed the entire encounter, you can't bill the liability carrier or Medicare.
 
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