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Wiki Work Comp

K

kadecker

Contributor
Messages
11
Location
Arnold, MO
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I have a billing manager trying to state that work comp carriers do not follow the rules of CPT or the modifiers.

Scenario:
Follow up within global period of a laceration repair, the manager wants a modifier 24 because it gets paid. I disagree because it is within the global period. Manager also wants an E&M billed because the physians are doing a full exam to see if the patient can be released from care.

Can anyone help?
 
Work comp is a Non-HIPAA payer, so unlike all other payers they are not required to follow HIPAA rules. They may not use the current year of either CPT or ICD-9 or 10 CM code. And they can apply their own definitions and rules of use. You will need to follow the rules for your particular states work comp carrier.
 
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