Wiki Workman's Comp Coding


Kelseyville, CA
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Any suggestions for publications or books on the ins and outs and tricks for Worker's Compensation billing. I've done it before, but would like to have something in print if possible.
Workers comp can vary from state to state. I'm not sure you'll find a universal guide. Example...our state requires modifier "B" for xrays. (I can see it now...WHAT?? modifier B...what is that??? This is unique to occupational health). Are there any specific questions I can help you with?
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B's are required in NC also. Without more specific questions, it's hard to reply to the question. I'd first look at any regs your specific state has regarding WC. In NC, the fee schedule is pretty good and hasn't changed for almost 10 years.

Thanks for your replys. I'm in CA which seems to be a different animal all on it's own. They require mod 17 on certain reports, etc., but I don't know if that's actually published anywhere.
You should be able to pull information from the CA gov. website. Most states publish guidelines. I do auditing on behalf of the workers/payor (insurance). I have done multiple states and would have to say that California is indeed in it's own "world". I had a book about 5 inches thick I would refrence from. I would rather have teeth pulled with no drugs!!! Texas, your're not far behind CA!! I'll take the other 50 states! Find yourself someone in CA that does the same type of work and network, network, network! I know I did not give any help but could'nt help sympathizing with you!

I just found a link for you to try..
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Workers comp E&M codes 99455 and 99456 are not listed with any % in the customized fee analyzer. DO we know what the RVU's are? I'm trying to figure out what is a good base amount to charge for this.
Hi KitKat,

I've been coding and auditing WC services in California and 39 other states for a while and can tell you that for California-the website isn't going to help you much. You cannot use the guidelines from another state as they are not the same-no state is the same as another where the guidelines are concerned.

If you (or anyone) has specific questions, please feel free to send me a private message.
I have been dealing with ohio and pennsylvania workers comp, totally different altogether, if there is anyone that deals with PA W/C that would be great. I have tried to locate any info off of the state website but nothing is available because PA is Commonwealth, so there is no direct link to a bwc website as in ohio. any advice would be greatly appreciated!!!

thanks soo much in advance
Pa Wc

Hi OhioCoder101,

PA is Medicare based for the WC regs and any CPT that is not in the Medicare fee schedule is paid at 80% of reasonable and customary or actual charge whichever is lower.