Tenn. Comp. R. & Regs. 0800-02-17-.25 - IMPAIRMENT RATINGS-EVALUATIONS AND IN MEDICAL RECORDS

(1) This rule applies to authorized treating physicians. This rule is not applicable to Independent Medical Examinations ("IME") or impairment ratings rendered as a part of an IME pursuant to Rule 0800-02-17-.09. As used in this Rule 0800-02-17-.25 only, an authorized treating physician is that physician, chiropractor or medical practitioner who determines the employee has reached maximum medical improvement regarding the condition or injury for which the physician has provided treatment. The authorized treating physician may include any of the following:

(a) A physician chosen from the panel required by T.C.A. § 50-6-204;

(b) A physician referred to by the physician chosen from the panel required by T.C.A. § 50-6-204;

(c) A physician recognized and authorized by the employer to treat an injured employee for a work-related injury; or

(d) A physician designated by the Bureau to treat an injured employee for a work-related injury.

(2) The authorized treating physician is required and responsible for determining the employee's maximum medical improvement (MMI) date and providing the employee's impairment rating for the injury the physician is treating. In some circumstances, a work-related accident may lead to multiple injuries that require multiple authorized treating physicians. In such cases, the physician that is treating a distinct injury shall determine that the employee has reached maximum medical improvement as to that injury only and is required and responsible for providing an impairment rating for that injury only. An authorized treating physician shall not be required or responsible for providing an impairment rating for an injury that the physician is not treating. The authorized treating physician shall only be required to provide an impairment rating when the physician believes in good faith that the employee retains a permanent impairment upon reaching maximum medical improvement. If, after completion of the rating, it is determined that the employee has an impairment rating of zero, then the provisions of Rule 0800-02-17-.25(6) shall still apply. If the treating physician does not have a good faith belief that the employee retains a permanent impairment upon reaching maximum medical improvement, then the authorized treating physician shall still be required to complete an impairment rating on the Bureau's form but shall not charge a fee for the impairment rating.

(3) All impairment ratings shall be made pursuant to T.C.A. § 50-6-204.

(4) Within twenty-one (21) calendar days of the date the authorized treating physician determines the employee has reached maximum medical improvement, the authorized treating physician shall submit to the employer a fully completed report on a form prescribed by the Administrator. The employer shall submit a fully completed form to the Bureau (if requested) and the parties within thirty (30) calendar days of the date the authorized treating physician determines the employee has reached maximum medical improvement.

(5) Upon determination of the employee's impairment rating, the authorized treating physician shall enter the employee's impairment rating into the employee's medical records. In a response to a request for medical records pursuant to T.C.A. § 50-6-204, a provider, authorized treating physician or hospital shall include the portion of the medical records that includes the impairment rating.

(6) The authorized treating physician is required and responsible for providing the impairment rating, fully completing the report on a form prescribed by the Administrator, and submitting the report to the employer. Notwithstanding Rule 0800-02-17-.15, the authorized treating physician shall receive payment of no more than $250 for these services to be paid by the employer. State-specific code Z0310 (up to $250) shall be used for charges related to the completion of the prescribed form. The payment shall only be made to the authorized treating physician if the authorized treating physician documents the consultation with the applicable AMA GuidesT. The analysis shall include documentation of the section, page, or table as applicable, as well as a description of the reasoning and methodology based upon the medical records. The fee is payable even if the analysis results in a zero impairment rating. The physician may bill for an office visit, in addition to Z0310, using the appropriate CPT code for services provided on the same day.

(7) Failure to fully complete the form and submit it within the appropriate timeframes may, at the discretion of the Administrator, subject the employer or authorized treating physician, as applicable, to a civil penalty of $100 for every fifteen (15) calendar days past the required date until the fully completed form is received by the parties and the Bureau (if requested).

Notes

Tenn. Comp. R. & Regs. 0800-02-17-.25

Original rule filed December 20, 2007; effective March 4, 2008. Public necessity rule filed January 8, 2009; effective through June 22, 2009. Public necessity rule filed May 19, 2009; effective through October 31, 2009. Amendment filed June 12, 2009; effective August 26, 2009. Amendment filed December 26, 2013; effective March 26, 2014. Repeal and new rules filed November 27, 2017; effective February 25, 2018. Amendments filed June 12, 2019; effective September 10, 2019. 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. §§ 50-6-102, 50-6-204, 50-6-205, 50-6-226, 50-6-233, and 50-6-246 [applicable to injuries occurring prior to July 1, 2014] and Public Chapters 282 & 289 (2013).