This article is intended for medical providers who need to write a history of a work-related injury.
The quality of a patient’s injury history can make or break the accuracy of an impairment rating. Read our eight rules on conducting a complete patient interview, including how to let silence be your friend, and the one comment that every good medical history should include.
Continue reading 8 rules for taking the perfect workers’ comp patient history
Update for 2021: RateFast Express is an even easier alternative to the wonderful RateFast software. Try RateFast Express today!
Accurately sending your bill for a PR-4 report can be a time consuming process, but it doesn’t need to be.
The RateFast PR-4 Billing Calculator counts the amount of pages in your PR-4 report, asks some basic questions, and then prints out a bill at the end of your report.
This article describes how to turn on the billing calculator and how to use it correctly.
Continue reading Automatic billing for your PR-4 reports! How to use the RateFast Billing Calculator
An impairment report without an inventory of the patient’s Activities of Daily Living (or ADLs, as we like to say) is like trying to drive to an unknown destination without a map. After all, how can you determine the severity of an injured worker’s impairment without understanding how his or her daily life is (or isn’t) affected?
If you’re a provider writing an impairment report such as a PR-4 report, then asking your patient about his or her activities of daily living is essential. If you’re a claims adjuster or an attorney reviewing an impairment report, keep an eye out for whether or not the physician has made note of the ADLs.
If you are examining a worker who has injured multiple body parts, then a separate ADL inventory must be performed on each injured body part. For example, if the worker has injured both her knee and her shoulder, then you should check to see how both her shoulder injury and her knee injury affect each activity.
It’s a lot of work, but it’s necessary. Here’s why:
If you, as a medical provider, assign a worker’s injury a very high impairment rating—such as 90% whole person impairment—then the claims adjuster for the claim needs to understand why. If you demonstrate that the injury has disrupted all of the worker’s activities of daily living, then the impairment rating is supported. But if you don’t mention the activities of daily living at all, then you might very well receive a phone call from the insurance company in short order.
Reports that lack mention of the complete ADL inventory should be carefully considered before the conclusions are accepted as valid.
If a reader of an impairment report is unable to understand how much an injury affects the individual’s daily life, understanding the reasons for arriving at the final whole person impairment (WPI) are nearly impossible.
Bottom line: If you create impairment reports, include a complete ADL inventory. If you’re a RateFast user, then you already know that our PR-4 report-writing system ensures that you ask about each activity for all body parts.
If you review impairment reports, insist that activities of daily living inventories are provided.
Doctors can’t calculate an accurate impairment rating without the proper tools. Here at RateFast, we’ve reviewed a lot (a lot) of impairment ratings, and in our experience, one reason why doctors produce incorrect unjustifiable ratings is because they did not take the necessary measurements.
Accurate impairment ratings require accurate measurements, and to get the right measurements, you need the right tools.
That does it. Once you get these tools, you’ll be ready to gather the correct measurements for your impairment ratings like a pro.
Of course, to actually calculate the impairment rating in California (and many other states), you’ll also need the A.M.A. Guides 5th Edition. Then, you’ll need some time to plow through all the tables, diagrams, and charts.
Alternatively, you can join RateFast, and let our impairment rating specialists calculate the rating for you.
Muscle atrophy is a medical term which is used to describe the loss of muscle size or mass when concerning orthopedic injuries or conditions.
Atrophy may occur in any orthopedic area, but for the purposes of impairment rating in the the AMA Guides 5th Edition, the term is usually applied to describe muscle loss in the arms or legs.
It’s important to note that the AMA Guides 5th Edition does not formally define the term “atrophy” anywhere in the formal text, glossary or the errata papers.
Muscle atrophy may be caused by disuse of muscles, injury to the central or peripheral nervous system, or a primary disease of the muscle itself. In the context of injury, muscle atrophy is most often caused by pain limiting the exercise of muscles or nerve damage which decreases the signal allowing the muscle to contract and exercise normally.
Muscle atrophy in the limbs are objectively measured (limb circumference) with a flexible tape measure. For impairment rating purposes it’s reported in centimeters (if you’re using the AMA Guides 5th Edition—which you should be, if you’re in California).
When measuring the arms, measure at the biceps and forearms. You can look it up for yourself in Chapter 15, The Spine, which instructs the medical evaluator to measure the injured worker’s arms “at the same distance above or below the elbow;” (page 392).
Strangely, there is no rating provided for muscle atrophy in Chapter 16, The Upper Extremities.
In the legs, measure at the thigh and calf. Chapter 17, The Lower Extremities, instructs the medical examiner to measure the leg “at equal distances from above the joint line or another palpable anatomical structure.”
You might notice that Table 17-16 specifically states that the thigh “is measured 10 cm above the patella with the knee fully extended and the muscles relaxed.” Also, it says the calf “is compared with the circumference at the same level on the affected side.”
Note: Nowhere in the AMA Guides does it mention the position for measuring atrophy e.g. sitting, standing, or prone.
Asymmetric means not symmetric, or unequal. Asymmetry of spinal motion means more movement in some directions than others.
A physical exam finding of asymmetric spinal motion is a gateway to a Diagnosis-Related Estimate (DRE) class II rating in the AMA Guides 5th Edition.
The AMA Guides 5th Edition in Chapter 15 The Spine on page 382 defines asymmetry of spinal motion as “Asymmetric motion of the spine in one of the three principle planes.”
But the AMA Guides goes to a little more effort here to help the medical examiner by stating: “To qualify as true asymmetric motion, the finding must be reproducible and consistent and the examiner must be convinced that the individual is cooperative and giving full effort.”
When documenting asymmetry of spinal motion in an impairment report for rating purposes, it is helpful to the reader of your impairment report if you provide comments on muscle spasm, muscle guarding and employee cooperation. These comments also makes the observation more compelling.
When reading a report that includes the finding of asymmetry of spinal motion look for comments on muscle spasm, muscle guarding and employee cooperation.
California PR-4 Reports are about reproducible observations and findings. Reports that are minimally supported may be more confusing than helpful, and lead to costly delay for the medical examiner, the insurance administrator, and, of course, the injured worker and the employer.
Muscle guarding is simply the body trying to avoid a painful stimulus. When irritable muscles are touched, they don’t like it and try to pull away.
A physical exam finding of muscle guarding is a gateway to a Diagnosis-Related Estimate (DRE) class II rating in the AMA Guides 5th Edition.
The AMA Guides 5th Edition in Chapter 15, The Spine, on page 382 defines “Muscle Guarding” as “a contraction of of muscle to minimize motion or agitation of the injured or diseased tissue.” Don’t confuse this with muscle spasm, which is an “involuntary contraction of a muscle or group of muscles.”
Associated finding may include loss of the low back contour (lordosis) and may have “reproducible loss of spinal motion.”
When documenting muscle guarding in an impairment report for rating purposes, it is helpful to the reader if comments on lordosis and actual measured spinal motion are provided. These comments also makes the observation more compelling.
When reading a report which includes the finding of muscle spam look for comments on lordosis and evidence of loss of spinal range of motion.
California PR-4 Reports are about reproducible observations and findings. Reports that are minimally supported may be more confusing than helpful, and lead to costly delay.
