Medical Examiners' Handbook July 2021 Update

Total Page:16

File Type:pdf, Size:1020Kb

Medical Examiners' Handbook July 2021 Update Medical Examiners’ Handbook July 2021 Update Impairment Ratings and Independent Medical Examinations in Washington State Workers’ Compensation For IME Examiners, Attending Doctors and Consultants Free 3 Hours Category 1 CME Credit The Department of Labor and Industries (L&I) is accredited by the Washington State Medical Association to provide continuing medical education for physicians. L&I designates this type of enduring material for a maximum of 3 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity meets the criteria for up to 3 hours of Category 1 CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission. Accreditation: Approval Date — July 1, 2021 Expiration Date — June 30, 2024 This publication contains guidelines, sample reports, and billing procedures for preparing and conducting impairment ratings and independent medical exams (IME) in Washington’s Workers’ Compensation system. The activity was planned and produced in accordance with the WSMA Essential Elements, Criteria, and Standards of Accreditation of Continuing Medical Education. Disclosure: None of the faculty involved with developing this handbook or self assessment test online has any financial relationship to disclose nor do they financially benefit from this product. First published April 1990 PUBLICATION F252-001-000 [07-2021] About the July 2021 Updated Medical Examiners’ Handbook The July 2021 updated edition of the Medical Examiners’ Handbook contains selected updates to the July 2020 edition. New or updated information is listed in the table below. Updates and Additions to the Medical Examiners’ Handbook, July 2021 Chapter Page Title Comments Cover Handbook Cover Page Updated with current dates including CME accreditation dates 1 3 Legislative Intent Added information regarding the 2020 legislative changes 1 4 Reasons Why IME are Update language per new legislation Requested 1 5 Confidential Clarified what an examiner designee is Information/Medical Records 1 7 Scheduling IMEs Added language regarding reasonably convenient and added clarifying language to the ‘Important Note’ 2 10 Types of Examiners Added note to see Chapter 13 to clarify billing differences between IMEs and Impairment ratings 2 18 Important to Know Added fax and phone numbers for Provider Quality and Compliance unit; added reminder to notify department of any change in information or availability 3 20 Preparing for the Exam/ Added language regarding telehealth scheduling as an option scheduling 3 21 Interpreter services Added language and links for the new interpreter scheduling system 3 24 Releasing Information to Update language related to SSB 6440. The department or self-insured employer Other Parties will provide a copy of the IME report to the AP and worker. 3 25 Telehealth/Telemedicine New section added including information regarding examiner responsibilities when scheduling telehealth exams. 4 33 Treatment Guidelines No updates 4 34 Pain Management and Additional language added regarding who to contact with prescribing concerns Opioid Prescribing 4 34-35 What to Avoid in the Clarified language regarding conditions accepted by the department. Added what Examination or Report to do about incidental findings 7 51-55 Preparing for Your Mental Add Language to the presumption section for firefighters/law enforcement. Health Report Updated requirements regarding WHODAS 8 60-62 Vocational Issues & Updated language to match preferred terminology. Removed Job Analysis 66-69 Physical Restrictions Summary form and added Job Analysis form 9 70-73 Providing Testimony Minor clarification edits, pages 70, 71, and 73 13 139-140 Billing for an IME Added clarifying language regarding when IME codes can be billed Append C 172-179 Relevant Laws and Updated RCW 51.08.142, 51.32.110, RCW 51.36.070 Regulations Append C 172-179 Relevant Laws and Added new RCW 51.08.121 Regulations Table of Contents Preface ........................................................................................................................... 1 CHAPTER 1 ............................................................................................... 2 Workers’ Compensation in Washington State ............................................................ 2 Background ........................................................................................................................................... 2 Legislative Intent & Department Role ................................................................................................... 2 Reasons Why IMEs are Requested ...................................................................................................... 3 Additional Types of Examinations ......................................................................................................... 4 Confidential Information ........................................................................................................................ 5 Claim Manager Role ............................................................................................................................. 6 Scheduling IMEs ................................................................................................................................... 7 CHAPTER 2 ............................................................................................. 10 The Independent Medical Examination Provider ...................................................... 10 Types of Examiners ............................................................................................................................ 