Claims Kit

LWC’s Office of Workers’ Compensation issues 2nd emergency rule

As concerns over the health and wellbeing of injured workers increase as a result of COVID-19 (novel coronavirus) the Louisiana Workforce Commission (LWC), Office of Workers’ Compensation Administration remains vigilant in its effort to ensure that injured workers receive the medical attention their injury warrants under the Louisiana Workers’ Compensation Act.

To that end, the LWC issued an emergency rule on Thursday, April 3, 2020 to be effective from 12:01am April 3, 2020 and shall remain in effect for the maximum time period allowed under the Administrative Procedure Act or for the period of the Governor’s Stay-at-Home Order, whichever shall end first. The Emergency Rule can be found at: https://www.doa.la.gov/Pages/osr/emr/emr.aspx .

The rule provides for the following during any period of time for which the Governor has declared a state of emergency:

 Workers’ compensation insurers should accept the use of modifier 95 to note telehealth/telemedicine methods.

 Additional temporary codes for General Medicine can be used, where applicable:

o 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION

o 90792 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES

o 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES

o 90833 PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN o 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES

o 90836 PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN

o 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES

o 90838 PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN

o 90863 PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY

o 92521 EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)

o 92522 EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE

o 92523 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION

o 92524 BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

o 96105 ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR o 96156 HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

o 96158 HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN

o 96159 HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN

o 97129 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES

o 97130 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES

 Additional temporary codes for Physical Medicine can be used, where applicable:

o 97161 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS

o 97162 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS

o 97163 PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS

o 97164 PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS

o 97165 OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS

o 97166 OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS

o 97167 OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS

o 97168 OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS

 Additional temporary codes for Evaluation and Management can be used, where applicable:

o 99495 TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE

o 99496 TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE

 These additional codes are listed as “By Report” (BR) for maximum reimbursement. Please review current L.A.C. 40:I.5125 Special Instructions if not familiar with BR.

Settlements and Attorney Fee Petitions April 3, 2020

This order is being issued in response to the recent outbreak of the Coronavirus Disease (COVID-19) in the State of Louisiana. The World Health Organization has declared that COVID-19 qualifies as a global pandemic. The President of the United States and the Governor of the State of Louisiana have declared a public health emergency throughout the State in response to the spread of COVID-19; and The Centers for Disease Control and Prevention (CDC) and other public health authorities have recommended social distancing as a means of limiting further community spread of COVID-19; and The State of Louisiana has issued a Stay at Home Order directing all Louisiana residents to shelter at home and limit movements outside of their homes beyond essential needs.

The Assistant Secretary of the Office of Workers' Compensation recognizes that the workers' compensation courts of the State of Louisiana are the only means by which workers' compensation claimants and their attorneys may potentially receive funds disbursed for settlements and the distribution of attorney fees, respectively, which have been maintained in trust accounts, pursuant to L.S.A.-R.S. 23:1272 and L.S.A.-R.S. 23:1143 which provide in pertinent part that

1272. Approval of lump sum or compromise settlements by the workers' compensation judge

A. A lump sum or compromise settlement entered into by the parties under R.S. 23:1271 shall be presented to the workers' compensation judge for approval through a petition signed by all parties and verified by the employee or his dependent, or by recitation of the terms of the settlement and acknowledgment by the parties in open court which is capable of being transcribed from the record of the proceeding.

B. When the employee or his dependent is represented by counsel, and if attached to the petition presented to the workers' compensation judge are affidavits of the employee or his dependent and of his counsel certifying each one of the following items: (1) the attorney has explained the rights of the employee or dependent and the consequences of the settlement to him; and (2) that such employee or dependent understands his rights and the consequences of entering into the settlement, then the workers' compensation judge shall approve the settlement by order, and the order shall not thereafter be set aside or modified except for fraud or misrepresentation made by any party.

C. When the employee or his dependent is not represented by counsel, the workers' compensation judge shall determine whether the employee or his dependent understands the terms and conditions of the proposed settlement, and shall approve it by order, unless he finds that it does not provide substantial justice to all parties, and the order shall not thereafter be set aside or modified except for fraud or misrepresentation made by any party.

1143. Excessive fees or solicitation of employment; penalty; withholding attorney fees; approval by workers' compensation judge .B. (1) An attorney may withhold, as proposed attorney fees, a sum not to exceed twenty percent of all amounts recovered in his trust account which funds shall remain the property of the claimant, pending approval of such fees by the workers' compensation judge.

