ML-102 (California)

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ML-102 (California)

Postby randlmedical on Wed Aug 05, 2009 12:57 pm

What is the proper way to bill for a ML-102?....The doctor i work for wants to bill for a ML-102 on every initial visit whether he's primary or secondary.
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Re: ML-102 (California)

Postby jonbrissman on Wed Aug 05, 2009 4:31 pm

Neither a primary nor a secondary treating physician may bill for ML102 services on the initial visit (or, absent exceptional circumstances, on any visit). The physician must recognize the difference between treatment charges and medical-legal charges.

Medical-legal charges are for those services requested by a party and required to prove or disprove a contested claim or a disputed medical fact. Generally, post-2005 dates of injury trigger the panel QME process.

If the physician improperly bills ML102 for the initial treatment visit, it is likely that he or she will receive an objection and no payment. A few adjusters might recharacterize the services as treatment and send some payment, but often the level of service will be downcoded. Seldom will the physician be paid appropriately.

The physician's billing for initial-visit treatment charges might come close to ML102 levels if he can justify the E/M services as CPT 99204 or 99205, does a medical records review (CPT 99358), and writes a narrative report (CPT 99080) encompassing both the office visit and the records review. Note that a narrative initial-visit treatment report that does not include a records review is not compensable. Also note that a Form 5021, Doctor's First Report of Occupational Injury or Illness, still must be completed and served regardless of whether or not a narrative report is written.

You might want to suggest that your physician-employer join CSIMS. They put on education seminars for physicians that might dissuade your boss from wanting to bill ML102s for treatment visits. WorkCompCentral may also have some seminars to enlighten your boss.

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Re: ML-102 (California)

Postby cmunday on Thu Aug 06, 2009 8:30 am


Just wanted to thank you for recommending CSIMS. (I currently serve as President of the organization). While I'm not really an expert on billing I've been amazed at the lack of knowledge regarding billing of many physicians who are active in Workers' Comp either treatment or evaluation. Mostly we see Doctors underbilling like the AME who didn't realize that the 25% premium for AMEs applied to ML104s - thought it just applied to 102s and 103s. In my experience it is usually simply ignorance but I've seen things done that could easily appear to be fraudulent. One of the goals of CSIMS is to assist Drs. in participating in the system ethically and legally.


Claude S. Munday, Ph.D.
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Re: ML-102 (California)

Postby rbaird on Thu Aug 06, 2009 10:38 am

CSIMS is helpful to its membership, and serves a useful educational role. The organization all in all represents the best of industrial medicine in California, and its newsletter is a good read.
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Re: ML-102 (California)

Postby on Wed Aug 12, 2009 4:45 pm

I agree with Jon 100%. I work for a billing company. We have doctors that always bill for ML-102 for initial visits. I advised them to bill using E/M codes, but they insist to uses ML-102. I have to say they get paid for the ML-102 more times than not. I've only seen 2 bills downcoded to 99204 which I resubmitted to proper codes and got paid. I believe the issue will catch-up when you fight your bill with a smart DA. They will never pay for a ML-102. They will pay for the E/M cpt code. The right thing to do here is to bill fee schedule and bill E/M codes. The hard thing to do is to get the doctor to agree with you!!
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Re: ML-102 (California)

Postby rider001 on Wed Aug 12, 2009 9:29 pm

Experience. I worked for an ortho who insisted on billing ML's on UR denials rebutals because someone at CSIMS told him he could because a dispute exists therefore a ML is justified. Whether CSIMS in fact told him this who knows. So ML's were billed some of them got paid as ML's others that were denied got rebilled and paid as regular reports. I noted there was a modifier -92 meaning ML report by ptp. But 4062.2 states the the AME dance or PME panel process has to be done prior to any comprehensive medical evaluation(ML).
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