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Thread Title: Billing supplies and burn treatment
Created On Wednesday January 07, 2009 2:51 PM

CompDoc
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Wednesday January 07, 2009 2:51 PM

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I'm an MD doing only Occ Med in a solo office. I've had great difficulty getting reimbursed for treatment of moderately serious burns (e.g. multiple 2nd degree of face and chest, arms and/or abdomen. There being no forum on billing that I can see, I hope someone reading here might suggest.

Treating burns involves a lot of expensive supplies and medication. I have very little success getting paid for supplies used to dress wounds or burns or suturing, etc. I don't know if I'm using the right coding, the right fee schedule - anyone know what I should be?

Treating burns also involves a large amount of time every day for weeks, including Sundays and Holidays. Billing *16025 ("initial burn dressing - medium") and 99025 "Visit with Starred procedure" usually gets me paid exactly nothing. In fact, using the starred procedure codes for lacerations is often unsatisfactory. I have been paid for a band-aid but not the wound repair or visit. But I digress.

Any suggestions how I can at least hope to break even on this case?

docwats

JTQUILTER
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Wednesday January 07, 2009 5:42 PM

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I haven been an OccMed biller for 20+ years. I would suggest that on the initial visit, you bill the appropriate EM cope with a modifier 25 (separately identifiable services) plus the appropriate burn dressing and/or debridement code (16010-16030). Bill sterile tray required for debridement. Bill supplies dispensed as separate items or Rx themand have the patient purchase and submit directly for reimbursement.

Subsequent visits scheduled specifically for the purpose of debridement do not support an office visit charge but again, charge the appropriate code for the burn dressing/and or debridement plus sterile tray and supplies. Whirlpool (97022) prior to debridement is also and appropriate charge.

Be sure that your documentation includes the percentage of body surface involved and the depth/degree of the burn.

Hope that helps.

steve appell
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Thursday January 08, 2009 8:06 AM

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Bill sterile tray required for debridement. Bill supplies dispensed as separate items or Rx themand have the patient purchase and submit directly for reimbursement.

NEVER COLLECT MONEY DIRECTLY FROM AN IW
(see below)

LC3751. (b) If an employee has filed a claim form pursuant to Section
5401, a provider of medical services shall not, with actual knowledge
that a claim is pending, collect money directly from the employee
for services to cure or relieve the effects of the injury for which
the claim form was filed, unless the medical provider has received
written notice that liability for the injury has been rejected by the
employer and the medical provider has provided a copy of this notice
to the employee. Any medical provider who violates this subdivision
shall be liable for three times the amount unlawfully collected,
plus reasonable attorney's fees and costs.

-------------------------
Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

JTQUILTER
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Thursday January 08, 2009 12:46 PM

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What I meant to say was rather than dispensing dressing supplies and not getting paid for them, give the patient a prescription for the dressing supplies and have the patient submit receipts for purchase of same to the carrier for reimbursement. (The same as with an Rx for medications, ointments, etc.) Not collect money from patient.

docwats
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Friday January 09, 2009 4:38 AM

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I don't think JTQuilter was suggesting that a physician charge the patient for supplies, only that the patient purchase them from a store and seek reimbursement from the WCC. This is routine. I can tell you the WCC almost never reimburses me for the supplies I dispense and mark as such, and it comes to as much as 25% of the E/M visit. That may say more about the CA fee schedule than the cost of dressings. I did at one time dispense rather freely, but couldn't stay in business doing so now.

docwats
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Friday January 09, 2009 4:57 AM

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Yes, that is helpful, thank you.

I have difficulty getting reimbursement for "sterile tray" for suturing, etc. I saw reference in another forum area about docs not using the correct coding for supplies - any suggestions there?

If I understand you correctly, the dressing changes do not warrant e/m charge, but a main purpose of changing the dressings is to see the burns and assess their condition, a medical decision-making process. I should hope at least the 99025 "Visit with starred procedure" should be paid. Bill reviewers seem widely unaware of how starred procedures are to be handled. However, I would be happy to be paid for the debridement and supplies. I often cannot get that. I have not filed liens in the past; it looks like more trouble than it might be worth.

