Wc/auto/med cob problem

I have a patient that is currently being treated for a work related injury, and auto related injury and chronic medical problems. (we are his PCP) I have a couple of visits that I can not split up. Only an office visit was performed and the services were equal in nature for each dx. pts insurance coverages are
work comp
auto
hap
medicare
So the insurance cob is different for each diagnosis.
Any suggestions as to how this should be billed would be appreciated.
thank you.

Make the patient come back the another day next time

No one else has responded so I'll try. Eval each part by the documentation and code and bill appropriately. They can share the exam obviously. So the back pain needs to be addressed in HPI, ROS and in Assessment and Plan; the diabetes and HTN need to be in HPI, ROS and Assessment and Plan. Count the points in each and code appropriately. The better the documentation is separated the easier it will be to defend an audit. I don't know if there is a rule that reduces the Medicare payment by the amount paid by another insurer for an unrelated treatment.

Wc/auto/med prob

I have already done this all, not one dx took up more of the office visit then the other. Now to bill accordingly would involve me billing out the office visit 3 times.
once with the work comp as the primary payer,with the work related dx primary, once with auto ins.as the primary payer, with the auto related inj. dx listed first, and once with Medicare as the primary payer,with the chronic medical condition dx listed first. This would result in 3 payments. Don't think that is right. but,
I have entertained doing just this, with a modifier,(not sure if it should be a 25 or 76) then a note on the claim to indicate circumstances. This way putting the ball in the insurance companies laps. What do you think. I'm open to opinions.

I have looked all over for some guidelines to handle something like this, and have found nothing.

careful with multiple billing

I agree with you regarding the issue of receiving multiple payments. I think that would, to a certain degree, constitute fraud. My first suggestion would be to evaluate what diagnosis the doctor is listing as the primary problem. Go to that insurance first. If it happens that that company states other insurance is primary because of related diagnoses, then you have a starting point in which to fight. Obviously, the ideal situation is to schedule specific appointments for specific problems. However, that is not always possible (i.e. if patient is elderly, doesn't get around easily, etc.) nor is it reasonable for the patient to come back multiple times for something that could be treated at one visit. Another suggestion would be to have the patient involve his/her work comp and no fault advocates in how to address this issue. There has to be some precedent as to the decending order or responsibility between the carriers.

Wc/auto/med prob

Thank you signauredoc for taking a stab at this