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Billing for MVA and Workers' Comp

  1. #1
    Default Billing for MVA and Workers' Comp
    Medical Coding Books
    I work in a multi-disciple practice (Chiros, Pain Mgtm. Spec, Physiatrists). One doctor is treating pt. for a MVA (neck) and WComp (low back). Pt comes in for treatment and works on both areas, bills the MVA/neck @ 100% and WC/back @ 100%; 2 carriers/2 claims. I'm very uncomfortable with this. Would rather send claims to each carrier and tell them to pay 50%. Feel like we are double dipping. Any and all help greatly appreciated.
    Anne Sill/MD410-09

  2. #2
    Stratford, NJ
    Default mva & w/c
    I say your ARE double dipping! I talked to our coding supervisor who also agrees. You can either see the pt and treat the neck and back at same encounter...but you can't bill both ins. You also can't bill out only 50% of the service to each. You'd either have to see the pt and treat both areas, but only bill one ins'd only bill out for the one area (neck or back..not both!) Or you could have pt come in one day to treat the neck and bill the auto carrier, then have her come in another day to treat the back and bill the w/c carrier. I would DEFINITELY not continue to treat both areas at the same time and bill both carriers for the same visit!! Hope this helps you.

  3. #3
    Seacoast- Dover New Hampshire
    How about when a pt comes in for Wcomp visit (back pn)and starts talking about medical issues and gets medication for current medical problems, has MRI for back scheduled?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4
    Kingsport, TN
    We have similar situations in our office. Usually more than one workers comp injury though. The way we handle this is, patient will have 2 appointments for the same day for each injury. Each injury is treated separately and dictated separately. We then bill separatly for each visit. We do this for the convenience of our patients as they have to take off from work to see the doctor. We have had no denials. Hope this helps.

  5. #5
    Duluth, Minnesota
    Anne, I agree with kmhall: and as long as your provider has documentation that supports the level of service - it should be fine. The documentation MUST STAND ALONE - in other words - if there's only one note, they we'd have to be able to score out "two" separate services and find the level appropriate for each. As kmhall stated, it is much easier if the providers document the separate services in separate notes so each service stands alone. One E/M might be higher than the other - they may end up both being low level E/M's... it all depends on documentation of services provided.

    kbarron, - sound as though that might be a split bill as well - two services. Again, documenation has to support both services. The workcomp services would be billed to workcomp - and the medical to their regular insurance.
    Donna, CPC, CPC-H

  6. Default
    We do the same in our office, I bill for Work Comp and Family Prac. One of the clinics is out in the country, so a patient will see one Dr. for both. We have two separate visits, two separate notes and two separate problem.

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