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workers comp/ rehab visit

  1. #1
    Kachina Coders
    Default workers comp/ rehab visit
    Medical Coding Books
    We have a patient being seen in a rehab setting for her workers comp issue - we were called in to see her (she is a current pt of ours) for her pulmonary issues- we were told that we had to bill her reg medical ins not the workers comp ins which we know is correct but unsure about the e/m codes to use- the rehab is in the hosp but the hosp is not billing reg ins (UHC) since all her issues except this one is due to the workers comp issues and we will be the only one billing the req ins- complicated hopefully I explained this right - any and all help will be appreciated to know what e/m codes to use-- Thanks

  2. #2
    Sioux Falls South Dakota
    Kathy, is the Rehab setting inpatient or outpatient rehab? That will drive what codes you use. Our hospital has a comprehensive inpatient rehab facility (POS 61) and for that setting, you use regular IP codes, either consult or subsequent care codes. If, however, it is a comprehensive OP rehab facility (POS 62), you would use OP codes, either consult or E/M. One problem I can see, however, is pre-authorization if inpatient. If the hospital is only billing the Work Comp carrier, would they have pre-authorized the stay with the medical insurance? You may want to check that out first. I hope this helps.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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