by Marc Rhee, Esq. and Jennifer M. Smith, Esq.

The 2014 Georgia Workers’ Compensation Fee Schedule went into effect on May 1, 2014, one month later than the typical effective date of April 1st. The delay this year was due to the delay in implementation of “ICD-10” (the Internal Classification of Diseases, 10th edition), the coding system used primarily for diagnosis coding but also procedure coding in healthcare billing. The State Board of Workers’ Compensation is adopting “ICD-10”, but has decided to delay implementation to coincide with the Centers for Medicare and Medicaid Services’ (CMS) date of implementation, which is currently set for October 1, 2015. Originally, ICD-10 was scheduled to be in effect on October 1, 2014, but federal law delayed the transition. It is possible that Congress could further delay the implementation as healthcare reform continues to be a hot topic on Capitol Hill. Because of the anticipated transition to “ICD-10”, however, the State Board made a number of significant changes to the fee schedule this year.

The State Board will follow the coding methodology of CMS and continue to recognize ICD-9 sections I and II for diagnosis coding, but not ICD-9 section III, used for procedure coding of outpatient procedures in the Hospital / ASC (Ambulatory Surgical Center) Section of the fee schedule. This section has been modified by adopting the Medicare OPPS (Outpatient Prospective Payment System) reimbursement model, with state specific guidelines. The fee schedule amounts will be found under the columns “APC” (Ambulatory Payment Classification) and “OP MAR” (Out Patient Maximum Allowable Reimbursement) in the Physician Fee Schedule.

Fee schedule amounts have been re-calculated for Physician, Home Health, Transportation and Inpatient Hospital codes. Rates for Independent Medical Evaluations (IMEs) and physician testimony and depositions, on the other hand, have not changed from the 2013 fee schedule: $600.00 for the first hour and $150.00 for each additional 15 minutes. Medical record copy reimbursement, supplies, DME, and orthotic fee schedules also remain unchanged from 2013.

Lastly, the State Board of Worker’s Compensation also implemented the revised CMS 1500 billing form, version 2/12. The grace period to change to the new form that has not been determined.

Please visit https://sbwc.georgia.gov/medical for all notable changes with the new 2014 fee schedule. If you have any questions, please contact Jennifer.Smith@atkinsdavid.com or (404) 446-4481.