Workers Compensation - Washington

Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

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L&I Claim Payment Coverage: New Billing Code Helps Providers with Online Communication

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.


L&I claim and IME exams during COVID

Workers’ compensation claim administrators can ask people with a work injury claim to attend an Independent Medical Examination (IME).  The IME exam is a standard procedure and an integral part of your L&I claim. This fact remains true during COVID.  The Department of Labor and Industries (L&I), self-insured employers and their third-party administrators continue to request IME tests during COVID. If a work injury claimant refuses to attend without good cause, they may receive a penalty. Here, penalties might include a missed-appointment fee or even suspension of benefits under the workers’ compensation claim.


Concerns for people with a workers’ compensation claim

Many people with a workmans comp claim raised concerns about this issue. In fact, here’s a short list of question I heard people ask about their IME exam during COVID-19:

1. If I am “at risk” when it comes to COVID, or if one of my household members is “at-risk”, must I attend the test in person?

2. Say that I live in a county with low Corona-virus infection rate. Do I have to travel to another county with higher infection rate for my medical exam?

3. What if I have an L&I claim but I live outside of Washington State? Must I travel to Washington State and attend the IME in-person?

4. Are there telemedicine IME exams as an alternative?

5. I have an IME exam for my workers’ comp claim. Can I bring an observer with me to the test?

Overall, claim administrators have been reasonably accommodating (so far) during COVID. If a work injury victim has a valid reason for not attending an IME, then you can usually reschedule without penalty.


Valid reasons to reschedule an IME exam under your L&I claim

In my experience, L&I claim managers accept several reasons for rescheduling medical exams. For example, if you are at an age that’s higher risk for COVID complications. Also, if you have health conditions that can put you, or people that live with you, “at-risk” for Corona-virus complications. Moreover, another good reason is feeling unsafe leaving home or traveling to areas with higher infection rates. Finally, when applicable, feeling uncomfortable with interstate travel to attend an IME.


Virtual IME exam

Telemedicine is another alternative. L&I indeed permits online virtual IME tests through telemedicine.  However, as of the date of writing this article, L&I didn’t offer online IME exams to any of my clients. Therefore, I can’t say how successful such tests might be.


Additionally, it’s important to note that some medical panels refuse to allow workplace injury victims to bring an observer. This isn’t right because work injury claimants have the right for an observer, regardless of COVID. In fact, L&I recently reminded the IME panels that work injury claimants have this right.  Consequently, some providers now require people to call in advance if they plan to bring an observer.


Final remarks and notes

In summary, IME tests are occurring during COVID.  Often, workplace injury claimants with a good reason can request to reset the exam without penalty. On top, L&I authorized telemedicine IME providers as an alternative to attending in-person. Most importantly, if you have an L&I claim, know that you have the right to bring another person to observe the exam. You may need to let the IME panel know in advance, however that is your right!


If the panel doesn’t permit you to bring an observer, you should report the incident to L&I right away. If this happens, it’s probably a good idea to consult with a workers’ compensation attorney as well.


Know Your Rights: Choose a Doctor for Your L&I Claim or Workers’ Compensation Claim

In Washington State, work injury claimants have the right to choose their doctor or attending provider (AP) for their claim. This right is part of RCW 51.36.010. Surprisingly, many people that suffer a workplace injury don’t know that they can select their own doctor. Yet, the only requirement is that the doctor or the provider must be part of the L&I Medical Provider Network (MPN).


L&I claim and your right to choose a doctor

There are many reasons for which people with an L&I claim or a workers’ compensation claim are unaware of their rights. Explicitly, the main reasons I see include:


  • Not understanding how a workers’ compensation claim works.  Most people never had a L&I claim They don’t know what an attending provider is, or what is their role. In fact, the attending provider has a very important role in L&I claims.  This provider manages treatment, reports progress, and provides critical assessments throughout the claim. Therefore, it’s important for work injury claimants to choose a doctor or provider who will help them recover and manage their claim productively.


  • Not realizing how a provider becomes their attending physician. Often, the Department of Labor and Industries (L&I) considers the provider that filed the application for benefits as the attending physician. If that provider is an urgent care provider, it’s unlikely they’ll agree to be the attending provider on the workers’ comp claim. If you had a workplace injury and treated in emergency setting, you should seek follow-up care from another doctor that will be an effective AP.


Making your own decisions in your L&I claim

In addition to the reasons above, there are other cases where work injury victims follow recommendations from others. In practice, many recommendations don’t help you choose the right provider for your claim. Such cases include:

  • Being directed to a specific clinic or medical provider. Frequently, work injury claimants tell me their employer told them to see a specific doctor for initial treatment. Then, when they report their injury back at work, the employer provides the name and address of a specific medical provider or clinic for further treatment. Here, claimants are usually under the impression they can only see that provider.


  • Getting referral to occupational medicine doctors from a primary care physician (PCP). Some people ask their primary care doctor for guidance after a work injury. Some PCPs are members of the MPN and can easily become the attending provider. Often, this is an ideal situation.  However, when the PCP is part of a large medical group, the work injury claimant gets a referral to the “occupational medicine” division of the same group.  These groups are often a L&I COHE.  This practice is common at The Everett Clinic and Kaiser Permanente, among others.  Yet, many folks with an L&I claim or a workers’ comp claim don’t realize they don’t have to get treatment there. Regardless of insurance, workplace injury claimants can treat with any provider in the MPN. Even if the attending doctor isn’t part of the same medical group as their primary doctor.


Changing a doctor in your L&I claim

There is no doubt that the attending provider has a critical role in a workman’s compensation claim. One key right is the ability to choose the doctor for your claim. Moreover, with some narrow exceptions, you also have the right to change the doctor for an L&I claim. Changing the attending provider is very simple. More explicitly, you can download and fill the Transfer of Care form (from the L&I website) and send it to your claim manager. As always, keep a record of all communications. This way, you can track and document your decision to designate a new provider.


Final remarks

In summary, the attending provider plays a very important role in workers’ compensation claims. And remember – people with a work injury claim have the right to choose their attending provider.  Therefore, it’s important to choose a physician that’s going to focus on helping you get better and will help move the claim forward productively. Finally, if your attending physician isn’t right for you, then you have the right to switch to a different provider.



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