10 Application Process............................................................................................................................. 11 Examiner Credentialing Requirements ............................................................................................... 11 Additional Requirements for Specific Examiner Specialties: .............................................................. 12 Examiner Training Requirements and Opportunities .......................................................................... 14 Site Standards and Business Requirements ...................................................................................... 14 Independent Medical Examination Firms ............................................................................................ 15 Requirements for IME Firm Providers ................................................................................................. 15 Review of Applications ........................................................................................................................ 17 Reporting Changes to L&I ................................................................................................................... 17 CHAPTER 3 ............................................................................................. 20 The Independent Medical Exam ................................................................................. 20 Preparing for the Examination / Scheduling ....................................................................................... 20 Missing Documents or Records .......................................................................................................... 20 Interpreter Services ............................................................................................................................. 21 Who is Allowed to Attend an IME? ...................................................................................................... 21 May the Worker Record the IME? ....................................................................................................... 21 Examiner Responsibilities ................................................................................................................... 22 Discussing the Examination Results with the Worker ......................................................................... 23 May I Offer to Provide Ongoing Treatment? ....................................................................................... 23 Ordering Diagnostic Tests .................................................................................................................. 23 Unable to Complete Examination ....................................................................................................... 23 Additional Examiner Needed .............................................................................................................. 24 No Show or Late Cancel ..................................................................................................................... 24 Releasing Information to Other Parties ............................................................................................... 24 Medical Records - Maintenance and Disposal ................................................................................... 25 Worker’s Questions about their Claims............................................................................................... 25 Telehealth/Telemedicine ..................................................................................................................... 25 Medical Examiners’ Handbook 07-2021 CHAPTER 4 ............................................................................................. 26 The IME Report ...........................................................................................................
Recommended publications
  • UK Clinical Guideline for Best Practice in the Use of Vaginal Pessaries for Pelvic Organ Prolapse
    UK Clinical Guideline for best practice in the use of vaginal pessaries for pelvic organ prolapse March 2021 Developed by members of the UK Clinical Guideline Group for the use of pessaries in vaginal prolapse representing: the United Kingdom Continence Society (UKCS); the Pelvic Obstetric and Gynaecological Physiotherapy (POGP); the British Society of Urogynaecology (BSUG); the Association for Continence Advice (ACA); the Scottish Pelvic Floor Network (SPFN); The Pelvic Floor Society (TPFS); the Royal College of Obstetricians and Gynaecologists (RCOG); the Royal College of Nursing (RCN); and pessary users. Funded by grants awarded by UKCS and the Chartered Society of Physiotherapy (CSP). This guideline was completed in December 2020, and following stakeholder review, has been given official endorsement and approval by: • British Association of Urological Nurses (BAUN) • International Urogynecological Association (IUGA) • Pelvic Obstetric and Gynaecological Physiotherapy (POGP) • Scottish Pelvic Floor Network (SPFN) • The Association of Continence Advice (ACA) • The British Society of Urogynaecology (BSUG) • The Pelvic Floor Society (TPFS) • The Royal College of Nursing (RCN) • The Royal College of Obstetricians and Gynaecologists (RCOG) • The United Kingdom Continence Society (UKCS) Review This guideline will be due for full review in 2024. All comments received on the POGP and UKCS websites or submitted here: [email protected] will be included in the review process. 2 Table of Contents Table of Contents ................................................................................................................................
