Recently, the OSCA has been fielding a number of calls with concern to the revised MEDCO 14 with Workers Compensation. We just got off the phone with the bureau and have clarification as to the expectation on this revised document.
For those that may not be up to speed on this let me digress for a minute. The MEDCO 14 is a document that is to be used when the Physician of Record (POR) is going to modify or restrict work activity of a patient. The Patient is to fill out the C-84 and the POR is to complete the MEDCO-14. When the MEDCO-14 was revised the goal was to have more accurate info as to why the POR was putting forward work restrictions and to ensure they were monitoring it appropriately.
Many providers were under the impression that the bureau was expecting them to complete this form each and every visit. THIS IS NOT CORRECT! The miscommunication originated from the definition of "Office Visit.” In the coding world an "office visit” is an evaluation or what most chiros call an exam. If you look in CPT you will find that your 9920x and 9921x codes are called "office visit” codes. In our profession we call each visit an office visit. This is where the assumption came from that chiropractors would be required to fill out the new MEDCO-14 each and every visit.
After communicating with the bureau and getting it in writing from them, we want to be clear on the expectation with this form. Please read below for the proper use of the MEDCO-14:
When you perform your initial evaluation of a patient and you are going to modify their work abilities in any way you need to complete a MEDCO-14. You need to consider this document as part of your treatment plan. Your treatment plan called for the patient to be seen for three times a week for four weeks at which time you will re-evaluate the progress of the patient. You would not complete another MEDCO-14 until that re-evaluation date. At that time you would have to do one of the two following notations:
1. If there are no changes to the work order than you would simply notate in your medical record for that day that there are no changes to the work order. You would not need to complete the actual form, rather just note it in your report or SOAP note depending on how you document your evaluations and treatment plans.
2. If there are modification that need to be made on the work order than you would complete a new MEDCO-14 to express those changes.
The only other time you would need to complete the MEDCO-14 is if there was significant change prior to the re-evaluation that would cause you to change the work order. You would complete the MEDCO-14 at any point that change would be appropriate. But at a minimum you would need to complete it at each evaluation.
You can use the new MEDCO-14 now but it will be mandatory to use the new form on and after August 17th. You need to look at the forms you have in your office to see which ones you are currently using. You can clearly see on the bottom left hand corner of the form. The new forms will say "BWC-3914 (6/27/2012).” If you do not have the new forms you can get them on the OSCA website under the "Members Only” section by clicking on the "BWC” tab.
As always feel free to give us a call if you have additional questions.
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