Author Topic: Assigning the right codes  (Read 2480 times)

Scott

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Assigning the right codes
« on: August 01, 2014, 07:37:02 PM »
Hopefully I ask this question correctly and I apologize if it's too broad.  A provider starting to treat work comp patients wants me to give him a list of possible codes and related charges he could bill for services he provides.  I am putting together a list of general questions I need him to answer for me to be able assign the appropriate codes.  I came up with the following questions and wondered if someone could tell me if I'm on the right track or way off base.  Thanks for your help.

1) State of jurisdiction
2) Detailed description of each service
3) Body parts typically treated
4) Time involved performing each service
5) What type of provider performs the services
6) What items/products consumed (meds, foods, supplies)
7) Are overnight stays involved

Michele

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Re: Assigning the right codes
« Reply #1 on: August 04, 2014, 10:35:47 AM »
Hopefully I ask this question correctly and I apologize if it's too broad.  A provider starting to treat work comp patients wants me to give him a list of possible codes and related charges he could bill for services he provides.  I am putting together a list of general questions I need him to answer for me to be able assign the appropriate codes.  I came up with the following questions and wondered if someone could tell me if I'm on the right track or way off base.  Thanks for your help.

1) State of jurisdiction
2) Detailed description of each service
3) Body parts typically treated
4) Time involved performing each service
5) What type of provider performs the services
6) What items/products consumed (meds, foods, supplies)
7) Are overnight stays involved

I'm sorry but I am confused.  If it is a specific provider asking you this then some of the questions above don't make sense.  For example, question 1 would be the area that the provider is in.  Question 2 and question 5 would be answered by the type of provider.  Question 7 ??  do you mean is the patient staying at a facility like a hospital overnight?  I'm just confused.  For example, if a DO asked me to provide possible codes & related charges for workers comp I would give back something such as:

Codes  - 

99201-99215 for office visits
98925-98929 for osteopathic manipulation

I would put the appropriate fee schedule amounts for those codes for the area the provider is in.

Did that help?

 
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Scott

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Re: Assigning the right codes
« Reply #2 on: August 04, 2014, 11:14:05 AM »
Thanks for helping.  I am not being as clear as I should because I'm flying a little blind.  Sorry about that.  The services this doctor is providing are somewhat cutting edge and so I have to find similar codes.  The closest related services I can come up with are EMG services.  I ask about jurisdiction because the patients come over from all over the country.

Basically I was trying to determine a list of appropriate questions to ask a provider who's never billed these services before so I can appropriately assign codes.  I know I am being way to vague and I'm sure I'm not asking the right questions (mostly because I'm new at coding).  If you were going in to a knew client who wanted you to provide coding services so he can determine what he's going to be reimbursed, what types of questions are important.  Maybe that's a better way to ask it.

PMRNC

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Re: Assigning the right codes
« Reply #3 on: August 04, 2014, 01:09:09 PM »
Quote
The services this doctor is providing are somewhat cutting edge and so I have to find similar codes.  The closest related services I can come up with are EMG services. 

I think I know what you mean, you want to know what you need to ask the provider about their services to help you identify the best procedural coding? If so can you tell us  more about the services they are providing?
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DMK

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Re: Assigning the right codes
« Reply #4 on: August 04, 2014, 02:19:31 PM »
You also need to make sure that the services provided to the WORK COMP patient is authorized by the carrier before you even see the patient.  In California it all has to be authorized or you're not going to get paid.  If the care is "cutting edge", the Doctor may want to find out how the specific insurance carrier wants it to be billed.  There are separate codes for W/C.  Fee schedules too.

RichardP

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Re: Assigning the right codes
« Reply #5 on: August 05, 2014, 01:31:43 AM »
... because the patients come over from all over the country.

For Workers Comp??  That sounds like folks are leaving their state and coming to your provider's state.  I didn't think Workers Comp crossed state lines.  We do some, but not much, Workers Comp billing, so I am uninformed about this paying across state lines thing.  Does that really happen?

Michele

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Re: Assigning the right codes
« Reply #6 on: August 06, 2014, 08:02:10 AM »
Thanks for helping.  I am not being as clear as I should because I'm flying a little blind.  Sorry about that.  The services this doctor is providing are somewhat cutting edge and so I have to find similar codes.  The closest related services I can come up with are EMG services.  I ask about jurisdiction because the patients come over from all over the country.

If they are cutting edge I would be careful that they are covered WC services.  If they are not widely accepted services yet then they may not be covered.  They may also not have CPT codes assigned yet, or they may have temporary codes.  I am also confused as to patients crossing state lines for WC services.

Basically I was trying to determine a list of appropriate questions to ask a provider who's never billed these services before so I can appropriately assign codes.  I know I am being way to vague and I'm sure I'm not asking the right questions (mostly because I'm new at coding).  If you were going in to a knew client who wanted you to provide coding services so he can determine what he's going to be reimbursed, what types of questions are important.  Maybe that's a better way to ask it.

The best thing you can do is ask for a specific description of the services.  Also, if the provider is using some form of equipment for the services the company that provides the equipment may also be able to provide codes. 
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Scott

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Re: Assigning the right codes
« Reply #7 on: August 06, 2014, 11:21:56 AM »
I appreciate everyone's input.  It is very helpful.  Crossing state lines for work comp treatment is somewhat common.  An example is someone from NY moving to FL, but the injury occurred in NY. The provider typically has to follow the jurisdicational state's rules.  In my particular case, the services are provided to athletes being treated by a specialist (the dr I'm trying to help) in another state.

I agree auth is important, esp in this case, although we're pretty good at good non-auth'd services collected.