Current through Reg. 49, No. 38; September 20, 2024
Case management responsibilities by the treating doctor are
as follows:
(1) Team conferences and
telephone calls shall include coordination with an interdisciplinary team.
(A) Team members shall not be employees of
the treating doctor.
(B) Team
conferences and telephone calls must be outside of an interdisciplinary
program. Documentation shall include the purpose and outcome of conferences and
telephone calls, and the name and specialty of each individual attending the
team conference or engaged in a phone call.
(2) Team conferences and telephone calls
should be triggered by a documented change in the condition of the injured
employee and performed for the purpose of coordination of medical treatment
and/or return to work for the injured employee.
(3) Contact with one or more members of the
interdisciplinary team more often than once every 30 days shall be limited to
the following:
(A) coordinating with the
employer, employee, or an assigned medical or vocational case manager to
determine return to work options;
(B) developing or revising a treatment plan,
including any treatment plans required by division rules;
(C) altering or clarifying previous
instructions; or
(D) coordinating
the care of employees with catastrophic or multiple injuries requiring multiple
specialties.
(4) Case
management services require the treating doctor to submit documentation that
identifies any health care provider that contributes to the case management
activity. Case management services shall be billed and reimbursed as follows:
(A) CPT code 99361.
(i) Reimbursement to the treating doctor
shall be $113. Modifier "W1" shall be added.
(ii) Reimbursement to the referral health
care provider shall be $28 when a health care provider contributes to the case
management activity.
(B)
CPT code 99362.
(i) Reimbursement to the
treating doctor shall be $198. Modifier "W1" shall be added.
(ii) Reimbursement to the referral health
care provider shall be $50 when a health care provider contributes to the case
management activity.
(C)
CPT code 99371.
(i) Reimbursement to the
treating doctor shall be $18. Modifier "W1" shall be added.
(ii) Reimbursement to a referral health care
provider contributing to this case management activity shall be $5.
(D) CPT code 99372.
(i) Reimbursement to the treating doctor
shall be $46. Modifier "W1" shall be added.
(ii) Reimbursement to the referral health
care provider contributing to this case management activity shall be
$12.
(E) CPT code 99373.
(i) Reimbursement to the treating doctor
shall be $90. Modifier "W1" shall be added.
(ii) Reimbursement to the referral health
care provider contributing to this case management action shall be
$23.