(2) An application for approval of fees shall be filed by the attorney within thirty days after the payment of the final weekly benefit, settlement of the claim, or payment of the judgment, whichever occurs later. Otherwise the funds shall be returned to the claimant. Accordingly, to facilitate the approval of settlements and attorney fee petitions the Assistant Secretary of the Office of Workers' Compensation Administration hereby issues the following order:

1. A Louisiana workers' compensation judge will review and/or approve workers' compensation settlements and attorney fee petitions for their respective district or division office or another district or division office, from 1:00 p.m. to 5:00 p.m. each day from now until the end of the Governor's Stay at Home Order issued on April 2, 2020, until terminated or extended, whichever occurs first;

2. Louisiana workers' compensation judges will receive, review and/or approve settlements and attorney fee petitions for their district or division office or another district or division office to which they are assigned below, in the following manner, to-wit:

a. District Judge Brenza Jones at BIrving-Jones@lwc.la.gov for District 1E - Monroe;

b. District Judge Linda Smith at LSmith7@lwc.la.gov for District 1W- Shreveport;

c. District Judge Adam Johnson at AJohnson1@lwc.la.gov for District 4 - Lafayette, District 2 - Alexandria and Cajun Division;

d. District Judge Charlotte Bushnell at CBushnell@lwc.la.gov for District 3 - Lake Charles and Western Division;

e. Division Judge Jason Ourso at JOurso@lwc.la.gov for Central Division and District 5 - Baton Rouge;

f. District Judge Catrice Reid at CReid1@lwc.la.gov for District 8 - New Orleans and District 6 - Covington;

g. District Judge Elizabeth Lanier at ELanier@lwc.la.gov for District 9 - Houma;

h. Division Judge Paula Murphy at PMurphy2@lwc.la.gov for Acadiana Division;

i. Division Judge Diane Lundeen at DLundeen@lwc.la.gov for Eastern Division; and

j. Workers' Compensation District Judge Shannon Bruno Bishop at SBruno@lwc.la.gov for District 7 - Harahan and Pro Se Settlements for all districts and divisions

3. All pro-se settlements must be submitted via e-mail to Workers' Compensation District Judge Shannon Bishop. Judge Bishop will schedule the pro-se settlement for a video hearing and will advise the parties of the date and time the hearing is scheduled.

4. Considering L.S.A.-R.S. 23:1272 and L.S.A.-R.S. 23:1143 the assigned judge of the Louisiana workers' compensation court is authorized to accept settlements and fee petitions via e-mail. Only pro se settlements will be scheduled for and conducted by video hearing.

5. Signed orders of the judge may be returned to the party submitting the documents by either e-mail, facsimile or scanning, whichever the judge, in his/her opinion deems appropriate;

6. A docket number(s) will be assigned to the settlement or fee petition at the expiration of the Governor's Stay at Home order and all parties will be notified, accordingly;

7. Members of the public and the media are strictly prohibited from recording or broadcasting any hearing, in whole or in part, in any fashion.

8. The transcript in any case certified by the reporter or other individual designated to produce the record shall be deemed prima facie a correct statement of the testimony taken and proceedings had. No transcripts of the proceedings of the court shall be considered as official except those made from the records certified by the reporter or other individual designated to produce the record.

This order will remain in effect until further orders of the Assistant Secretary of the Office of Workers' Compensation Administration.

Order in effect until further orders of the Assistant Secretary of the Offices of Workers Compensation Administration April 3, 2020

In light of the Novel Coronavirus (COVID-19) outbreak, the Office of Workers' Compensation Administration (OWCA) at the Louisiana Workforce Commission (LWC) is providing this bulletin to ensure that workers' compensation carriers, both domestic and foreign, are aware that the existing Louisiana Medical Fee Reimbursement Schedule currently has three Non Face-to-Face CPT codes that can be used by physicians to bill for telephone office visits, to-wit:

CPT 99441, 99442 and 99443 These codes may be used when a physician provides telephone evaluation or maintenance (E/M) service to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. The above-referenced codes allow the physician to bill for telephone services that last from 5 -10 minutes, 11 - 20 minutes or 21 - 30 minutes, respectively. There are also three Non Face-to-face CPT codes that can be used by non-physicians to bill for telephone office visits, to-wit:

CPT 98966, 98967 and 98968 These codes may be used for telephone assessment and management service provided by a qualified non-physician health care professional to an established client, parent or guardian. The above-referenced codes allow the non-physician health care professional to bill for telephone services that last from 5 -10 minutes, 11 - 20 minutes or 21 - 30 minutes, respectively

During this perilous time, the OWCA encourages the use of these codes to improve the health of injured workers, to help those who need routine care and to keep vulnerable patients with mild symptoms in their homes while maintaining access to the care they need. Limiting community spread of the virus, as well as limiting the exposure to other patients and staff members will slow viral spread of COVID-19. Therefore, the remote provision of services, including care unrelated to COVID-19 will promote, protect and safeguard the public health, safety and welfare of the injured workers of this state and others and is in keeping with Governor John Bel Edwards' Stay At Home order, 33 JBE 2020 of March 22, 2020.

The HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, during the COVID-19 nationwide public health emergency. For more information see, https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html Therefore, a carrier not specifically set up for telephone evaluation and maintenance should not be overly concerned with violations of the HIPPA provisions, during this time.

The WCIO has updated the Injury Description Tables that are used by the IAIABC to reflect specific coding in response to COVID-19

A new Cause of Injury Code (DN0037) - 83 for “Pandemic” and a new Nature of Injury Code (DN0035) - 83 for “COVID-19” were approved. The codes are anticipated to be used for the reporting for any claim effective December 2019 or later. The IAIABC recommends that EDI reporting and collection systems be modified to recognize these new codes by April 1, 2020. The new Injury Description Tables may be found on the WCIO website, Injury Description Table page at: https://www.wcio.org/Document%20Library/InjuryDescriptionTablePage.aspx..
LWC will be ready to accept these new codes as recommended by the IAIABC on 4-1-2020.

LWC’s Office of Workers’ Compensation issues emergency rule

As concerns over the health and wellbeing of injured workers increase as a result of COVID-19 (novel coronavirus) the Louisiana Workforce Commission (LWC), Office of Workers’ Compensation Administration remains vigilant in its effort to ensure that injured workers receive the medical attention their injury warrants under the Louisiana Workers’ Compensation Act. Emergency Rule

To that end, the LWC issued an emergency rule on Thursday, March 19, 2020 to be effective from 12:01 a.m. on March 19, 2020 to 12:01 a.m. on April 13, 2020.

The rule provides for the following during any period of time for which the Governor has declared a state of emergency:

• Workers’ compensation insurers should accept an approved LWC-WC 1010 for longer than thirty (30) days, especially if a treatment facility is closed because of COVID 19.
• Workers’ compensation insurers shall allow injured worker’s to obtain refills of their prescriptions even if the prescription was recently filled, for at least a 30 day supply and up to a 90 day supply of medication, consistent with approval from a patient’s health care provider and/or pharmacist, and the patient has an authorized refill order.
• If an injured workers requests that mail order prescriptions be mailed to an alternate address the insurer should consider doing so.
• Time restrictions on prescription medication refills shall be waived. This is to include suspension of electronic “refill too soon” edits to pharmacies, to enable injured workers or subscribers to refill prescriptions in advance, if there are authorized refills remaining.
• If a prescription is not for a Schedule II drug, the workers’ compensation insurer shall authorize payment to pharmacies for at least a 30 day supply of a prescription medication when:

  1. The refill order expired within 90 days of the date the request to refill the prescription is made;

  2. The medication is essential to the maintenance of life or to the continuation of therapy in a chronic condition;

  3. In the pharmacist’s professional judgment the interruption of therapy might reasonably produce undesirable health consequence or may cause physical ormental discomfort.
• The dispensing pharmacist shall notify the prescriber of emergency dispensing within a reasonable time after such dispensing.
• Finally, pharmacist are allowed to refill most medications, one time, with a 30 day supply, even though the pharmacist cannot reach the patient’s physician.

Reporting of Claim by Employer  RS 23:1306

The insurer or the administrator of the employer's workers' compensation claims must submit notice of injury via electronic data interchange (EDI) format. This is due to the Office of Workers' Compensation Administration (OWCA) within 10 days of the employer knowledge of injury.

Posting Requirements  RS 23:1302

The employer must keep the following notice posted at a convenient and conspicuous point within their place of business. The notice must read as follows:

"In case of accidental injury or death, an injured employee or any person claiming to be entitled to compensation either as a claimant or as a representative of a person claiming to be entitled to compensation must give notice to (NAME AND ADDRESS OF EMPLOYER) within thirty days. If notice is not given to the above party within thirty days, no payments will be made under the law for such injury or death. In addition, any fraudulent action by the employer, employee, or any other person for the purpose of obtaining or defeating any benefit or payment of worker's compensation shall subject such person to criminal as well as civil penalties."

Workers Compensation Poster

Workers Compensation Poster (Spanish)

An employer failing to post the above notice will extend the timeline for which an injury must be reported or otherwise claimed. An employee who is injured while working for an employer who did not have the above notice posted will have 12 months from the date of injury to report the occurrence.

Physician Selection  RS 23:1121(B)  RS 23:1142

The injured worker may choose their treating physician and may switch from one specialty of care to another without having to seek approval of the employer or insurer. The worker must, however, have permission to switch from one provider to another within the same field of specialty.

While the injured worker has the freedom to select the treating physician, the physician must have approval from the employer or insurer to continue treatment beyond $750 worth of care unless the care is provided under emergency conditions. However, the withholding of the consent is not to be arbitrary and capricious or without probable cause.