Billing Codes for Performance in Workers’ Compensation

TRACK: Management and Administration in OEM

Robert C. Blink, MD, MPH, FACOEM, Worksite Partners Medical Group, Inc., San Francisco, CA
Marianne Cloeren, MD, MPH, FACOEM, Managed Care Advisors, Inc., Bethesda, MD
Kimberly George, Sedgwick Claims Management Services, Inc., Chicago, IL
Lee S. Glass, MD, State of Washington, Department of Labor and Industries, Mercer Island, WA

There is a long-standing disconnect between required documentation in patient encounters in order to be paid, and what needs to done in a clinical workers’ compensation encounter in order to practice evidence-based medicine and have good outcomes. A committee under the ACOEM Council on OEM Practice is developing a model for coding workers’ compensation care, which, if adopted, would incentivize clinicians to provide the kind of care needed to help patients recover more quickly, lose less time, and avoid unnecessary or harmful diagnostic testing and treatment. This panel discussion, featuring system stakeholders including OEM physicians, employers, and payers, will address efforts to change coding and payment arrangements that would reward critical OEM services and bypass irrelevancies of current compensation systems. Topics will include feasibility, precedent (Washington and Colorado examples), potential champions, synergy with other efforts, and potential obstacles. This session was organized by the Private Practice in Occupational Medicine Special Interest Section.