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ADVISORY 2003-17

SUBJECT: Revision of TWCC-67 and TWCC-62

This advisory announces the revision of two TWCC forms, the TWCC-67 [Word, PDF] (Instructions for Completing the HCFA-1500) and the TWCC-62 [Word, PDF] (Explanation of Benefits), effective for dates of service on or after August 1, 2003. The Texas Workers' Compensation Commission (Commission) will allow a transition period for use of the new TWCC-67 and TWCC-62 forms. System participants may use the new form instructions as early as August 1, 2003, but will be required to use them on and after October 1, 2003. The revisions are necessary due to the implementation of the Medical Fee Guideline (MFG), Commission rule 134.202, effective for service dates on or after August 1, 2003. The new MFG rule 134.202 (b), states:

"For coding, billing, reporting and reimbursement of professional medical services, Texas Workers' Compensation system participants shall apply the Medicare program reimbursement methodologies, models, and values or weights including its coding, billing and reporting payment policies in effect on the date a service is provided with any additions or exceptions in this section."

At this time there are no changes to the TWCC-68 form (Instructions for Completing the UB-92), but the form may be revised in the future.

In order to facilitate implementation of Medicare (Centers for Medicare and Medicaid Services or CMS) coding, billing, and reporting payment policies it is necessary for TWCC to revise the TWCC-67 and the TWCC-62 as follows:

TWCC-67 Revisions:

Some overall changes, along with the addition of the current Medicare CMS-1500 Instructions, have been incorporated into the revised TWCC-67 form. The revised TWCC-67 is designed to remain constant for the Medicare specific items, even though Medicare may change the instructions or code definitions periodically. Some of the items correspond directly to the Medicare CMS-1500 Instructions. For other items denoted with an asterisk (*), TWCC rules should be followed as the TWCC specific instructions differ from the Medicare CMS-1500 instructions. In addition, items to be completed are listed as "required," "conditional" (meaning they are required under certain claim specific circumstances), or "optional."

TWCC-62 Revisions:

The TWCC-62 Explanation of Benefits is used for payment or denial of all medical bills, both professional and facility, in the Texas workers' compensation system. The new MFG requires the use of Medicare coding, billing, and reporting payment policies in effect on the date a service is provided. The existing TWCC-62 Payment Exception Codes (PEC) list is expanded to include an additional PEC value, "Y", to allow for the use of the Medicare payment policies for professional medical services and supplies, or those services billed on a CMS-1500.

The TWCC system, through the efforts of our Business Process Improvement (BPI) initiative, has a long-term strategy for moving the carrier medical billing data submissions from the existing format to the International Association of Industrial Accident Boards and Commissions (IAIABC) 837 format, similar to the Health Insurance Portability and Accountability Act (HIPAA) electronic billing requirements. When the Texas workers' compensation system transitions to the new electronic standards, the replacement of all existing TWCC PEC codes will be considered. At this time, the revisions to the TWCC-62 do not include complete replacement of the exception codes, but instead provide for some revised definitions to existing codes in order to clarify existing processes and support the new Commission approved doctor list requirements.

Electronic Claim Submission (ECS) Record Layout Specifications Revisions:

The ECS specifications will not have any format or data element changes at this time; however, there will be revisions to the medical codes lists (PECs, Medicare CMS modifiers, Place of Service codes, Provider Prefix codes and current CPT-4 codes) effective August 1, 2003. The Commission ICD-9 code set is updated annually and was last updated January 2003. The updated ECS specifications relating to the code lists for carrier medical billing data submissions to the Commission will be posted on the TWCC website.

Signed on this 18th day of August, 2003

Richard F. Reynolds, Executive Director

TWCC Staff
Medical Professional Associations
Carrier Representatives
Forms Notification List
Public Information List
TWCC website

TWCC 62 [Word, PDF]
TWCC 67 [Word, PDF]