Assistance for Medical Providers
The Bureau would like to assist you as a medical provider treating injured workers involved in a Tennessee workers’ compensation claim. If an employee gets hurt at work or gets sick from his/her job, the employer is expected to immediately notify their insurance carrier or third party administrator (TPA) so that the claim can be processed timely. Tennessee’s workers’ compensation system requires most employers to pay for the medical treatment needed. It does not generally matter whether the accident was the employee’s fault, another worker’s, or the employer’s. Employees still get the benefits spelled out in Tennessee’s Workers’ Compensation law.
Advisory from the Medical Director
The use of certain injections in orthopedic office practice is routine. As a result, these are not considered to require pre-authorization separately from the office visit and should be reimbursed by the correct CPT ® codes for the same day of service.
These include single steroid and analgesic injections into a trigger point, bursae or joint in the office setting. Documentation of the results at the next office visit is appropriate.
This advisory does not apply to visco-supplementation, multiple trigger point injections, epidural injections, ultrasound guidance, or other sequences of injections.
The Bureau accepts only ICD-10 on all correspondence for all dates of service on or after October 1, 2015
Tennessee Clinical Practice Guidelines for the Outpatient Management of Chronic Non-Malignant Pain
Read the Appendix to the Tennessee Department of Health: Tennessee Clinical Practice Guidelines for the Outpatient Management of Chronic Non-Malignant Pain.
There are special circumstances in the management of chronic pain for injured workers that are addressed by this Appendix. Please, first review the Tennessee Department of Health Guidelines and Brochure before reviewing this appendix. Please note that this is a reference guide and aid to help the practitioner safely and effectively manage medications used for chronic pain. Rules regarding all treatment guidelines will be developed and presented to the public in the near future.
Chronic Pain Guidelines
Read the brochure entitled 'If opioids have not relieved your chronic pain'.' This may be copied for your patients.
The AMA Guides™ to the Evaluation of Permanent Impairment, 6th Edition is effective for injuries which occur on or after January 1, 2008. Please see Tennessee Code Annotated, Section 50-6-204.
The edition of the AMA Guides that is in effect on the date of injury is the edition that shall be applicable to the claim. Please see Tennessee Code Annotated, Section 50-6-102.
For dates of injury on or after July 1, 2014, Tennessee Code Annotated Section 50-6-204 states, in part, that ratings:
“…shall not consider complaints of pain in calculating the degree of impairment, notwithstanding allowances for pain provided by the applicable edition of the AMA Guides™..."
This requirement changes the way that some parts of the 6th Edition of the AMA Guides™ should be utilized.
Need More Help?
If you have additional questions, please call 615-532-4812 or 800-332-2667 or contact us by email at firstname.lastname@example.org.