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Wiki IME or EVAL & TREAT? WORK COMP question please!

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mlemlr

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My doctors are wanting to bill 99455 for work comp patients that have been scheduled as Eval & Treat. They say that work comp patients take longer and that there are also outside records to review so just billing a regular patient visit doesn't compensate them for their time spent. I agree, but the work comp carriers are denying all these claims stating this code (99455) is for an IME only and they didn't scheduled these patients as an IME but as an Eval & Treat. In our State we do have a fee schedule with our work comp carriers so it doesn't do any good to raise the price of the office visits and even a level 5 doesn't get the doctors what they feel is fair for the time spent.
Is there anyone out there that bills work comp that can give me an idea what to do? Thank you so much!
 
Unfortunately, in this State, the patient is sent to us only by a Case Manager, so no consult code.
 
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