tci General Surgery Coding Alert - 2004 Issue 7

Reader Question: Bill a Single Visit for Multiple Problems

Question: The surgeon saw a patient as a follow-up for a workers' compensation claim (burn injury). He identified a malignant mass on the skin, unrelated to the workers' comp case. If the majority of the visit relates to the workers' compensation claim, should we bill the whole visit to the workers' compensation carrier? Or should we bill the patient's private carrier?Alabama Subscriber Answer: Don't submit two claims for the same visit. If the visit primarily concerned the workers' compensation claim, report the appropriate work-related evaluation code (99455-99456) along with the condition that represents the patient's original illness."[A]...

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