Clear documentation rules are needed for multiple types of clinical services critical or specific to workers' compensation care. This page details the current plans or draft documents related to each of these types of service.
Here is a one-page value statement to describe the project and plans.
Evaluation and Management Codes
Evaluation and Management (E&M) Codes are the codes used to bill routine encounters (initial or follow-up care) with any kind of specialist. We have developed alternative documentation rules for using these routine care codes for workers' compensation encounters.
Although CMS does not recognize outpatient consultation code services, there is still a great need for these codes and rules for using them in workers' compensation. Draft rules for applying these codes and documenting care are in development.
We plan to develop specific rules for documentating physician case management services separate from the routine encounter, for workers' compensation purposes.
We plan to develop specific rules for deploying formal risk factor screening in workers compensation care, and for documenting this service.
Work Disability Prevention Counseling
When work disability risk factors, such as fear/avoidance or disability beliefs, are identified, there is a role for treating providers to provide targeted counseling, education and follow-up to mitigate the impact of these risk factors on recovery and return to work. This service will likely need new codes, with specific rules for documenting the need for such service, the counseling provided, and the outcomes.