Coding, Classification and Reimbursement

Medicare and Workers Comp

  • 1.  Medicare and Workers Comp

    Posted 14 days ago
    I received an email from my corporate billing office asking me to remove 2 codes (neck pain, back pain M54.2, M54.9).
    I was told that a Medicare billing rep said they match a workers comp claim exactly. But we are chemical dependency and psych facility. The neck and back pain are coded as secondary diagnosis not primary.
    Does anyone have any experience with this?

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    Theresa Guerra, RHIT
    HIM Coder
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  • 2.  RE: Medicare and Workers Comp

    Posted 11 days ago
    I don't believe our facility has ever received a request like that. At least not since I have started working here. We report various pain codes as well when the patient receives medication for the pain. Perhaps the primary diagnosis wasn't reported to billing properly? As long as it meets the requirements for reporting additional diagnoses there shouldn't be an issue.

    Have you heard back from billing?

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    Megan Del Rio
    His Discharge Coder
    mparnt@gmail.com
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  • 3.  RE: Medicare and Workers Comp

    Posted 10 days ago
    Hi Theresa,

    Try to see if you have a diagnosis for the cause of the pain such as spinal stenosis or lumbar spondylosis.  I worked for a Pain Management Clinic and that is usually what they need, to be preceded by a code for acute or chronic pain if the physician diagnosis it. If it is an Inpatient encounter and not for Pain Management, sequence the code for the specific site of the pain first, then the code for acute or chronic pain.

    Mary Headley, CCS
    Remote Inpatient Coder
    Tallahassee Memorial Healthcare
    Universal Coding Solutions







  • 4.  RE: Medicare and Workers Comp

    Posted 10 days ago
    No I told them I had to look into it because I was not comfortable deleting codes. I will be talking to our CBO today now that I have some more information from both of you. Thanks






  • 5.  RE: Medicare and Workers Comp

    Posted 11 days ago
    ​We have been asked by our business office to remove codes as well or change them to something else that is not reflected in the record, but MC has it on file or at least that is what I think is happening.  It is on my "try and figure out why" list.  We are an acute care hospital.

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    Stacey Goodenough
    Manager of Medical Records / Privacy Officer
    Wayne Memorial Hospital
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  • 6.  RE: Medicare and Workers Comp

    Posted 10 days ago
    I work for a multi-specialty group and we see this often. If the patient was not treated for the complaints and was at the office for a different reason we do not attach those diagnoses to the claim. There are some instances where we have no choice to but to use the diagnosis that Medicare considers part of a third payer liability incident. In these cases we might appeal with records or contact the patient and we have even billed the work comp/auto insurance to get the denial from them which use use to appeal and that usually resolves the issue with Medicare. Happy billing! :) 
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    Amy Martinez RHIT
    779-770-4211





  • 7.  RE: Medicare and Workers Comp

    Posted yesterday
    UR did appeal based on treatment for opioid detox was from the opioid dependence from the back injury. I will post an update.

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    Theresa Guerra, RHIT
    HIM Coder
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