The OMFS says that range-of-motion testing (CPT 95851) and grip-strength testing (CPT 95852) are separate procedures, not normally charged on the same date as an E/M code (office visit). The OMFS does not say how an adjuster is to pay for the services when they are billed concurrently. Some adjusters/bill review services pay for the E/M code and disallow the testing, others pay for the testing and disallow the E/M code, and still others pay for whichever is greater. In pursuing recovery for such billing by my clients, I adopt the latter strategy, consistent with Civil Code 3536, "The greater includes the lesser." After all, it doesn't make much sense to think that three ROM charges (at $46.74 each) and a GST (at $34.47) are somehow included in CPT 99211 (for $23.35), for instance. Similarly, my in-house billing service disallows a single ROM charge when CPT 99213, 99214, or 99215 is charged on the same date of service.
In lien trials where the concurrent charges were at issue, WCJs have accepted the approach that the greater of the two charges is payable and the lesser is disallowed. None of those decisions went to the WCAB on reconsideration.
When Sue Honor Vangerov was in charge of the DWC's Medical Unit a few years ago, she said that it was her personal opinion, not speaking for the DWC, that both the testing charges and the office visits should be paid if the testing measurements were included in a report. She said that the OMFS ground rules may be revised to address the issue, but then nothing happened.
Since there is often a dispute when charges for both services are billed concurrently, I advised my clients to bill only for the office visit or for the testing, whichever is greater. Like magic, the disputes disappeared and payment arrived for the service that was billed.