Wiki Wc e/m help!!

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indy1583

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Hello
I need help!!!

One of our Worker's Comp Ins (CorVel) are denying our office visit when we bill with injection and have mod 25 on visit. We do send the note's with it.
It said that Doc does not support mod 25 which I understand. I keep telling Dr's, notes do not support mod 25 as an significant, separately ID. They asked me what should be on the note to make it significant, separately ID.

Thanks Indiana
 
Were the injections previously planned? For instance at the previous visit did the doc note that if there was no improvement he would try an injection (or something similar)? If so then you would not bill an office visit with the injection. If the doc decided at the present encounter to do the injection then ideally he should have two notes, the E/M which clearly shows the work and the decision for the injection and a separate procedure note for the injection.

I can't guarantee that this will be enough for your W/C carriers, but it gives you a better case for appeal. I also have told the docs I work with that if I can't get a 99213 minimum for the visit I won't bill the E/M. My reasoning is that 99212 is a minimal amount of work, straightforward decision making, each procedure has an E/M element built in so what they do must be more than the minimum.
 
I was told by the SC State Accident Fund before that under no circumstances will an office visit and an injection be paid together. They said the injection was a "starred" procedure. Any E/M code billed with a starred procedure would not be paid. I wonder if CorVel has a policy that is similar.
 
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