AMA Guides® Newsletter - Issue Archive

Articles

1. Standards for Independent Medical Examinations

   Chet Nierenberg, Christopher Brigham, Lorne K. Direnfeld, Clarissa Burket

   Pages 1–9

   DOI: 10.1001/amaguidesnewsletters.2005.NovDec01

   Abstract

   An independent medical evaluation (IME) may be more comprehensive and may contain more elements than an impairment evaluation, but to date no standards have defined a high-quality IME. The authors, a group of experienced IME physicians, note the variability of requirements in individual IME cases, but they have identified standards that generally apply to IME reports and include the following: definition of IME and key concepts; examiner qualifications; methodology and procedures; the physical examination; suggested generalized report format; and quality assurance. An IMR is a specialized examination and report, ideally performed by a medical physician with special training and experience in IMEs; an IME is not a medical consultation and report but rather an opportunity to determine diagnosis and document the clinical course over time. Examiners should be qualified by experience and qualifications and ideally should have a special credential from an independent medical examiners association and must be knowledgeable about IME report writing. A section of the article describes the structure of the IME report, which may vary from examiner to examiner but should include careful attention to descriptive data, history, record review, oral history, physical examination, records of other objective data, and an opinion section (with diagnoses, discussion, past medical treatment, maximum medical improvement, future medical treatment, causation and apportionment, disability/functional status, prognosis, answers to specific questions, and references.
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2. Impairment Tutorial: Billing for Impairment Ratings

   Allan Colledge, Greg Krohm

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2005.NovDec02

   Abstract

   The AMA Current Procedural Terminology (CPT) codebook lists specific codes that can be used for impairment ratings, and in some industrial cases insurance carriers require an impairment rating determination at medical stability for which a CPT code is needed. For billing purposes, an impairment rating performed by the treating physician usually is considered an extension of the treatment process (office visit, medical records review, diagnostic studies, current physical findings, and a written report). A table in this issue of The Guides Newsletter shows current nonspecific CPT procedure codes; if the report does not conform to the established criteria as outlined in the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), the evaluating physician may not be entitled to reimbursement. A work-related or medical disability examination involves taking a medical history commensurate with the patient's condition, examination, diagnosis, assessment of capabilities and stability, calculation of impairment, development of a treatment plan, and completion of documentation or certificates and report. Treating physicians who perform the examination can bill this work using CPT code 9455; CPT code 99456 applies if a nontreating physician performed the work (the code is used for each 30-minute increment). AMA recommends tht payment for these codes be dependent on the complexity of the case, the time required in the evaluation and report writing, and the value of the examiner's time.
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