Joe Paduda of Managed Care Matters discusses rising Workers Comp cost in California:
Of particular interest is the growing prevalence of unlisted codes in physical medicine (PM). Last year saw a huge jump in PM services coded as 97799 – “unlisted physical medicine”.
Note that jump happened while the use of normal/traditional/common PM codes for services including therapeutic exercises and manual therapy declined.
Oh, and these 97799 codes account for a third of all PM spend in California – at an average cost of $1700 each.
What are unlisted codes and why do we need them? PlutusHealth explains:
Medical science is advancing exponentially. New services, devices, and medicines are entering the field quicker than ever before. Unfortunately, the American Medical Association (AMA) may take 18-24 months to modify CPT codes to reflect these advancements. In these circumstances, unlisted codes meet the crucial task of expediting the process of coding and billing.
This seems odd. While these unlisted codes are highly reimbursed, payers often reject them unless there is extensive documentation around the service performed, the extenuating circumstances, and technical specifications.
However, with AI, doing all this documentation is much easier. Are physicians simply entering a description of the services and asking AI to document in such a way that insurance will reimburse? While I don’t have evidence to say that AI is the reason for the rise in unlisted medical codes, it is true that AI is being widely used for medical documentation. Is AI the explanation or is there another reason? What do you think?
