‘Split’ Billing for Workers’ Comp
We usually do “split” billing on workers’ compensation patients. We bill the patient’s primary insurance for the medical condition that is not work related - say, hypertension or diabetes - and then bill the same E&M code on the same day for the same amount to the workers’ comp insurance with the work-related diagnosis. We do two complete visit notes. Is that right?
Question: We usually do “split” billing on workers’ compensation patients. We bill the patient’s primary insurance for the medical condition that is not work related - say, hypertension or diabetes - and then bill the same E&M code on the same day for the same amount to the workers’ comp insurance with the work-related diagnosis.
We do two complete visit notes. Is that right?
Answer: It is OK to bill two separate insurance companies, one for workers’ comp issues and one for nonworkers’ comp issues.
It may not be safe to assume that each service merits the same E&M code. Code based on work done.
A single note to document two services is fine. Of course, both services need to be supported. That is, if an auditor from either carrier were to review the record, each should be able to pull out her company’s documentation requirements.
In other words, a key issue here is whether the patient actually is being seen for hypertension or diabetes during the visit and there is a legitimate, related, medically necessary review of systems and medical decision making for that problem.
Split/Shared Billing in Emergency Medicine: Why Attestation Matters More Than Ever
June 2nd 2025Emergency Medicine is Evolving—And So Are the Billing Rules Team-based care is now the norm in emergency departments, but outdated billing practices are putting revenue and compliance at risk. In this must-read article, Michael Jeffery, President of Emergency Medicine at Coronis Health, breaks down what every ED leader needs to know about split/shared billing, recent CMS rule changes, and the critical role of attestation. A Smarter, Simpler Approach to Compliance Michael shares real-world examples and best practices used by high-performing EDs to keep documentation clean, billing accurate, and compliance risks low. If you oversee ED operations or billing, this article is your go-to resource.
