Thursday, February 10, 2005

More Disability Training

OK, I don't want to sound like I never see a valid claim. We pay approximately 98% of the claims submitted. I only see the ones that someone else has screened and denied for some reason. The most common reason I will find medical support for impairment when a previous reviewer didn't is the submission of additional information.

When I was in private practice before I started this job, I didn't record certain observations that may have helped my patient. If you notice that your patient has trouble walking down the hallway to the exam room, mention it. Document whether she has trouble arising from the chair in the exam room and if she has trouble getting onto the exam table.

Don't be afraid to order a functional capacity exam.

In all respect to my fellow FP's, an exam and opinion from a specialist will carry more weight. Anyway, if the disease process is so severe that your patient can't work, shouldn't you get a consultation with an expert in that field, even if it is just one visit to confirm your diagnosis and treatment plan?

Don't restrict your comments to specific activities. Feel free to use examples. If a patient has knee pain from osteoarthritis, you may want to say:

Positional activities (such as sqatting/bending/ stooping/kneeling/crawling) are limited to no more than brief periods on a limited basis. For example, it is reasonable that [your patient] would be able to bend/stoop/squat as required to get something out of a floor level cabinet or drawer, but should not assume these types of positions to perform work activities.

If your patient has cervical spondylosis, you may want to say:

No prolonged static positioning without the ability to change positions as necessary. Use of a computer monitor, for example, is allowed if [your patient] has the freedom to move her head and change her viewing angle as necessary. However, job activities that require prolonged head positioning, such as an auto mechanic under a car, are restricted.