    [Show full text]
  • Hair-Thread Tourniquet Syndrome in an Infant with Bony Erosion a Case Report, Literature Review, and Meta-Analysis
    REVIEW ARTICLE Hair-Thread Tourniquet Syndrome in an Infant With Bony Erosion A Case Report, Literature Review, and Meta-analysis Arman Z. Mat Saad, MB, AFRCSI, Elizabeth M. Purcell, MB, and Jack J. McCann, FRCS(Plas) tissue to cause bony erosion of the underlying phalanx of a Abstract: Hair-thread tourniquet syndrome is a rare condition toe. where appendages are strangulated by an encircling strand of hair, a thread, or a fiber. The condition usually occurs in very young patients in the first few months of life. We present a unique case of CASE REPORT a 3-month-old baby girl with hair-thread tourniquet syndrome in A 3-month-old baby girl was referred to our unit from whom a hair cheese-wired through the skin and soft tissue of the toe the emergency department, with a history of irritability and a and caused bony erosion of the underlying phalanx. An extensive red swollen right middle (third) toe, which failed to resolve 3 literature review and meta-analysis of the topic are also presented. days after removal of a hair tourniquet (in the emergency department of the referring hospital). Key Words: hair, thread, toe, finger, penile, clitoris, tourniquet Careful examination in our own emergency department syndrome with loupe magnification showed intact skin on the toe and no (Ann Plast Surg 2006;57: 447–452) further evidence of a residual hair tourniquet. A course of antibiotics was prescribed for cellulitis, and improvement was noted on review in our outpatient department at 1 week. Six weeks later, the patient represented to the outpatient air-thread tourniquet syndrome is a rare condition that department, with recurrent swelling and redness of the toe.
    [Show full text]
  • Hand Gestures
    L2/16-308 More hand gestures To: UTC From: Peter Edberg, Emoji Subcommittee Date: 2016-10-31 Proposed characters Tier 1: Two often-requested signs (ILY, Shaka, ILY), and three to complete the finger-counting sets for 1-3 ​ (North American and European system). None of these are known to have offensive connotations. HAND SIGN SHAKA ● Shaka sign ​ ● ASL sign for letter ‘Y’ ● Can signify “Aloha spirit”, surfing, “hang loose” ● On Emojipedia top requests list, but requests have dropped off ​ ​ ● 90°-rotated version of CALL ME HAND, but EmojiXpress has received requests for SHAKA specifically, noting that CALL ME HAND does not fulfill need HAND SIGN ILY ● ASL sign for “I love you” (combines signs for I, L, Y), has moved into ​ ​ mainstream use ● On Emojipedia top requests list ​ HAND WITH THUMB AND INDEX FINGER EXTENDED ● Finger-counting 2, European style ● ASL sign for letter ‘L’ ● Sign for “loser” ● In Montenegro, sign for the Liberal party ● In Philippines, sign used by supporters of Corazon Aquino ● See Wikipedia entry ​ ​ HAND WITH THUMB AND FIRST TWO FINGERS EXTENDED ● Finger-counting 3, European style ● UAE: Win, victory, love = work ethic, success, love of nation (see separate proposal L2/16-071, which is the source of the information ​ ​ below about this gesture, and also the source of the images at left) ● Representation for Ctrl-Alt-Del on Windows systems ● Serbian “три прста” (tri prsta), symbol of Serbian identity ​ ​ ● Germanic “Schwurhand”, sign for swearing an oath ​ ​ ● Indication in sports of successful 3-point shot (basketball), 3 successive goals (soccer), etc. HAND WITH FIRST THREE FINGERS EXTENDED ● Finger-counting 3, North American style ● ASL sign for letter ‘W’ ● Scout sign (Boy/Girl Scouts) is similar, has fingers together ​ Tier 2: Complete the finger-counting sets for 4-5, plus some less-requested hand signs.
    [Show full text]
  • Variations in the Finger Length of the Human Hand
    Proceedings of the Iowa Academy of Science Volume 61 Annual Issue Article 63 1954 Variations in the Finger Length of the Human Hand Elizabeth Barnard Grinnell College G. Mendoza Grinnell College Let us know how access to this document benefits ouy Copyright ©1954 Iowa Academy of Science, Inc. Follow this and additional works at: https://scholarworks.uni.edu/pias Recommended Citation Barnard, Elizabeth and Mendoza, G. (1954) "Variations in the Finger Length of the Human Hand," Proceedings of the Iowa Academy of Science, 61(1), 458-462. Available at: https://scholarworks.uni.edu/pias/vol61/iss1/63 This Research is brought to you for free and open access by the Iowa Academy of Science at UNI ScholarWorks. It has been accepted for inclusion in Proceedings of the Iowa Academy of Science by an authorized editor of UNI ScholarWorks. For more information, please contact [email protected]. Barnard and Mendoza: Variations in the Finger Length of the Human Hand Variations in the Finger Length of the Human Hand By ELIZABETH BARNARD AND G. MENDOZA INTRODUCTION Although a great deal has been written concerning the occur­ rence of abnormalities of the hands and fingers, relatively few studies have been made to determine variations of the normal hand. The purpose of this study is to gather some valid statistics concerning the occurrence of variations in finger length within a segment of the general population. It is hoped that this study will serve as the beginning of a valid basis upon which a study of human inheritance can be built. Because the interindividual difference in the pattern of finger length consists in the relationship between the index and ring fingers, this varying relation has been most often reported in the literature.
