Alternative Ground Rules for Evaluation and Management
Here are the proposed alternative rules for documenting clinical care provided for a work injury. These are meant to be used by any type of clinical provider treating an injured worker. These rules follow evidence-based best practices.
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About this Project
ACOEM is partnering with other organizations and individuals interested in getting better clinical outcomes for people injured at work. We have developed aternative documentation rules for initial and follow-up clinic visits for patients with work injuries, based on research-proven best practices.
We are also in the process of developing alternative documentation rules for other codes important for workers' compensation care, and in some cases, proposed new codes for services that are important in workers' compensation, for which there are no existing codes that may apply.
We hope that these proposed new rules will assist insurers, workers' compensation commissions, healthcare providers and other stakeholders in understanding what elements of care lead to the best patient outcomes in workers' compensation. These rules are designed to be adopted as an alternative to the documentation requirements established for different clinical purposes.
Note that these proposed ground rules will provide a mechanism for promoting research-proven best practices in workers' compensation, but the impact of using these rules still needs to be studied. ACOEM is also looking for research partners to study the impact of adopting these rules on practice and outcomes.
We anticipate that work disability time will be decreased, and that value of health care services will be improved, when the coding for reimbursement is aligned with the assessments that are necessary to guide health care delivery in a manner that will return patients injured at work to health, function and employment as efficiently as possible.
To see how this proposed system of documentation will help clinical providers focus on the elements of care important in workers' compensation visits, take a look at this case makeover example, using the proposed new rules for Evaluation and Management Codes.
Evaluation and Management Encounters
Several years ago ACOEM's Council on Occupational and Environmental Medicine Practice established a committee to address the long recognized problems in the requirements for documenting clinical care, as applied to workers' compensation. This committee determined that the most feasible and potentially impactful approach to solving this problem, would be to develop a specific set of ground rules appropriate for workers' compensation clinical care.
The committee started with the most important codes, those that govern routine visits for initial and follow-up care. The committee is also working on rules for other important clinical services in workers' compensation.