report and medical record review billing (California)

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report and medical record review billing (California)

Postby rosadiaz on Tue Dec 03, 2013 1:01 pm

My understanding is that under Medicare guidelines there is no CPT code for medical record review and report charges that currently are billed as cpt code 99080 and 99358 does anyone know alternate codes that we can use to bill ptp medical reports?
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Re: report and medical record review billing (California) (Calif

Postby appliedpsych on Tue Dec 03, 2013 2:58 pm

This lack of ability to now bill for those review services or report writing time was apparently discussed in a workshop that some of the group treatment and referral practices attended related to the RVBS or whatever other BS it may be. Apparently there will be NO WAY to bill for such records review after 1/1/2014, nor for the time to write the report.

I am told by one of the attendees that even DWC reps at the meeting seemed surprised to figure this out.

I guess its another case of you have to pass the bill to see what's in it.

So the concern for the practice management groups is that especially psych providers will tend to shy away from consultation or treatment evaluations, as they will NOT be able to bill for the time to review that 500 pages of documents that the IC sends. This apparently will apply to any treating or consulting doc though, as there will be no way for anyone to bill for the time expended in examining case records, or time to write the report.

Supposedly CSIMS and some other groups are at work on it, last I heard, but as of today, no way to bill for records review or report writing time after 1/1/2014.
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Re: report and medical record review billing (California)

Postby suekarp on Thu Dec 05, 2013 8:13 am

I was one of the attendees at the RBRVS seminar that was presented by Sue Honor. She specifically addressed the issues, but no one was thrilled by her answers.

1) There are no codes for a consultation. The exam bill code is gong to be a new patient examination.
2) The rules for prolonged service codes for things such as record review will be based on the Medicare documentation guidelines. The non face to face codes will not be paid unless the time spent exceeds the time factor in the documentation guidelines. I think this may be the end of the 15 minute non-face to face time except for extrordinary situations.
3) There are no reimbursement codes for the familiar coinsultation codes, so we are left to fee negotiation for the reports.

The seminar was on 11/15, so some of this may have changed. The marketing director for WorkComp Central indicated that they were going to make the seminar available as a webinar soon.

Disclamer - These are my recollections of the seminar, and I am no expert on RBRVS.
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Re: report and medical record review billing (California)

Postby bakodoc on Thu Feb 12, 2015 7:36 pm

Sue Honors is very defense oriented. So you won't get anything out of her that will help applicant provider. Even talking with her regarding fee schedule for FCE after the change took effect, she gave some really conservative number which was far below what it should've been. She knows what she knows. But I have a feeling her heart is quite biased.

Having said that, like all changes, this problem as a work around also. You 'CAN' bill for the review and report and get paid for it with another code. But for the fear of abuse, I won't post it here. That's how record review and report got hacked in the first place. And as usual, the lawmakers' patch up job leaves a loophole for one to take advantage of and it's back to square one.
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Re: report and medical record review billing (California)

Postby Dunbar on Fri Feb 13, 2015 11:08 am

In effort to get paid for a record review and a consultation report you can ask the claims adjuster to agree to it in writing. Usually they ignore the proposal but once in awhile you will have a more reasonable and smart adjuster who will approve it in writing. But unfailingly bill review then denies the bill even if you attach the written agreement to the bill. You then have to do a request for a second bill review and spell everything out with again an attached copy of the written agreement. Bill review may or may not then pay upon the agreed amount; sometimes they cut the bill arbitrarily so the more specific the terms of the written agreement, the better.
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Re: report and medical record review billing (California) (Calif

Postby bakodoc on Fri Feb 13, 2015 12:15 pm

No... there's a CPT code you can use. And you don't need prior authorization. If you know your Labor Code, it's not that difficult to figure out. We've been using it since early 2014 when the new fee schedule went into effect and have been successful with it. But if you do figure it out, please don't post it here. People will start abusing it and thing will be back to square one. I'm tired of reforms that target everyone while only few screw around. I guess it's the limitation of our justice system. Enforcement units just don't seem able to catch up with the bad guys.
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