Changes to Rule 18

The DOWC adopted a two percent increase for all of the Rule Conversion Factors. It also adopted the 2011 edition of the Relative Values for Physicians (RVP) and the Current Procedural Terminology (CPT) 2011, Professional Edition.

Rule 18-5(I)(1)

Medical record documentation shall encompass the E/M Documentation Guideline criteria as adapted in Exhibit 7 to this rule to justify the billed level of E/M service. The E/M level of service can be determined using the documentation of these three relevant and legible key components: history, exam, and medical decision making. The level of service can be denied if the documentation does not equate to the level of service billed. The EOB from the payer must be clear and persuasive on what is not consistent with the billed level of service. Documentation of a chief complaint is required for any billed office visit.

Rule 18-6(F)(4)(a)

Impairment Ratings – Extensive medical records that take longer than one hour to review can be billed as a separate report. This will require prior authorization and agreement from the payer for the separate record review. See Rule 18 for complete requirements.

Rule 18-5(G)(10) Medicine Section

Intra-Operative Monitoring (IOM) – Review the complete information in Rule 18. IOM is used to identify compromise to the nervous system during certain surgical procedures. Evoked responses are constantly monitored for changes that could imply damage to the nervous system.