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.
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