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Thread: Workers Comp E & M

  1. #1

    Exclamation Workers Comp E & M

    AAPC: Back to School
    I work in a Rural Health Clinic and one of our providers is determined to use new patient e&m codes when seeing a patient(s) for a work comp visit for the first time. I have repeatedly tried to tell this provider that new patients mean the patient has not been seen by herself or anyone else in our clinic for over 3 years. She doesn't accept this. I am looking for additional proof of how these visits should be coded, she doesn't accept the CPT code book information. The patient(s) in question have been the providers regular patient(s) for several years now and are by no means new to our clinic. Please advise!!!! If I am wrong in the way I am reading the cpt book. please explain.

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    You will need to check on your state's work comp regulations. In our state, when a WC patient is seen for a new work related illness/injury, it is a new patient (or consult) code, even if the provider has seen that patient previously - even if for another work comp case. Some want the NP code charged, while others want the consult code - depending on episode of care, did the case manager request a consultation, etc.
    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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