New York Workers Compensation Critical Update: Part 2

US Chiropractic Directory

from the desk of:

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

"NYS WC Critical Update, Part 2"

Getting Existing Patients into the New System

Disclaimer: This opinion does not reflect any organization, including, but not limited to, the US Chiropractic Director or any state or national organization. It is the sole opinion of Dr. Mark Studin and is intended to be a tutorial for the new NYS WC Guidelines. Each doctor has to base his/her utilization of the guidelines, codes and treatment plans based upon the clinical findings of his/her individual patients.

Getting your patient into the new WC system is quite easy, however, so is getting a denial. I have been getting calls statewide as to why the patients are getting denied in the new system when the doctor is providing services within the guidelines. The solution is an easy one and ensures timely payments.

The regulations state that for a new patient, you need an evaluation that clearly outlines the goals of care. In the new system, the same process is required so that the WC Board and the carriers have care goals defined to determine the metric of the efficacy of your care and when that care is no longer indicated. In order to create that, you need to perform a re-evaluation on all of your existing patients on the first visit starting December 1, 2010, regardless of when the last re-evaluation was performed.

The only option for coding a re-evaluation is 99212, the same as the old 99213; confusing and not smart. During the re-evaluation visit, the doctor may charge 11 RVU's on the visit to include the treatment as well.

The next consultation will outline potential treatment plans.