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Verify CPT codes for Employee health

  1. #1
    Post Verify CPT codes for Employee health
    Medical Coding Books
    Could someone please clarify what CPT code I would use when a Employer/Supervisor advises their employee to search medical care for a work related injury?
    I have a clinician who select codes from the consultation series even though it is dcoumented that the patient supervisor's filled out the necessary paperwork to seek medical care.
    Can someone please advise me?

  2. #2
    Seattle First Hill
    I guess I'm a little confused as to your question. If I'm understanding correctly, a supervisor is recommending that an employee seek medical care for a work-related injury and the doctor that sees them is wanting to charge a consultation code? Per CPT, "a consultation not requested by a physician or other appropriate source, is not reported using the consultation codes, but may be reported using the office visit codes." Look at 99201-99205.

    Hope this helps!

  3. #3
    Default CPT codes for Workers' Comp
    I may have been unclear in presently this but yes - a clinician in Employee Health is seeing the patient- and selecting consultation codes. I have explained that you can't use this code unless approciate source is referring the patient to you and you are documenting that information in the body of your note.
    Presently I am changing those codes to reflect whether the patient is new or established and based on the level of care documented in the note.
    Last edited by rm426; 10-21-2009 at 03:05 PM. Reason: correction

  4. #4
    Milwaukee WI
    Default Appropriate Source
    Well ... an "appropriate source" does NOT have to be a physician. The examples listed in CPT guidelines include social workers, lawyer or insurance company. I would think a good argument could be made that a work supervisor who is requesting advice on whether the employee can safely return to work, qualifies as an "appropriate source."

    I welcome other opinions.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 10-23-2009 at 03:44 PM.

  5. #5
    Default CPT codes for Employee Health
    That is the discussion that we have been having. Whether or not a supervisor is a approciate source to refer the patient to the clinician to render the opinion on whether or not the employee can return to work. If that is the case, then I could use a consultation code as long as it is documented in the body of the note that patient was referred to be seen by the employer/supervisor.
    I welcome any feedback.

  6. #6
    Default employee health
    I don't know whether I would consider the supervisor qualified to make that referral, but I might consider an employee health nurse. Will the records go back to the supervisor as the requestor? I would be upset about that, but I can see where they could go in my record via the employee health nurse and she/he could approve return to work. Hmmm, something to consider.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  7. #7
    I have to agree with Anna, an employee health nurse, yes, a supervisor, no. I work in worker's comp benefits and we consider that a new or established patient visit depending on the standard guidlines.

    Hope that helps.
    Melony Reed CPC

  8. #8
    What about the article in May 2009 Coding Edge Consult or Not (pg 20)I found it very informative on what is really a consult. That may help you.
    Colleen R Cox CPC

  9. #9
    I went back throught the archives and read that article. It was very helpful. I actually remembered reading it when it first came out and never thought to reference it as a guide for future consulting questions. Thanks

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