    [Show full text]
  • Cubital Tunnel Syndrome)
    DISEASES & CONDITIONS Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome) Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand, and can be constricted in several places along the way, such as beneath the collarbone or at the wrist. The most common place for compression of the nerve is behind the inside part of the elbow. Ulnar nerve compression at the elbow is called "cubital tunnel syndrome." Numbness and tingling in the hand and fingers are common symptoms of cubital tunnel syndrome. In most cases, symptoms can be managed with conservative treatments like changes in activities and bracing. If conservative methods do not improve your symptoms, or if the nerve compression is causing muscle weakness or damage in your hand, your doctor may recommend surgery. This illustration of the bones in the shoulder, arm, and hand shows the path of the ulnar nerve. Reproduced from Mundanthanam GJ, Anderson RB, Day C: Ulnar nerve palsy. Orthopaedic Knowledge Online 2009. Accessed August 2011. Anatomy At the elbow, the ulnar nerve travels through a tunnel of tissue (the cubital tunnel) that runs under a bump of bone at the inside of your elbow. This bony bump is called the medial epicondyle. The spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone." At the funny bone the nerve is close to your skin, and bumping it causes a shock-like feeling.
    [Show full text]
  • Breathing Techniques for Kids (Toolkit)
    BREATHING TECHNIQUES FOR KIDS exercises to center kids and help them focus CREATIVE TECHNIQUES SQUARE BREATHING On their desk or table, have kids trace a horizontal line with their fingers for a count of four as they breathe in (the top of the square). Then, trace downward to form the side of the square as they hold the breath for a count of four. Then they trace horizontally again to make the bottom of the square as they exhale. Finally, they trace upward to form the other side of the square as they hold their breath out for a count of four. Repeat. DRAW YOUR BREATH Give the children a marker and a sheet of paper. Have them place their marker on the paper. As they inhale and exhale, have them allow their markers to move up and down on the sheet. The end product is a scribble–an image of their breath! PHYSICAL TECHNIQUES TUMBLE DRYER Sitting in cross-legged position, point your index fingers towards each other and position them so your left finger is pointing to the right and your right finger is pointing to the left, overlapping a bit in front of your mouth. Inhale, then blow out as you spin your fingers round each other, making a long exhalation and a satisfying swishy sound. ALTERNATE NOSTRIL BREATHING For this breathing exercise, kids bring attention to their breath by holding one nostril closed as they breathe in and then holding the other nostril closed as they breathe out. SHOULDER ROLLS Sit comfortably. As you breathe in, roll your shoulders up and back.
    [Show full text]
  • Palm Reading
    Palm Reading Also known as palmistry or chiromancy, palm reading is practiced all over the world with roots in Indian astrology and gypsy fortune-telling. The objective is to evaluate a person’s character and aspects of their life by studying the palm of their hand. There is no substantiate evidence of correlation between palm features and psychological traits; palm reading is for entertainment purposes. Getting Started Which hand to read? There are two main practices: For males, the left hand is what you’re born with, and the right is what you’ve accumulated throughout your life. For females, it’s the opposite. Your dominant hand (the hand you use most often) determines your future and your other, non-dominant hand, is used to determine the past or hidden traits Take these into consideration when choosing which hand to read. Reading the Primary Lines of your Hand 1. Interpret the Heart Line This line is believed to indicate emotional stability, romantic perspectives, depression, and cardiac health. Begins below the index finger = content with love life Begins below the middle finger = selfish when it comes to love Begins in-between the middle and index fingers = caring and understanding Is straight and short = less interest in romance Touches life line = heart is broken easily Is long and curvy = freely expresses emotions and feelings Is straight and parallel to the head line = good handle on emotions Is wavy = many relationships, absence of serious relationships Circle on the line = sad or depressed Broken line = emotional trauma 2. Examine the Head Line This line represents learning style, communication style, intellectualism, and thirst for knowledge.
