ivonneatanacio
Guru
Hello,
What code can I bill for medical record review this is for a W/C case????
What code can I bill for medical record review this is for a W/C case????
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Wiki Medical records review????
- Thread starter ivonneatanacio
- Start date
RebeccaWoodward*
True Blue
Is this an IME?
ivonneatanacio
Guru
No, The patient was seen and medical records were reviewed we billed a 99244 and 99354 th claim was denied.
RebeccaWoodward*
True Blue
Typically, we don't charge the WC carrier for the review of medical records when the patient has been sent to our specialists' for consultation services. I suppose depending on your documentation and the nature of the visit and if the requirements were met, 99358 could apply; however, that is non face-to-face. My guess is that the carrier has denied the additional service based on the documentation and medical necessity. Our WC carriers don't consider payment for our claims until they receive the documentation; whether it be with the claim form or thereafter. WC carriers have the upper hand when processing claims for payment. I have seen many carriers conduct a pre-audit, per se, and reduce services based on the documentation.
ivonneatanacio
Guru
thank you.
mitchellde
True Blue
Truely depends on the state you are in for WC. Each state is very different. California does allow you to bill for medical record review in addition to the visit by using the 99358. You will need to investigate your states WC rules for billing to find out.
ivonneatanacio
Guru
Thanks for the information to all.