Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5135 - Evaluation and Management

Universal Citation: LA Admin Code I-5135

Current through Register Vol. 50, No. 9, September 20, 2024

A. Examination, evaluations, treatments, conferences with or concerning patients, and similar medical services necessitate wide variations in the skill, effort, time, responsibility and medical knowledge required for the diagnosis and treatment of work-related illnesses and on the job injuries. The various types of physician visits have been categorized into different levels of service in the CPT.

B. Reimbursement may be made for only one visit per physician per patient per day at the highest level of care provided.

C. When billing for visit and consultations, providers must use the appropriate CPT procedure code that best describes the service rendered.

D. Consultation Services (Procedure Codes 99241-99275).

1. A consultation includes services rendered by a physician whose opinion or advice is requested by another physician or other appropriate source for the further evaluation and/or management of the patient.
a. A consultant may initiate diagnostic or therapeutic services at the request of the attending physician.

b. When the documentation supports a consultative service, reimbursement must be at the appropriate consultative level.

c. A copy of the consultation report must be submitted with the bill in order for reimbursement to be made.

d. The reimbursement for a consultation includes payment for the report. Separate reimbursement must not be made for the report.

e. When a physician performs consultative services and subsequently becomes the treating physician for either total or partial care, reimbursement for the consultative services should not be denied by the carrier. The subsequent services must be billed and reimbursed under the appropriate visit codes, not consultation codes.

E. Hospital Discharge Day Management (Procedure Code 99238). Reimbursement must not be made for this service in addition to another hospital visit billed by the same physician on the same day for the same patient.

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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