La. Admin. Code tit. 40 § I-5141

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5141 - Soft Tissue Injury Care

A. Initial Visits

1. Initial (new patient) treatment for soft tissue injuries must be billed under the appropriate medical (office) visit code.

2. When a cast or strapping is applied during initial visit, supplies and materials used such as stockinette, plaster, fiberglass, ace bandages, etc., may be itemized and billed separately using Procedure Code 99070.

3. Replacement casting and strapping codes (29000-29799) must not be used for initial care.

B. Follow-Up Visits

1. Replacement casts or strapping, provided during follow-up visits, must be billed under the appropriate replacement Procedure Codes (29000-29799).

2. The reimbursement for replacement casts or strapping includes reimbursement for the service, supplies and materials usually required and the removal of casts, splints or strapping.

3. Special supplies, such as fiberglass casting materials, may be billed under Procedure Code 99070 and reimbursed separately.

4. Follow-up visit charges may be reimbursed in addition to replacement casting and strapping procedures only when significant, identifiable, further medical services are provided. The HCFA 1500 Form should indicate an additional diagnosis, when appropriate, and office notes should substantiate the medical necessity of the visit.

5. When replacement and strapping procedures are not performed during follow-up visits, the services should be billed under the appropriate established patient visit code in the evaluation and management section.

6. When an initial casting and strapping is applied for the first time during a follow-up visit, reimbursement may be made for the supplies and materials itemized under Procedure Code 99070 in addition to the appropriate established patient follow-up visit level.

La. Admin. Code tit. 40, § I-5141

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

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