MEMORANDUM NO. 1998-15
Revisions to the Official Connecticut Practitioner Fee Schedule
|TO:||The Workers' Compensation Community|
|FROM:||Jesse M. Frankl, Chairman|
|DATE:||October 21, 1998|
|RE:||Revisions to the Official Connecticut Practitioner Fee Schedule|
The purpose of this memorandum is to correct errors in the Official Connecticut Practitioner Fee Schedule and to provide answers to some questions that have been referred to this office.
- On page 5 of the Fee Schedule the interest calculation example is incorrect. To find the interest factor appropriate for a late payment, the formula is the number of days from receipt of the complete bill filing (68) divided by 365 and multiplied by 10% (.10). The correct factor for interest is 68/365 x .10 = .0186. The total payment due the provider would be 1.0186 times the fee amount.
- On page 6 of the Fee Schedule, item Q, the words "for the same injury" should be deleted.
- On page 7 of the Fee Schedule, item G, the second paragraph should be changed to read, "This information is required for the initial visit for any new injury to a new body part that occurs to an established patient as well as the initial visit of a new patient. Visits that meet these guidelines will be reimbursed at level 4 for new patients and at level 3 for a new injury to a new body part for an established patient."
- On page 7 of the Fee Schedule, item G, the fourth paragraph should read, "Visits that meet these guidelines will be paid at the appropriate level 2 rate." Everything after this should be deleted.
- On page 7 of the Fee Schedule, "Other Guidelines", item A, the next to the last sentence should read, "Reimbursement for supplies and equipment must not exceed 130% of the acquisition price."
- On page 73 of the Fee Schedule, CPT code 29888 should allow for an assistant surgeon.
- On page 213 of the Fee Schedule, after the sentence that reads, "Code Q0103 is allowed only once per each compensable event," add the following: "This code eliminates the need to use codes 97001 and 97003 for an initial visit. Reevaluation codes 97002 and 97004 are to be used at the end of a treatment plan in determining any future course of action. The fee for this service is included in the $90 daily cap and should be incorporated in the activity on the final day of the treatment plan."
- Down coding of bills is still appropriate when the billing code is incorrect; however, all down coding has to be explained on the explanation of the payment. This comment must contain the rationale for the down coding.
- The guidelines do not allow for an RN to be an assistant surgeon. They do allow for a PA to be an assistant surgeon in hospitals that do not provide interns or residents. The reimbursement for a non-MD provider is 70% of the 20% of the surgical fee that would be paid to a physician acting as an assistant surgeon.
- In regard to Pharmacy Reimbursement, page 7 of the Fee Schedule:
- The dispensing fee applies to all sites of purchase including pharmacy, physician office and hospital.
- The dispensing fee applies to all drug prescriptions.
- The billing should be separate for ingredients and dispensing fee.
- The NDC code must be included on the bill.
- The guidelines do not anticipate that a physical therapist will use the 25 modifier. Payment should not exceed $90 except where the initial Q0103 code is applicable or where the payer is requesting additional information.
- A chiropractor can bill for an initial evaluation separately from any manipulation charges. As the treating physician, the chiropractor is allowed to bill for a reevaluation over and above billing for treatment. This charge is in addition to the $90 allowable charge for treatment. The reevaluation is allowable at the end of the treatment plan in order to determine patient status and future direction. A reevaluation is not allowed more than once every 6 weeks and is subject to the documentation requirements outlined in "General Guidelines," section II G.
To order a copy of the Official Connecticut Practitioner Fee Schedule, please contact Medicode, Inc. at 1-800-999-4600.