    [Show full text]
  • Raynaud's Disease Affecting Tongue As Well As
    38 THE HOSPITAL. October 12,- 1907. AN UNUSUAL CASE OF RAYNAUD'S DISEASE. The Tongue as well as Extremities Affected. The three degrees of Raynaud's disease?local almost the whole of its terminal phalanx is black the necrosis the bone as syncope, local asphyxia, and local gangrene?are and gangrenous, involving as the soft index has lost much well enough known, and cases exhibiting the first well parts. The of tissue over its second and its third and second degrees of the trouble in the fingers and the phalanx, is little more than a de- toes are not uncommon; the third phalanx represented by very fortunately formed nail. The middle finger is semi-ankylosed, which is.a sad is much rarer. stage, condition, very and its terminal phalanx has disappeared except for The is an of with following example it, together a small and deformed nail. The ring finger is gone Raynaud's disease of the tongue at the same time. altogether. The little finger is- twisted and alto- The patient is a woman now aged 44; there is gether deformed. The left hand digits are all nothing notable about her family history, and, atrophic, cyanosed, and painful, and each has lost except for the ordinary ailments of childhood, she almost the whole of its terminal phalanx; at the ends was perfectly well except for occasional neuralgia of the thumb and index finger there is a tiny corru- in various parts of her head, until she was twenty gated nail; the ring finger is the only one that has eight.
    [Show full text]
  • Individual Differences in the Biological Basis of Androphilia in Mice And
    Hormones and Behavior 111 (2019) 23–30 Contents lists available at ScienceDirect Hormones and Behavior journal homepage: www.elsevier.com/locate/yhbeh Review article Individual differences in the biological basis of androphilia in mice and men T ⁎ Ashlyn Swift-Gallant Neuroscience Program, Michigan State University, 293 Farm Lane, East Lansing, MI 48824, USA Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9, Canada ARTICLE INFO ABSTRACT Keywords: For nearly 60 years since the seminal paper from W.C Young and colleagues (Phoenix et al., 1959), the principles Androphilia of sexual differentiation of the brain and behavior have maintained that female-typical sexual behaviors (e.g., Transgenic mice lordosis) and sexual preferences (e.g., attraction to males) are the result of low androgen levels during devel- Androgen opment, whereas higher androgen levels promote male-typical sexual behaviors (e.g., mounting and thrusting) Sexual behavior and preferences (e.g., attraction to females). However, recent reports suggest that the relationship between Sexual preferences androgens and male-typical behaviors is not always linear – when androgen signaling is increased in male Sexual orientation rodents, via exogenous androgen exposure or androgen receptor overexpression, males continue to exhibit male- typical sexual behaviors, but their sexual preferences are altered such that their interest in same-sex partners is increased. Analogous to this rodent literature, recent findings indicate that high level androgen exposure may contribute to the sexual orientation of a subset of gay men who prefer insertive anal sex and report more male- typical gender traits, whereas gay men who prefer receptive anal sex, and who on average report more gender nonconformity, present with biomarkers suggestive of low androgen exposure.
