La. Admin. Code tit. 40 § I-5135
Current through Register Vol. 50, No. 11, November 20, 2024
Section I-5135 - Evaluation and ManagementA. Examination, evaluations, treatments, conferences with or concerning patients, and similar medical services necessitate wide variations in the skill, effort, time, responsibility and medical knowledge required for the diagnosis and treatment of work-related illnesses and on the job injuries. The various types of physician visits have been categorized into different levels of service in the CPT.B. Reimbursement may be made for only one visit per physician per patient per day at the highest level of care provided.C. When billing for visit and consultations, providers must use the appropriate CPT procedure code that best describes the service rendered.D. Consultation Services (Procedure Codes 99241-99275).1. A consultation includes services rendered by a physician whose opinion or advice is requested by another physician or other appropriate source for the further evaluation and/or management of the patient.a. A consultant may initiate diagnostic or therapeutic services at the request of the attending physician.b. When the documentation supports a consultative service, reimbursement must be at the appropriate consultative level.c. A copy of the consultation report must be submitted with the bill in order for reimbursement to be made.d. The reimbursement for a consultation includes payment for the report. Separate reimbursement must not be made for the report.e. When a physician performs consultative services and subsequently becomes the treating physician for either total or partial care, reimbursement for the consultative services should not be denied by the carrier. The subsequent services must be billed and reimbursed under the appropriate visit codes, not consultation codes.E. Hospital Discharge Day Management (Procedure Code 99238). Reimbursement must not be made for this service in addition to another hospital visit billed by the same physician on the same day for the same patient.La. Admin. Code tit. 40, § I-5135
Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.