Designated Physician Report Writing
By Michael S. Blott, D.C., FAFICC and Gary N. Lewkovich, D.C., FAFICC
It may be hard for AFICC fellows to remember back to when they wrote their first medical report. Through years of practice, scores of training seminars, and hundreds of such reports under our belts, most report writing has become second nature to us. Unfortunately, this is often not the case for many doctors, especially those with little experience in writing permanent and stationary reports in the worker comp arena. Poorly reasoned or improperly formatted reports can harm the patient, the treating doctor and the reputation of chiropractic in general.
The IMC is attempting to simplify this P & S report writing procedure with "fill-in-blank" type forms. As structured as this approach may become, it will probably never replace the quality of a well-structured, narrative report, especially in the more complicated cases. In the more simplified cases, these proposed IMC forms still presume that the treating doctor is well versed in all the common QME terminology. Concepts such as Permanent and Stationary, Work Restrictions, Future Care, Apportionment, Subjective Factors, Objective Factors and Vocational Rehabilitation have relatively precise legal and medical meanings. As difficult as this procedure is for the treating doctors, even many QME’s, quickly forget the science of this process without constant practice. Many others just dread the whole time-consuming process and would rather just treat their patients and leave the report writing to someone else.
Fortunately the Labor Code provides a solution. Labor Code 4061.5 provides for the treating doctor to designate another doctor to write the P&S report.
The procedure is fairly straightforward and well accepted by the insurance carriers. The carriers would rather have a well-constructed report than the alternative written by a less than polished doctor.
The report follows the same protocol as the QME report, with the addition of a statement by the treating doctor at the end. It should state that the treating doctor agrees with the contents of the report and include their dated signature. This comment follows the report writer's signature. Make it clear what the circumstance are concerning authorship of the report (remember Labor Code 4628 and 139.3). State in the introduction of the report that you have been designated to write the report by the treating physician.
The carrier is responsible for payment of this report. Include your billing on your stationary with the report. The codes I use are as follows (you may wish to use different codes):
Examination 99244-17 .....$189.55
Records review 99358 .....$137.00
Report 99080 first page .... $39.98
99080 2-6 pages ................$123.00 @ $24.60 per page (six page maximum)
This total is slightly below the charge for an average QME report, but there is a little less paper work and you are helping a fellow chiropractor, the chiropractic profession, and, of course, the patient. If you should have any questions regarding this issue, you can contact Dr. Michael Blott at email@example.com.