Virginia : The primary purpose of my blog posts is to inform Nevada’s injured workers about the law and the claims process. However, I occasionally like to offer my readers from the workers’ compensation industry a more detailed analysis of a current issue that requires a working familiarity with Nevada workers compensation claims. The following is a guest blog post by a well-respected Nevada rating doctor on a difficult rating issue. (Chiropractors on the DIR’s list of rating doctors are qualified to rate any injury to the musculoskeletal system.)
Under the 5th edition of the AMA Guides to Permanent Impairment, when a rating doctor is evaluating a cervical, thoracic, or lumbar spine injury, such as a herniated disc, the doctor must correctly choose one of two rating methods in the book. Whether the rating doctor uses the range of motion method , or uses a DRE category can significantly change the percentage of impairment. Ultimately, the amount of money the injured worker receives as his PPD award, will be affected. I asked Paul Pirruccello, D.C, currently on the DIR’s panel to review Nevada ratings for errors, to explain when the Guides require that the rating doctor use the Range of Motion method of rating spinal injuries:
When Should the Range of Motion (ROM) Method Be Used for Spinal Impairment?
When an adequate number of PPD ratings have come across your desk, you will inevitably come across spinal ratings where the ROM Method has been used because the rating doctor thinks there is “multilevel involvement.” The major concern in these cases lies in the rater’s understanding of the AMA Guides definition of multilevel involvement. The proper utilization of the ROM Method is best defined in Section 15.2a #4 on page 380 of the AMA Guides, as follows: a. Fractures at more than one level in a spinal region. b. Radiculopathy bilaterally or at multiple levels in the same spinal region. c. multilevel motion segment alteration (such as multilevel fusion) in the same spinal region. d. Recurrent disk herniation or stenosis with radiculopathy at the same or a different level in the same spinal region.