ACOEM Guidance Related to Workers' Compensation

Occupational and environmental medicine is the medicine specialty devoted to prevention and management of occupational and environmental injury, illness and disability, and promotion of health and productivity of workers, their families, and communities.

ACOEM, an international society of thousands of occupational physicians, provides leadership to promote optimal health and safety of workers, workplaces, and environments.

ACOEM provides leadership in research, education and guidance to promote clinical care that provides optimal clinical and functional outcomes for workers injured on the job.

Defining Documentation Requirements for Coding Quality Care in Workers’ Compensation

Position Paper

                                                                                   

Executive Summary

In the United States, every year there are more than one million workplace injuries or illnesses severe enough that days are lost from work. Injured workers require medical care and careful attention to factors that will help them recover their ability to work, but American medical practice focuses on disease diagnosis and treatment, with little attention paid to functional ability. In the workers’ compensation arena, health care providers must address issues such as causation, functional impact and return-to-work planning, issues that are not represented in the most widely used payment systems, based on codes and coding rules designed for primary care and other group practice settings. These coding rules fail to capture and incentivize the delivery of services that are critically important in the workers’ compensation arena, while reimbursing other services that have little value.

    

The American College of Occupational and Environmental Medicine (ACOEM) supports modifying the rules for documentation of care in workers’ compensation in order to provide reimbursement and other incentives to deliver care that adheres to best practices, including focus on assessing and improving patient function.

 

The recommended changes include alternative ground rules for documentation and coding evaluation and management encounters, physician case management services and consultation services as they relate to workers’ compensation care. These alternative rules may be adopted by states or payers seeking to realign incentives toward improved functional and clinical outcomes and decreased costs.

Find the full paper here:

http://www.acoem.org/uploadedFiles/Public_Affairs/Policies_And_Position_Statements/Guidelines/Guidelines/Defining_Documentation_Requirements_for_Coding.19.pdf 

American College of Occupational and Environmental Medicine

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Tel: 847-818-1800

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