Impairment Ratings-Evaluations And In Medical Records

(1) This Rule applies to authorized treating physicians. This Rule is not applicable to Independent Medical Examinations (“IME”) or impairment ratings rendered as a part of an IME pursuant to Rule 0800-02-17-.09. As used in this Rule 0800-02-17-.25 only, an authorized treating physician is that physician, chiropractor or medical practitioner who determines the employee has reached maximum medical improvement regarding the condition or injury for which the physician has provided treatment. The authorized treating physician may include any of the following: (a) A physician chosen from the panel required by T.C.A. § 50-6-204; (b) A physician referred to by the physician chosen from the panel required by T.C.A. § 50- 6-204; (c) A physician recognized and authorized by the employer to treat an injured employee for a work-related injury; or (d) A physician designated by the Bureau to treat an injured employee for a work-related injury. (2) The authorized treating physician is required and responsible for determining the employee’s maximum medical improvement (MMI) date and providing the employee’s impairment rating for the injury the physician is treating. In some circumstances, a work-related accident may lead to multiple injuries that require multiple authorized treating physicians. In such cases, the physician that is treating a distinct injury shall determine that the employee has reached maximum medical improvement as to that injury only and is required and responsible for providing an impairment rating for that injury only. An authorized treating physician shall not be required or responsible for providing an impairment rating for an injury that the physician is not treating. The authorized treating physician shall be required to provide an impairment rating when the physician believes in good faith that the employee has reached maximum medical improvement. (3) All impairment ratings shall be made pursuant to T.C.A. § 50-6-204. (4) Within twenty-one (21) calendar days of the date the authorized treating physician determines the employee has reached maximum medical improvement, the authorized treating physician shall submit to the employer a fully completed report on a form prescribed RULES FOR MEDICAL PAYMENTS CHAPTER 0800-02-17 by the Administrator. The employer shall submit a fully completed form to the Bureau (if requested) and the parties within thirty (30) calendar days of the date the authorized treating physician determines the employee has reached maximum medical improvement. (5) Upon determination of the employee’s impairment rating, the authorized treating physician shall enter the employee’s impairment rating into the employee’s medical records. In a response to a request for medical records pursuant to T.C.A. § 50-6-204, a provider, authorized treating physician or hospital shall include the portion of the medical records that includes the impairment rating. (6) Notwithstanding Rule 0800-02-17-.15, the authorized treating physician shall receive payment of no more than $250 (unless a CPP physician) for these services to be paid by the employer. State-specific code Z0310 (up to $250) shall be used for charges related to the completion of the prescribed form. The payment shall only be made to the authorized treating physician if the authorized treating physician documents the consultation with the applicable AMA Guides™. The analysis shall include documentation of the section, page, or table as applicable, as well as a description of the reasoning and methodology based upon the medical records. The fee is payable even if the analysis results in a zero-impairment rating. The physician may bill for an office visit, in addition to Z0310, using the appropriate CPT code for services provided on the same day. A rating of zero without appropriately consulting the Guides® shall not receive a payment. (7) Failure to fully complete the form and submit it within the appropriate timeframes may, at the discretion of the Administrator, subject the employer or authorized treating physician, as applicable, to a civil penalty of $100 for every fifteen (15) calendar days past the required date until the fully completed form is received by the parties and the Bureau (if requested).