To, David

Providence St. Joseph Medical Center, a medical provider lien claimant, treated David To for a left hip fracture from a workplace trip and fall, performing open reduction and internal fixation surgery. The provider billed using DRG 481 (which requires a complication or co-morbidity), asserting an osteoporosis ICD-10 code, while the defendant reassigned the bill to DRG 482 and paid $23,080.04. The WCJ found that no substantial medical evidence established osteoporosis as a documented co-morbidity—the only reference came from a physician's assistant's speculative, unsubstantiated assessment unsupported by required Dexa or CT imaging. The WCJ also denied penalty and interest because the provider failed to establish that the required medical reports were served on the defendant with the bill under Labor Code section 4603.2(b)(2). The WCAB adopted and incorporated the WCJ's Report and denied reconsideration.