Tenn. Comp. R. & Regs. 0800-02-17-.15 - MEDICAL REPORT OF INITIAL VISIT AND PROGRESS REPORTS FOR OTHER THAN INPATIENT HOSPITAL CARE

(1) Except for inpatient hospital care, a provider shall furnish the employer with a narrative medical report for the initial visit, all information pertinent to the compensable injury, illness, or occupational disease if requested within thirty (30) calendar days after examination or treatment of the injured employee.

(2) If the provider continues to treat an injured or ill employee who is receiving temporary disability payments (total or partial) for the same compensable injury, illness or occupational disease, the provider shall provide an updated medical report to the employer, including an assessment of functional progress toward employment (restricted or unrestricted as appropriate), at intervals not to exceed sixty (60) calendar days.

(3) The narrative medical report or the medical office visit note including an assessment of functional progress toward employment, of the initial visit and the progress or follow-up visit shall include (in addition to applicable identifying information) all of the following information:

(a) Subjective complaints and objective findings, including interpretation of diagnostic tests;

(b) For the narrative medical report of the initial visit, the history of the injury, and for the progress report(s), significant history since the last submission of a progress report and the diagnosis;

(c) As of the date of the narrative medical report or progress report, the projected treatment plan, including the type, frequency, and estimated length of treatment;

(d) Physical limitations and expected work restrictions and length of time of those limitations and/or restrictions if applicable.

(4) When copies of narrative medical reports required by 0800-02-17-.15(1) and (2) are requested, the provider of the requested reports shall be reimbursed at the following rates using code Z0710: initial and subsequent reports - not to exceed $10 for reports twenty (20) pages or less in length, and twenty-five (25) cents per page after the first twenty pages. No charge is allowed for routine office notes as these are not considered narrative reports under this rule. No fee shall be paid if a request for medical records does not produce any records.

(5) A medical provider shall complete any medical report required by the Bureau without charge except completion of the C-30A (Final Medical Report) or the C-32 (Standard Form Medical Report) or their replacement forms.

(6) After an initial opinion on causation has been issued by the physician, a request for a subsequent review based upon new information not available to the physician initially, may be charged by the physician and paid by the requesting party using state-specific code Z0210 ($200 for one hour or less) and state-specific code Z0211 ($100 for each additional hour). No additional reimbursement is due for the initial opinion on causation or a response to a request for clarification (that does not include any new information) of a previously issued opinion on causation.

(7) Extra time spent in explanation or discussion with an injured worker or the case manager (that is separate from the discussion with the injured worker) may be charged on the same day as an office visit charge provided the extra time is equal to or greater than fifteen (15) minutes. State-specific code Z0410 shall be used for thirty (30) minutes or less ($40 for 15-30 minutes). State-specific code Z0411 shall be used for greater than thirty (30) minutes ($80 for 31 minutes or greater). The physician may charge for consultation with a case manager using the appropriate consultation or team conference CPT® code, when not on the same day as an office visit.

(8) Extra time spent assessing, counseling or providing behavioral intervention to a Workers' Compensation patient for substance and/or alcohol use, or for substance and/or alcohol use disorder may be charged on the same day as an office visit charge using state-specific code Z0510 up to a maximum of eighty dollars ($80) in addition to a standard E/M code. An assessment by structured screening shall be documented. The code may only be charged if the patient is on a long term (over 90 days) Schedule II medication or long term (over 90 days) combination of one or more Schedule II, III, and/or IV medications.

Notes

Tenn. Comp. R. & Regs. 0800-02-17-.15

Public necessity rule filed June 5, 2005; effective through November 27, 2005. Public necessity rule filed November 16, 2005; effective through April 30, 2006. Original rule filed February 3, 2006; effective April 19, 2006. Repeal and new rules filed November 27, 2017; effective February 25, 2018. Administrative changes made to this chapter on September 10, 2019; "Tennessee Workers' Compensation Act" or "Act" references were changed to "Tennessee Workers' Compensation Law" or "Law." Amendments filed June 28, 2021; effective September 26, 2021. Amendments filed June 27, 2023; effective 9/25/2023.

Authority: T.C.A. §§ 50-6-204, 50-6-205, and 50-6-233 (Repl. 2005).