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Work Comp and Other Insurance billed on the same day?

Jolene Posted Thu 19th of September, 2013 12:29:57 PM

'During an office visit for a work comp injury our patient also discussed with our physician two other chronic diagnosis problems and our physician addressed them with the patient. Can I bill the work comp injury diagnosis to the work comp company and also bill the chronic visit diagnosis to the patient's other insurance which is a different company on this same date of service? The two chronic diagnosis have no bearing at all on the work comp injury diagnosis and vice versa.

SuperCoder Answered Thu 19th of September, 2013 13:43:18 PM

Workers' comp is tricky. But yes, you can bill both visits to the respective payers. The documentation will have to be separate and top notch, however.
While your physician can technically and legally see a patient for a workers’ comp visit and other unrelated problems on the same day, you may find it easier in the long run to keep the visits separate. Keep in mind that you’ll have to send claims to two different payers if your physician treats the WC condition and an unrelated problem in the same visit -- one claim will go to the WC carrier and the other to the patient’s normal insurance.
Visits like this can be billed, but you have to take great care to be sure all the information is filed to the appropriate payer.
Best bet: If a patient wants to discuss other issues, try to have him schedule a new appointment so you’ll have a clearly separate record for your workers’ comp claim. Although medical necessity may require the physician to treat unrelated problems during a workers’ comp visit, the best scenario is to have the patient return for a separate appointment to address other nonrelated problems.
If the physician chooses to see the patient for both problems in one visit, tell the doctor to dictate separate notes for the workers’ comp claim and the unrelated problem. Having a clear and separate record for your workers’ comp claim will help reduce payer confusion and expedite payment.
I hope this is helpful.

Jolene Posted Thu 19th of September, 2013 14:45:14 PM

It is very helpful, thank you! This is an awesome service and resource especially for those of us who are the "one and only" person in our office who does the coding and billing. Thanks again!

SuperCoder Answered Tue 01st of October, 2013 01:01:12 AM

You are always welcome!


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