California represents one-fifth of total workers’ comp benefits.

Joe Paduda

So we’d better pay a lot of attention to what’s happening in the Golden State, which is undergoing rising medical expenses and rising insurance premiums.

Why?

Several reasons, which we will unpack one at a time. Today, it's “unlisted codes,” a label applied to services delivered that are “not accurately described by other HCPCS CPT (current procedural terminology) procedure codes.”

The fine folks at the California Workers' Compensation Institute have been tracking this issue for some time. 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 the 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 $1,700 each.

What does this mean for you?

There’s always some looking to plunder workers’ comp. 

You should take a very close look at your spend and drivers thereof.

Joseph Paduda is the principal of Health Strategy Associates, a consulting firm focused on improving medical management programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.