    [Show full text]
  • Upper Extremity Impairment Rating Methodology and Case Presentation
    Upper Extremity Impairment Rating Methodology and Case Presentation Dr. M. Alvi, PhD, PEng, MD, FRCSC To Rate or Not to Rate That is the Question! 2 Objectives Definition of terms The process of impairment evaluation using the AMA Guidelines Components of an impairment report Demonstrate ability to perform musculoskeletal impairment evaluations 3 Impairment ≠ Disability Disability Pain Impairment 4 JAMA Feb 15, 1958 12 other guides were published in the JAMA over the next twelve years. Of interest to us are the guide on the vascular system, published March 5, 1960, and the guide on the peripheral nervous system which was published July 13, 1964. Musculoskeletal System 5 Evolution of the Guides 1970 1980 1990 2000 2010 1st 2nd 3rd 3rd R 4th 5th 6th 1971 1984 1988 1990 1993 2000 2007 6 History of the AMA Guides 1956 - ad hoc committee 1958-1970 - 13 publications in JAMA 1971 - First Edition 1981 - established 12 expert panels 1984 - Second Edition 1988 - Third Edition 1990 - Third Edition-Revised 1993 - Fourth Edition (4 printings) 2000 – Fifth Edition (November 2000) 2007 (December) – Sixth Edition Radical paradigm shift 7 AMA Guides Growth in Size 700 600 500 400 Pages 300 200 100 0 Third Second Third Fourth Fifth Sixth Rev. Pages 245 254 262 339 613 634 8 Goals Explain the concept of impairment Discuss the proper use of the AMA Guides Explain source and limitations of the Guides Describe the steps involved in evaluating impairment Discuss critical issues encountered in the use of the Guides 11 Purpose of the Guides Provide a reference framework Achieve objective fair and reproducible evaluations Minimize adversarial situations Process for collecting, recording, and communicating information 12 The AMA Guides must adopt the terminology and conceptual framework of disablement as put forward by the International Classification of Functioning, Disability and Health (ICF).
    [Show full text]
  • Classification of Finger Posture in Drop Finger Due to Cervical Foraminal Stenosis: a Mini-Review
    hysical M f P ed l o ic a in n r e u & o R J l e a h International Journal of Physical n a b o i t i l i a ISSN: 2329-9096t a n r t i e o t n n I Medicine & Rehabilitation Mini Review Classification of Finger Posture in Drop Finger Due to Cervical Foraminal Stenosis: A Mini-Review Mitsuru Furukawa1*, Michihiro Kamata2 1Department of Orthopedic Surgery, Murayama Medical Center, Tokyo, Japan; 2Department of Orthopedic Surgery, Keiyu Hospital, Kanagawa, Japan ABSTRACT Few reports have been published examining cervical foraminal stenosis as the cause of drop finger. This mini-review, therefore, will provide a summary of the findings of articles published on this topic, written in both English and Japanese. Cervical foraminal stenosis is difficult to diagnose from imaging findings alone; thus, physical examination findings are often needed to make a firm diagnosis. Numbness of the fingers, the extent of interscapular pain, and finger posture can be used to differentiate drop finger due to cervical foraminal stenosis from other diseases. It is crucial to provide sufficient explanation to the patient before a decompression surgery is performed because the recovery of muscle strength is often incomplete and the improvement may be small. Keywords: Drop finger; Cervical foraminal stenosis; C7 nerve root; C8 nerve root ABBREVIATIONS: RESULTS CFS: cervical foraminal stenosis; PION; Posterior Interosseous The search obtained three case reports, one clinical feature, and Nerve; ECR; Extensor Carpi Radialis; EDM; Extensor Digiti one surgical outcome from PubMed, whereas two case reports Minimi; EIP; Extensor Indicis Proprius and two reviews came from the Japan Medical Abstracts Society.
    [Show full text]
  • Cubital Tunnel Syndrome
    CUBITAL TUNNEL SYNDROME The ulnar nerve, along with the radial and median nerves, is one of the three major nerves of the arm. It supplies sensation to most of the hand muscles, as well as to much of the forearm. If there is pressure on the ulnar nerve as it passes through the cubital tunnel, a bony passageway along the inside of the elbow, there will be sensory and motor changes in the hand. Entrapment of the ulnar nerve is also known as cubital tunnel syndrome. If you “hit your funny bone” and have a tingling sensation in the small and ring fingers, you have hit the ulnar nerve as it is pulled into the bony groove of the cubital tunnel. With cubital tunnel syndrome there is pressure on the ulnar nerve each time the elbow is bent, reducing the supply of blood to the nerve. This causes damage to the nerve over time. There are three long bones in the arm: the humerus, or upper arm, and the ulna and radius, the two bones of the lower arm. The bone on the little finger side of the forearm is the ulna, and the bone on the thumb side of the forearm is the radius. The elbow joint is a hinge joint formed by the end of the humerus and the end of the ulna, the larger bone. The ulna is smaller at the wrist, and widens quite a bit towards the elbow. Multiple ligaments attach these bones together at the elbow, allowing the joint to bend like a hinge.
    [Show full text]