Med Legal Charges (California)

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Med Legal Charges (California)

Postby laesquire on Mon Nov 02, 2009 2:14 pm

SCENARIO:

1. PTP on Psyche for a New Schedule case. Injury denied. PTP does a Med Legal upon seeing the Applicant then upon discharge. Also various treatment. The bills come out to about $ 5,000.

QUESTION:

Does the PTP on injury denied cases still get paid for Med legal charges ( M-L 103, ML 106 etc.) considering 4062.2 Panel QME process?
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Re: Med Legal Charges (California)

Postby vampireinthenight on Mon Nov 02, 2009 2:55 pm

Sure, LC 4061.5, CCR 9793(c). Was it used to prove or disprove a contested claim?

Need more information on the denial, reasons and timing, if that is what you are hanging your hat on.
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Re: Med Legal Charges (California)

Postby jonbrissman on Mon Nov 02, 2009 7:13 pm

The defect I most often see in a medical-legal report issued by the PTP is that there is no written request by a party. The PTP may not decide on his own that he may produce a M-L report. Remember the definition: It must be requested by a party to prove or disprove a contested claim or a disputed medical fact.

The majority of final reports by the PTP are simply treatment reports (CPT 99080) and do not qualify as medical-legal. Generally, M-L reporting comes later when one party of the other objects to the conclusions of the PTP.

The charges for a PTP's final services can come close to M-L levels when the doctor charges for an office visit (CPT 99213, 99214, or 99215), and as appropriate, records review (CPT 99358), range-of-motion testing (CPT 95851), grip-strength testing (CPT 95852), x-rays, and the narrative report (CPT 99080).

JCB
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