Pinnacol is reviewing bills and matching them with the submission of WC196 forms. The WC196 form needs to be completed to be eligible for supplementary payment. The most common reason for denial of the supplemental payment is the WC196 form was incomplete.
No. The WC196 form was developed to be used as a communication form from the therapist to the referring or authorized treating physician (ATP) for follow-up visits with the physician. However, we do encourage the PT/OT to administer the functional tool at the initial evaluation and first assessment to determine a baseline for subsequent evaluations on return visits.
Yes. They will administer a test each time they want to re-assess function. They will use the WC196 form to report progress at the prescribed intervals. The WC196 form may be submitted and reimbursed every 2 weeks for the first six weeks and once every four weeks for the duration of the therapy.
The WC196 form is used as a communication tool between the therapist and the referring provider. At the initial assessment, the physical therapist obtains scores from the functional tool. Two weeks later, the same functional assessment is administered and the WC196 form is completed with the initial and subsequent test results. The WC196 form is sent to the referring provider before the patient’s follow-up appointment with the ATP and is also sent to the insurer so the therapist can be reimbursed for completing the WC196 form.
No, providers report that it is difficult to decipher information contained within the note to determine functional gains. The WC196 form allows for clear and concise information in a consolidated format to the referring provider.
The correct billing code for completing the form and reporting it to the provider is Z0817. It will be reimbursed at $15.61 for 2023 or the contract fee schedule rate when correctly submitted and completed.
No, this form is to be completed by PTs and OTs only. Massage therapists are not routinely trained in utilizing functional tools and PTs and OTs are trained and use them regularly.
Reporting the status and progress for multiple diagnoses can be performed one of two ways:
In either case, the billing code Z0817 will only be billed once.
We’re here to help ensure your billing success. If you have questions or need information, please contact Pinnacol Assurance at billingsuccess@pinnacol.com or 303.361.4940.