Question work related injury calims

Kipro

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Hello,

I wanted to check if anyone has more experience billing work related injuries. I was just told that E/M code should be N/P when patient is seen for a new injury. So if patient is seen first time is N/P all follow up visits for that same injury will be E/P, but if that same patients comes for a different injury it should be billed with E/M code for New Patient.
Please let me know if this is correct, we see patients in Virginia and Washington DC.
 

Tonyj

True Blue
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Lithonia, GA
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Hi Kipro.

I would suggest you follow the guidelines documented in the CPT code book. There's a decision tree for new vs established patients which clearly states how to differentiate the 2. In answer to your question, if the patient was seen by your physician within a 3 year period then the patient is established. If its a new injury to an established patient then the only difference would be in the number of diagnoses or management options under the medical decision making portion of the audit tool.

Hope this helps.

Best
 

Cls1530

Contributor
Local Chapter Officer
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Gainesville, GA
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If you are contracted to with a Worker's Compensation Insurance you will also need to review how they want the charge billed. Sometimes they have very specific guidelines.

Hope this helps you some. Thanks!
 
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