California comp drivers Part 1

Coding for Dollars!

California represents 1/5th of total workers’ comp benefits.

So we’d better pay a LOT of attention to what’s happening in the Golden State…which is rising medical expenses - and rising insurance premiums. The fine folks at CWCI have been tracking this issue for some time.

Why?

Several reasons - which we will unpack one at a time. Today its “unlisted codes”, a label applied to services delivered that are “not accurately described by other HCPCS CPT (Current Procedural Terminology)procedure codes.”

Of particular interest is the growing prevalence of unlisted codes in physical medicine (PM). Last year saw a huge jump in PM services coded as 97799 - “unlisted physical medicine”.

Note that jump happened while the use of normal/traditional/common PM codes for services including therapeutic exercises and manual therapy declined.

Oh, and these 97799 codes account for a third of all PM spend in California - at an average cost of $1700 each.

What does this mean for you?

There’s always some looking to plunder workers’ comp.

You should take a VERY close look at your spend and drivers thereof.