If I charge 16020, supposedly $45.90, get discounted by an MPN to about $38 (a discount I have never agreed to, but a matter for another forum), it barely covers out-of-pocket costs for supplies, ignoring rent, labor, and utilities. Even so, I can't seem to get that in many cases. The Silvadene alone is about $20 for a good-sized burn.

As I often tell my patients, if you're looking for logic and fairness in Workers Compensation, you may be disappointed.

Thank you, CompDoc

JTQUILTER
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Friday January 09, 2009 12:25 PM

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Yes, it is quite difficult to stay in business when the reimbursement rate according to the outdated fee schedule is out of sync with reality. To discount that, is even worse. If you have not agreed to a discount, do not accept it! We get reimbursed for our sterile debridement trays because we purchase them from a vendor and can provide an invoice for them to prove cost.

I have also experienced that treating burns turns out to be a long and expensive process that is not well reimbursed. If it is anything other than a minor trauma, I would suggest that you consider referring the IW to a plastic surgeon or wound care program. i am certain that reimbursement is not so much of a problem once the claim is "kicked up a notch".

Hang in there! We need to keep as many (good) OccMed docs in the WC arena as possible -

docwats
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Friday January 09, 2009 12:59 PM

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Fortunately, that is how this one has apparently gone, but it is 1 - 3 hours drive each way to any of the three nearest burn centers - and we're near Stockton! Referrals to Plastic, Derm, and so many other specialties are near impossible. And it appears the new rate schedule, good for docs like me, but with cuts for specialists, may make it more difficult still.

Can you tell me what fee schedule is used for supplies?

Thank you for your encouraging words.

JTQUILTER
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Friday January 09, 2009 1:15 PM

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We continue to bill supplies using code 99070. We include DME codes whenever appropriate and/or possible. Oh, by the way, the 99025 (initial office visit with asterisk proceedure) is only appropriate for the initial visit. I guess they feel that follow-up visits are scheduled not so much for evaluation but specifically for debribement and wound care.

When a doctor does what is best for the patient, it is a good and noble thing. It is extremely unfortunate that his care plan is most often diluted and convoluted by the many "layers" that have become a part of the WC care delivery system. It is not a wonder that the good docs are fleeing the system for other specialties that are less complicated, more lucrative and much more fulfilling!

Somethin's gotta give!

Lienexaminer
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Monday January 12, 2009 8:52 AM

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When billing for supplies it is necessary to us a HCPCS code.
The HCPCS code is a part of the DMPOS fee schedule (DME, prosthetics, orthotics and supplies) -- the S in DMEPOS.
For every supply there is a HCPCS code. The code 99070 is a miscellaneous code that can be used for anything -- and often a provider will NOT get paid when using this code because there is not enough information for the bill reviewer to dtermine reimbursement -- it just means miscellaneous. The bill reviewer may indicate on the EOR zero payment and request more information from the provider in order to review the bill properly. So if a HCPCS code is used then reimbursement should be made as each of these codes have a description and a value.

Here is the link for more information about HCPCS:

http://www.cms.hhs.gov/MedHCPCSGenInfo/20_HCPCS_Coding_Questions.asp

And here is the link to more information about the DMEPOS:

http://www.dir.ca.gov/dwc/OMFS9904.htm#3

I hope I did the links right ...

CompDoc
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Tuesday January 13, 2009 7:19 AM

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Thank you, Lineexaminer, I believe this gets me closer to what I'm looking for. I was able to download the spreadsheet that seems to be the most recent DMEPOS fee schedule, and I see the HCPC codes. Some of it is very cryptic, for example the F1 code for "LEFT HAND SECOND DIGIT". It is not clear to me whether this refers to a dressing change. I haven't gone through all 10,000 entries but hope to find topical summaries referenced on the Coding Questions page at the HHS site.

Perhaps of more immediate interest, is if and where the codes are translated to allowable dollars. I don't bill Medicare or private insurance or this would probably be second nature. I think I found the Medicare fee schedule for E/M and other Level I services, but don't recall whether I found supplies.

The links worked fine. The Coding Questions page refers such questions as mine to a PDAC contractor who is to provide answers to questions. It appears to be without an actual link despite one being referred to in the body of the text.

I have been billing everything 99070- with a two digit modifier of my own creation for each item. This info should help me to correct that.

OccDoc

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