Medical Legal Updates

The “Dahl” Case

The “Dahl” Case is pending on appellate grant and may be a strategic advantage for the applicants to increase permanent disability (PD) ratings by using a vocational expert.

“Whether the Board properly relied upon the opinion of a vocational expert retained by the injured employee to award 79% permanent disability for her neck and right shoulder injury, concluding that the opinion was substantial evidence to rebut the Diminished Future Earning Capacity component of the 2005 Schedule for Rating Permanent Disabilities.” (A141046, ADJ1310387, WRIT ISSUED 1/8/2015)

AB 1542

California Professional Firefighters and California Society of Industrial Medicine and Surgery (CSIMS) are urging the Governor to sign AB 1542 for California’s injured workers to be evaluated by a health care professional for concussions.

Recent support for similar bill (AB 2127) addressed head injuries when they occur in high school athletes. As a result, the California Education Code now mandates that intermediate and high school students who may have suffered a concussion, be evaluated by a health care professional specially trained in concussions before they can return to practice or games. Schools must now provide direct access to specialists who are trained in head trauma. Every family with athletes in high school sports benefits. And AB 1542 requests the same level of care for California’s injured workers.

Online QME Panel Selection

The Division of Workers’ Compensation (DWC) implemented a new online panel process for represented initial panel requests on October 1. It requires parties in a represented case to submit initial Qualified Medical Examiner (QME) panel requests online and immediately receive a QME panel.

“Represented injured workers can get QME medical legal without delay, and this will also allow DWC resources to help unrepresented workers obtain panel doctors,” said Christine Baker, Director of the Department of Industrial Relations (DIR). DWC is a division of DIR.

Attorneys must have a Uniformed Assigned Name (UAN) to access the online QME Form 106 Panel Request. (Unrepresented injured workers will continue to use the paper Form 105.) Information on the new online panel process, including FAQs and a training video, is available on the DWC Medical Unit website.

ICD-10

The number of codes increases from 18,000 codes with ICD-9 to 150,000 codes with ICD-10.

The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) posted the final approved regulations regarding transitioning the California workers’ compensation system from the ICD-9 system of diagnosis to the ICD-10 system of diagnosis, effective October 1, 2015.

The International Classification of Diseases—10th Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases —10th Revision, Procedure Coding System (ICD-10-PCS) have been adopted for workers’ compensation for services rendered and inpatient discharges on or after October 1, 2015, in order to be consistent with the coding system that will be mandatory for most health care providers across the country beginning October 1. ICD-9 codes are not allowed for services rendered, or inpatient discharges, on or after October 1, 2015.

The regulations that have been approved by the Office of Administrative Law include updates to the following forms and related regulations:

· Doctor’s First Report of Injury (Form 5021)
· Primary Treating Physician’s Progress Report (Form PR-2)
· Primary Treating Physician’s Permanent and Stationary Report (Forms PR-3, PR-4)

The regulations provide a “grace period” for use of the revised forms. From October 1, 2015 through December 31, 2015, providers may use either the old or new versions of the forms. However, for services rendered on or after October 1, 2015, the ICD-10 code is required, whether the old or new form is used. For services rendered on or after January 1, 2016, the new forms are required.

In recognition of the challenges involved in transitioning to the new coding system, the regulations provide some leeway in relation to the accuracy of the ICD-10 code used. The DWC has adopted a provision stating that a bill shall not be denied solely due to the level of “specificity” of the ICD-10 code. This is similar to the guidance provided by the Centers for Medicare and Medicaid Services, allowing some flexibility in the selection of the ICD-10 code, as long as the diagnosis code used is a valid ICD-10 code.

The Centers for Medicare and Medicaid Services’ website contains useful information and resources relating to preparation for the ICD-10 implementation, including a list of valid ICD-10 codes.