Bernadine Singh
Chief Medical Fee Examiner
N.C. Industrial Commission
E-mail: Bernadine.Singh@ic.nc.gov
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NOTE 1: To purchase a complete copy of the American Medical Association’s Current Procedural Technology Codes, telephone Ingenix, Inc. at (800) INGENIX (464-3649), option 1, or go to http://www.shopingenix.com/modules/catalog/catalog_category.asp to order a CPT® code book online. NOTE 2: Please report any problems or errors directly to Bernadine.Singh@ic.nc.gov. NOTE 3: This page was last revised on February 20, 2009. |
|
Introduction |
CPT
Codes and Fees /
Commission Assigned Codes |
| Evaluation and Management Section 3 | Physical Medicine Section 10 |
| Anesthesia Section 4 (effective April 1, 2000) | Chiropractic Fee Schedule Section 11 (effective March 1, 2001) |
| Surgery Section 5 | Industrial Rehabilitation Section 12 (effective January 1996) |
| Radiology Section 6 | Dental Fee Schedule Section 13 (effective May 1, 2007) |
| Pathology and Laboratory Section 7 | Hospital and Ambulatory Surgical Center Section 14 (effective July 15, 2002) |
| Medicine Section 8 | Forms Section 16 (effective February 1, 2000) |
| Special Services Section 9 | Durable Medical Equipment/Supply Fee Schedule (effective January 1, 2008) |
· Nerve conduction studies: CPT Codes 95900, 95903, 95904, and 95937 require the number of nerves in the time field. These should be listed on Form 25M or the Form 1500. There is a technical and professional component for each of these codes in the new Medical Fee Schedule and modifiers are required.
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Special Services CPT codes will require modifiers. Please
reference the Master File to see which codes require 26 and 27.
Technical (taking) “27” or “TC”
Professional (reading) “26”
· The North Carolina Industrial Commission has reviewed processing procedures of diagnostic testing when physicians perform both the technical and professional components at a hospital facility. In accordance with the North Carolina State Health Plan, whom by law the Industrial Commission is to emulate, the North Carolina Industrial Commission is issuing the following rules to apply in cases when the physician or radiologist performs the interpretation (professional) and the diagnostic services (technical) within the hospital facility.
1. Hospital may charge for use of equipment.
2. No allowance for hospital visit, unless medically necessary for physician to treat patient.
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The Industrial Commission asked Medicode to research CPT Codes
90700-90799. Because of the
variance of cost for the different injections, the providers are not receiving
reimbursement to cover their cost. We
are implementing a policy to allow flexibility in payment when the injection
materials have a significant cost over and above the value of the procedure.
The invoice may be attached to the bill to verify the cost.
If invoice is not submitted, the Carrier has the right to request a
copy if they feel it necessary. We allow a 20 percent (20%) markup above the
cost.
When an injection is given during an office visit service provided by a physician, the cost of providing the injection is included in the payment for the office visit. The cost of the injectable medication may be billed using CPT code 99070 or the CPT code(s) assigned in the North Carolina workers’ Compensation Fee Schedule, which is for materials. When the injection is provided without services by the physician, you may use CPT code 99211 and charge for the medication using code 99070 or CPT codes assigned in the Fee Schedule which is for the materials.
Psychiatric Bills
Psychological Services
| Code | Procedure Description | Time Required | Allowance |
| PSY01 | Consultation | No time required | $119.00 |
| PSY02 | Return visit | Time required | $75.00 per hour |
| PSY03 | Testing | Time required | $75.00 per hour |
| PSY04 | Group | Time required | $20.00 per hour |
Code Allowance (Previous Allowance) CPT Code 90901 $78.00 ($22.00) CPT Code 90911 $124.00 ($176.11)