Provider Connection

Coding, Modifiers and More Details.

All the guidelines for a smooth process.

Modifier 51. This modifier is appended to multiple procedures per the CPT guidelines in Appendix A of the CPT manual. It reads, “When multiple procedures, other than E/M services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). NOTE: This modifier should not be appended to designated ’add-on’ codes.” The 51 modifier is therefore applied based on this definition.

Physical Status Modifiers P1 through P6.

Per the Anesthesia Guidelines section of the CPT manual, “All anesthesia services are reported by use of the anesthesia five-digit procedure code… plus the addition of a physical status modifier.” Please make sure you use the applicable physical status modifier when billing anesthesia codes 00100 – 01999.

P1: A normal healthy patient.

P2: A patient with mild systemic disease.

P3: A patient with severe systemic disease.

P4: A patient with severe and constantly life-threatening systemic disease.

P5: A moribund patient who is not expected to survive without the operation.

P6: A patient declared brain-dead, whose organs are being removed for donor purposes.

Assistant Surgeon Services. Assistant surgeon services may only be billed when provided by an MD or DO, a physician assistant, nurse practitioner or advanced practice nurse. For assistant surgeon services provided by a physician assistant, nurse practitioner or advanced practice nurse, modifier 81 must be used in addition to the applicable CPT code. Per the American Medical Association, modifiers 80, 81 and 82 were established to reflect surgical assistant services provided by an MD.

Chiropractic, Physical Therapy and Occupational Therapy Providers. To expedite payment of physical medicine bills, here are some tips on getting your bills paid the first time:

  1. Submit bills with the injured worker’s complete 12-digit claim number.
  2. Document all exercises performed; if a flow sheet is referenced for this purpose, please attach the flow sheet.
  3. Document time spent per code(s) for those codes with a time element.
  4. Evaluations and re-evaluations should document changes and/or progress in the injured worker’s condition and/or function in addition to any other exam information.
  5. Supplies must be listed in the documentation.
  6. For chiropractic services, document all manipulations by region.
  7. Remember—if it isn’t documented, it isn’t done.

For a complete list of physical medicine codes allowed per the ARM, please contact anyone on the medical team and we will fax or mail you a copy.

DOLI’s 2007 Workers’ Compensation Conversion Factor for Medical Services

This information is also available at http://erd.dli.state.mt.us/wcregs/medreg.asp.

Acupuncture 5.85
Anesthesia 45.23
Chiropractic 5.51
Dental 11.35
Medicine 5.85
Occupational Therapy 5.51
Pathology 21.06
Physical Therapy 5.51
Radiology 24.28
Surgery 125.87
CPT code 97750 31.81

2007 Annual Medical Conference.

MSF’s 7th Annual Medical Conference is scheduled for November 9,2007 at Helena’s Great Northern Hotel. This year’s topic is Upper Extremity Joint Injuries: Diagnosis, Intervention and Rehabilitation. Registration details will soon be posted on MSF’s website at www.montanastatefund.com.

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Bill Status – 1-866-274-7464

Main Phone Number 406-495-5000 or 800-332-6102

Main Fax  406-495-5020

Medical Team – 406-495-5011

Submit your Claims and/or Correspondence To
Montana State Fund
PO Box 4759
Helena, MT  59604

RMS (Bill Status)
Phone  866-274-7464
Email customer.care@risingms.com

For questions about information in this bulletin, call 800-332-6102 and ask for a member of the Medical Team.
For questions about Advanced Nurse Review contact Kym Vonada at 406-495-5389.


Medical Team

Michele Fairclough
Medical Team Leader
406-495-5362

Justin Kennedy
Nurse Manager
406-495-5417

Shannon Hadley
Provider Relations Specialist
406-495-5245

Kym Vonada
Medical Auditor
406-495-5389

Annalyn Stewart
Medical Payment Auditor
406-495-5367

Sheryl Semans
Pharmacy Liaison
406-495-5010

Susan Bomar
Medical Payment Auditor
406-495-5271

Cindy Gallus
Medical Customer Service Liaison
406-495-5189

Sherri Sprenger
Medical Customer Service Liaison
406-495-5420

Shannon Mergenthaler
Medical Customer Service Liaison
406-495-5185

Maggie Pentecost
Medical Customer Service Liaison
406-495-5322

Jamie Statton
Medical Customer Service Liaison
406-495-5386

Website Information

Montana State Fund montanastatefund.com

Department of LaborDepartment of Labor and Industry (DLI) website.
The website includes the Facility and Non-Facility Fee Schedule information as well as the Administrative Rules of Montana (ARM) and the instruction set for the Non-Facility Fee Schedule. Historical fee schedule information can also be found on this website.

If you have questions regarding the fee schedules call 406-444-6530 and someone will direct you to a DLI representative. For NPI information click here National Plan and Provider Enumeration System (NPPES)