A comprehensive physical exam using CMS criteria includes many elements that are totally irrelevant to workers’ compensation injury evaluation and care, and the CMS criteria are missing many critical factors that should be examined.
CMS permits specialty specific examinations, based on 1995 criteria, for comprehensive examinations relevant to a specific specialty, as an alternative to the general examination 1997 criteria. ACOEM has developed an Occupational Medicine Specialty Examination template for a musculoskeletal examination. Although developed for workers' compensation encounters, this examination could also be used for musculoskeletal examination for other Occupational Medicine purposes, such as disability evalution or fitness for duty.
The ACOEM criteria recognize the need to examine and document both a comprehensive examination of the injured part of the body, and factors that may point to risk for prolonged work disability.
Level of Exam Criteria
Because all the function-oriented exam elements are all relevant to a musculoskeletal injury or condition that may be seen in workers’ compensation care, scoring is much simpler for levels of care than the CMS level of care scoring system.