PIP BILLING

[KARREN]

can you bill two PI CASES AT THE SAME TIME: Example: pt was in an auto accident (1) on 8/30/10 dx: 847.0,723.3,847.1,353.1
pt treating under this accident with 98941, 97014,97010  now pt has a new accident (2) dated 10/28/10 dx: wrist sprain & strain and low back..  the doctor wants to treat pt under both cases: 
pt comes in case 1 treats for 98941,97014,97010 and also treats under case 2= 98940,97012,97014,97010  is this okay to do..
I've heard offices running two cases by this is my first experience billing two cases.. need clarification .. i'm uncertain about this
Thanks!

[DMK]

You CAN NOT bill the same services to 2 different cases.  You would bill the new case until the patient reaches the level of injury he was prior to the 2nd accident, then you go back to billing the 1st case again.

You should not even treat one day on one case and another day on the other case.  That would be discovered when the case settles.  Bear in mind that the records (usually by subpoena) will be requested, and it is usually ANY AND ALL records, so any hanky panky will come out.

The 1st company should NOT be on the hook for injury sustained in the 2nd accident.

We've had this happen to us in the PI and Worker's Comp arena.  Be sure the doctor documents well!

Do not bill 2 companies for the same service the same day!  That's fraud!!!  Personal injury claims usually pay pretty well, don't let the doctor get greedy!

[Michele]

DMK,
  I agree completely with what you said, but isn't that if the injury is to the same body part/area?  The example given below was for whiplash/neck on the first case and low back/wrist on the second.  In the case where the injuries are clearly for two separate areas of the body I do believe it is ok to have two separate cases.  They must be treated completely separately and have separate charts/notes.  The patient must also have two separate appointments, one for each case, but they can be on the same day and they can be back to back.  Services billed must be specific to the area that the provider is treating, for example, he can't put heat on the whole back and bill separately for heat on both cases.  It is not a case of being greedy, but a case of billing appropriately.  For example, if the first case is a NF, and the second is a comp, and they stop billing the first while they treat for the second, then the NF case can be closed by the argument that the patient wasn't receiving any medical care for a specific period of time.

Curious to see responses on this one.  



Michele


PS  Also, if this is a Chiropractor, in NYS they are not reimbursed very well for WC or NF.

[DMK]

Michele, you are correct if it was separate body parts you could bill a 98940 to each case, but you'd have to apply any modalities to the proper case and proper body part.  Looking at the CPT codes the doctor is billing, he is wanting to bill the full spine to both companies. That's not right. It's double billing and will come back and bite you.

Keep the claims separate, document each case separate.  The most appropriate way to treat this case is to treat the new case until they reach the medical place that they were prior to the 2nd accident, then go back to the first case until the patient reaches Maximum Medical Improvement.  I can not stress enough the importance of good documentation.  You will have records requested, so the doctor needs to really cover his butt. 

I'm sorry to hear that WC and PI don't pay well in NY.  In CA PI is the ONLY 100% payment left and that is quickly dying as the Auto Ins Companies are beginning to contract with the health insurance companies.  WC in CA is very regulated, but the reimbursement is good when you adhere to the rules and bill correctly.

Dina