This is when there is little to no more improvement anticipated. Essentially if improvement is expected to be less than 10% improvement over the next six months, the claimant has reached MMI. IR-Impairment Rating also called PPI or permanent partial impairment This rating is given at the end of treatment for any condition that is permanent. It should be expressed as a percentage to the extremity and taken out to the body as a whole. In Arkansas we still use the AMA Guidelines to Permanent Impairment Fourth Edition. Some accounts such as the US Dept. of Labor will require the Fifth Edition. When providing this information, be sure to include the page number, table and edition used. In the extremities range of motion can be used, but this is not acceptable in Arkansas with regard to the spine. All spinal ratings must be on objective findings to the disc rather than range of motion. TTD-Temporary Total Disability This is usually referred to the compensation the claimant receives if they are unable to return to work for a period of time during treatment. PPD-Partial Permanent Disability This is usually referred to the compensation received as a result of the impairment rating. It is compensation for the permanent change to the body as a result of the injury or accident. PTD-Permanent Total Disability This is the pay received by a claimant when their disability is permanent and the claimant is unable to return to work. It is often used in a settlement. IME-Independent Medical Evaluation This examination is performed by a physician who has not previously seen the claimant and none of his/her associates has been involved in the treatment of the individual. It is typically used when a conflicting opinion has been given or if treatment seems questionable. Please note that if you want to treat the patient you should not perform an IME, but rather a Second Opinion. Any IME must include diagnosis, prognosis, and causality as it relates to the injury or accident, impairment, functional ability or limitations, whether the claimant has reached MMI and if not, when it is anticipated. Any further treatment recommendations should be made known as well.
Needed with each and every visit:
1. Work Note-A work status form of some kind is needed after each visit. It does not matter if the recommended work duties have changed or not. The best work note provides written recommendations regarding sitting, standing, lifting, pushing, pulling and makes notes for any special instructions such as wearing a splint or brace. Can not do rather than can do. Employer to figure out the accommodation. 2. Estimated length of disability-At the initial visit we need some kind of idea as to how long treatment is expected to last. We understand this may change upon each visit, but a general idea is needed. At each appointment the length statement regarding disability is more about the reduction or elimination from work i.e. light duty for four more weeks. 3. Treatment plan-what is the treatment plan and how long is it expected to last. If you know what the next step will be, be sure to let us know this as well. i.e. we will try an ESI at L5-S1 and if this does not resolve her complaints we may consider a facet injection 4. MMI-Is the claimant at MMI? If not, let us know when it is expected (if known). If yes, then provide us with the rating at the appointment if able. 5. Copies- As case managers we will request copies of prescriptions for medications, therapy, return appointment date if applicable 6. Office Dictation-a fast turn around on dictation allows us to obtain authorization for tests or procedures. It also helps us to close our file for those claimants who have reached the end of their healing time. For any questions or clarification, feel free to contact either of us. We are here to help your practice succeed! Victoria Powell, RN, CCM, ALNC, CNLCP, CEAS VP Medical Consulting, LLC 501-778-3378