Dr. Lee’s pen hovered mid-note as her phone buzzed, shattering the focus of her patient consultation. It wasn’t the first time an unexpected call from a workers’ compensation attorney had disrupted her schedule, stealing precious minutes and leaving a trail of frustration. These interruptions weren’t just inconvenient; they ate away at her ability to deliver the best care to her patients.
Enough was enough. Dr. Lee knew it was time to address the issue head-on to establish clear expectations for payment when dealing with attorneys and workers’ compensation insurance carriers. Whether she billed directly or relied on the insurance system, efficient and transparent communication was key.
The Code Conundrum and Standard Rates:
Selecting the appropriate CPT code for a less than 15-minute phone consultation with an attorney regarding work comp injury care depends on several factors, including state regulations and payer policies. Here’s a breakdown of some appropriate codes and their standard billing rates (remember, actual reimbursement may vary based on location and payer contracts):
- 99075 (Medical testimony): 99075 offers flexibility with determining time spent discussing with the attorney. It can be reported in 15-minute increments, with the standard rate of around $50-$60 per 15 minutes. Note your clinic(s) might also utilize this CPT code for provider depositions, it is recommended to have your fees set accordingly for those situations.
- 99358 (Prolonged Services before and/or after direct patient care): This code is used to report 30-74 minutes of prolonged service on a given date in relation to patient management. This code typically starts at $90. It can be used for extensive record review related to previous evaluations and management services performed earlier. However, it must relate to a service or patient in which (face-to-face) patient care has occurred or will occur and relate to ongoing patient management.
- Note: It is recommended to arrange and discuss the fee and your time requirements to let the attorney know all expectations at the beginning of the call.
Choosing the Right Path:
The safest approach hinges on these considerations:
- State Regulations: Workers’ Compensation is regulated differently by each state, it is recommended that you check with your state’s rules and regulations for specific guidance.
- Payer Policies: Contact your payer directly for their preferred codes and limitations for attorney consultations in work comp cases.
- Documentation Strength: Regardless of the chosen code, thorough documentation is key. Note the date, duration, purpose, and specific medical-legal topics discussed during the consultation.
Recommendations from the AAPC Forum:
According to the AAPC forum discussion on the topic, some additional insights can be considered:
- 99075 (Medical Testimony): Billing this code directly to the attorney with an explanation of the service provided (discussing the chronology of the patient’s medical care) is an option, though ensuring prior agreement with the attorney for accepting the bill is crucial.
- Workers’ Compensation Specific Codes: Certain states might have dedicated codes for work comp services like consultations with external parties. Research your state’s regulations and payer manuals for applicable options.
- Transparency and Communication: Open communication with both the attorney and payer about the nature of the consultation and chosen billing code can help avoid potential denials or misunderstandings.
Here’s how Dr. Lee tackled the fee conundrum:
- Upfront Agreements: Before consulting with attorneys, setting a clear fee schedule was crucial. This would eliminate any ambiguity or potential for future misunderstandings about compensation.
- Coding Know-How: When workers’ compensation insurance covered the cost, understanding the appropriate billing codes for phone consultations became paramount. Whether using codes like 99075 (supplemental reporting for services code – Medical Testimony) or exploring state-specific options, Dr. Lee knew accurate and compliant billing was essential for timely reimbursement.
- Documentation is King: Detailed notes outlining the date, duration, and specific topics covered during the consultation would be invaluable in supporting any claim for payment, whether to the attorney or the insurance carrier.
By implementing these strategies, Dr. Lee aimed to reclaim control over her time and ensure fair compensation for her expertise. No more frustrating interruptions, no more ambiguity – just clear expectations and a system that worked for her, her patients, and the legal professionals involved.
Proactive Tips:
- Communicate with the Attorney: Discuss billing expectations and documentation needs upfront.
- Seek Pre-Approval: Consider requesting confirmation from the payer regarding the appropriate code before submitting the bill.
- Stay Informed: Keep updated on changes in state regulations and payer policies.
Remember: Accurate and compliant billing protects both you and your patients. By carefully considering the options, thoroughly documenting the consultation, following relevant regulations and payer policies, and incorporating insights from the AAPC forum discussion, you can confidently navigate the billing maze for attorney consultations.
Disclaimer: This article is for informational purposes only and should not be interpreted as legal or medical advice. Please consult with an appropriate professional for specific guidance.