The attending provider (AP) has an important role in your workers’ compensation claim. In many cases, people with a work injury claim have trouble finding a doctor for an L&I claim. That’s because many medical providers are simply not willing to get involved with L&I claims. In fact, from my personal experience, medical providers don’t feel they get fair payment for the time they spend responding to administrative inquiries. Sometimes, this is true. However, many providers don’t realize they can bill for time spent on responding to L&I, to claim managers, to administrators and others. The Department of Labor and Industries (L&I) has several billing codes for administrative work. For reference, providers can find the appropriate billing codes for admin work in the L&I billing and payment policy manual.

 

New billing code for workers’ compensation claim providers

Recently, L&I announced an important new billing code that providers can use for online communications with patients and beyond. L&I created the new billing code largely due to COVID. During COVID, many in-person appointments converted to remote or online sessions. Specifically, the new billing code is 9918M. Many treating providers can use this billing code; it’s not limited to the attending provider. More explicitly, attending providers, consultants, psychologists, physical and occupational therapists, and nurse case managers may all use this code. Moreover, they can use this code once per claim per day.

 

What does the new billing code cover in my workers’ comp claim?

L&I claim providers can use the billing code to charge for the following work:

1) Non in-person follow-ups to prior in-person appointments.

2) Non-urgent consultations for L&I claim accepted conditions (assuming the provider would otherwise charge for an equivalent in-person appointment).

3) Reporting and interpreting diagnostic tests that require discussion, medication, or treatment adjustments.

4) Detailed discussions regarding care or treatment plans and medical rationale.

5) Discussions regarding employability.

6) Detailed discussions concerning non-compliance to L&I claim managers, and

7) Discussions with work injury claimants, employers, vocational counselors, and claims managers relating to return to work

 

How is this billing code different?

Unlike before, this code allows providers to bill for communications with non-patient claim parties including vocational counselors. Consequently, it’s important to note that the prior codes 99444 and 98969 are no longer active. There’s no question that L&I claims can be time consuming for providers. Especially when it comes to administrative tasks. However, like this new code for online communications, there are many ways providers can bill for the time they spend on workers’ compensation claims.