FAQs
Below are some of the most frequently asked questions regarding the work comp services we offer to other doctors.
| Questions regarding Permanent and Stationary Reports |
| Questions regarding Co-Management and Referrals |
| Questions regarding Ergonomic Evaluations |
Permanent and Stationary (P&S) Reports
When is an injured worker considered permanent and stationary?
An injured worker is considered P&S when their recovery has reached a plateau (no further significant improvement or decline), but they have not returned to pre-injury condition.
Is it legal to refer my P&S report writing to another doctor?
Yes, LC 4061.5 allows for such referrals to qualified doctors. We have done many over the years.
How much will it cost to refer my reports to another doctor?
There is no cost to the referring doctor. The evaluating doctor bills the insurance carrier directly.
Can I bill the carrier for reading and adopting the referred report?
Yes, you must read and adopt the report; you can bill the insurance carrier for these required services.
What codes do I bill for reading and adopting the report?
Common Current Procedural Terminology (CPT) and Evaluation & Management (E/M) codes are used to bill for reading and adopting the report. The following are often used and are outlined in the Official Medical Fee Schedule (OMFS):
99358 (non face-to-face time) for every 15 minutes for reviewing the report
99080 (special report 1st page) for the report adoption letter sent to the
insurance carrier
The insurance carrier is denying such a referral, and indicates they will not pay for such a report. Can they do that?
No. You are responsible for submitting a referral letter to the insurance carrier. You do NOT require pre-authorization. The doctor who writes the report is responsible for getting paid by the carrier.
What if I disagree with part of the report?
Simply indicate the parts of the report with which you disagree and support your opinion in the adoption letter. The adoption letter will then override what is written in the report. Remember, it is YOUR opinion that is important.
What if my patient does not speak English?
An interpreter will be provided and paid for by the insurance carrier. In such cases, you may want to allow for additional time, because the interpreter will most likely want to have their services pre-authorized.
What is involved in referring a P&S report?
There are three steps in the referral process:
| 1. | Inform the insurance carrier. |
| 2. | Have patient schedule an exam with the evaluating doctor. |
| 3. | Adopt the report provided. |
Co-Management and Referrals
Why co-manage a patient?
Every doctor has his or her specialty. We are a chiropractic clinic specializing in workers' compensation. However, we do not prescribe medication, perform surgeries or injections, or do advanced testing, such as CT or MRI scans, etc. For these services, we refer the patient to specialized providers. Likewise, medical doctors and surgeons do not perform chiropractic adjustments or axial traction, provide physical therapy, or manage the "med-legal" side of the case. Our office provides these services.
If a patient is referred, who is the Primary Treating Physician (PTP)?
There can be only one PTP at any given time. In order to become the PTP, you must inform the insurance carrier. Being the first or only doctor who provides treatment does not automatically make you the PTP. When a PTP refers a patient for chiropractic services, the referring doctor remains the PTP.
Ergonomic Evaluations
Who requires ergonomic evaluation?
Many employees spend long hours working on ill-fitting or poorly arranged workstations, which often contributes to symptoms including wrist, forearm, should, neck, and low back pain. As the PTP, you may consider requesting an ergonomic evaluation whenever you believe that the patient's work environment is hindering a speedy recovery.
How do I request an ergonomic evaluation?
Submit a request (on a PR-2 form) to the insurance carrier to have an ergonomic evaluation performed to determine if the workstation is contributing to the injury. The insurance carrier must pre-authorize the evaluation. Contact our office and we can make arrangements with the patient to conduct the evaluation at their workplace.
How will the ergonomic evaluation be performed?
A doctor will visit and evaluate the patient at their workplace; each evaluation
requires about 30-40 minutes with the patient. A written report will be provided
to the insurance carrier and the referring doctor. Pre-authorization from
the insurance carrier is required.