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Official Disability Guidelines -

Treatment in Workers’ Comp

ODG

Work Loss Data Institute (WLDI)169 Saxony Road, Suite 101

Encinitas, CA 92024Phone: 800-488-5548

www.worklossdata.com

WELCOME!

This is a self-paced training module for the ODG website.

Click on the button at the lower right-hand corner to begin.

NOTE: To ensure success, right click and select “Full Screen”.

Instructions Before You Begin…This training module is designed to be interactive.• Opportunities for you to “practice” your new skills have been

built into the training.• When the instructions appear on the screen, use your mouse

to participate in the activity.

Use your mouse “clicker” for rewinding or advancing slides or text boxes if you miss something. DO NOT USE THE SCROLL WHEEL on your mouse.• Similar to a VCR, use the two blue buttons at the bottom of

the screen to rewind or to play forward

• You can advance pop-up buttons by using the left-click on your mouse to speed the process

The average run-time for the module is 20-25 minutes

Training Objectives• Understand when, why & how to use ODG

• Learn how to access the ODG website

• Learn how to use the navigation options to find the information you’re looking for

• Learn about the different components of the guidelines

• Understand which guidelines you will use the most to do your job

REMINDER: Click on button when you’re ready to go.

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ODGThe Evidence-Based Authority on

Utilization Review and Disability Duration

Reasons for Using ODG

• Prospective Case Management

• Setting Reserves / Claims Adjusting

• Retrospective Benchmarking

• Utilization Review / Management

• Clinical Practice

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How to Get Into the WebsiteODG Access Information

Logging into the Site from Web• Begin by opening your Web browser (i.e.

Internet Explorer):

• Type in the address for the website• www.odgtreatment.com

• You will get a pop-up box, like the one below, for your log-in information:

ODG Main Menu Your Toolbar is located at the top of

the page.

After logging in, click on the picture of the books to enter the site. This will open the Contents Page

The Contents Page is “Home Base”. From here, first decide if

you want treatment or duration guidelines, then enter Section A or B appropriately.

(Section D has important background

info, including the Preface and Users

Guide).

From the Contents Page…

The Contents Page contains 3

types of guidelines.

Section A contains the ODG Treatment Guidelines (most

useful for UR / UM, nurses and doctors).

Section B contains the ODG Disability

Duration Guidelines (useful for all users).

In Section C, you will find Impairment Guides from

IAIABC (not ODG).

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How to Find What You’re Looking For

ODG Indexing Functions

From the Contents Page

Starting with an example in Section B, there are 3 ways you can search for duration guidelines.

Index options for duration guidelines

are listed under Section B.

We will begin by going over the ICD9 Index option. Click anywhere

on this page to proceed.

You can look up by ICD9 diagnosis code,

by keyword (i.e. name or body part)

or by the CPT procedure code.

Using the ICD9 Index

Starting from the Main Menu, use

your mouse to click on ICD-9 Index to begin your search.

Hint!

In this example, say you’d like to find

disability duration guidelines for ICD9

code 847.2.

Using the ICD9 IndexBy clicking on ICD9

Index, you will come to this list of the 18 major

ICD9 categories.

Note: You can use this Index even when you don’t know the ICD9 code. For example,

notice Chapter 5 covers Mental, Chapter 8 covers Respiratory, 17 has Injures, etc.

Using the ICD9 Index

The ICD9 codes are listed in numerical

order and in ranges.

Using your mouse, click on the blue numerical range where the ICD9 code

847.2 would fall.

Hint!

With the ICD9 Index, let’s open ICD9 code:

847.2

Using the ICD9 Index

The categories are organized by types of conditions and similar

conditions will be grouped together.

Note fractures, then dislocations. Later

come sprains & strains, contusions, etc. (many workers’ comp conditions are

found in this chapter).

Clicking on (800-999) will take you to this

page of sub-categories.

Using the ICD9 IndexThe diagnosis code of 847.2 would fall within the range of 840-848 Sprains and Strains.

And under Sprains and Strains you’ll find 847 Sprains and

Strains of the Back.

Using your mouse, click on 847 to narrow your search

down even more.

Hint!

Using the ICD9 Index

Now all conditions that start with 847 are listed, with those that

are most common found in Bold Face.

Select the diagnosis code 847.2 from the list.

Hint!

Using the ICD9 Index

Now you have the RTW Guidelines for ICD9 code 847.2, Lumbar Sprains and Strains

We will go over how to use each of these areas

later in the module.

Another Index Method

You may know the name of the condition, but not the ICD9 code. You can

use the Keyword Index to locate the duration

guidelines by name.Hint

!

For example, your investigation reveals the claimant has a diagnosis

of Lumbago.

How will you find duration guidelines for this condition?

Starting from the Contents Page, use your

mouse to click on Keyword Index to begin

your search.

Using the Keyword IndexThe Keyword

Index is alphabetical by

keyword.

Let’s look for the condition Lumbago.

Using your mouse, click on the letter “L”

from the list.

Hint!

Using the Keyword IndexKeywords are

listed alphabetically.

You will need to scroll down to the bottom of

the list to find Lumbago.

Using the Keyword Index

Here’s the keyword “Lumbago.”

Conditions matching the keyword are listed

by ICD9 code.

Clicking on the ICD9 code will take you to the duration guidelines for that

condition. Using your mouse, click on ICD9 code 724.2 for Lumbago.

Hint!

Using the Keyword Index

This page contains the duration guidelines for the

diagnosis of Lumbago with the ICD9 code 724.2.

We will go over how to use each of these areas

later in the module.

Another Index Method

The last Index method for Section B is the CPT Index

For example, 97110

Starting from the Main Menu, use your mouse to

click on CPT Index.

Hint!

Use the CPT Index when looking for benchmark

procedure costs from the Medicare fee schedule (Note:

these are not treatment recommendations).

Using the CPT Search FunctionBy accepting the

licensing agreement, you will come to this

numerical list of procedural codes.

Now, using your mouse, click on the “9” CPT Codes to proceed.

NOTE: Only the most common procedural codes are listed in the system. If you are unable to find the code you’re looking for, refer to a CPT reference book for more details.

Hint!

Procedural code 97110 begins with the #9 and

would fall within the range as listed (90788 to 99556).

Using the CPT Search Function

All codes beginning with the number “9” will be

listed in ascending numerical order.

You will need to scroll down towards the

bottom of the list to find procedural code 97110.

Using the CPT Search Function

Below the CPT code 97110, there is a list of conditions. Note: these are not necessarily recommended – refer to ODG Treatment (later)

for recommendations.

Lumbago is the medical condition we’re interested in. Using your mouse,

click on the ICD9 code for Lumbago to proceed.

Hint!

The CPT code and the name of the procedure will be listed in bold text on the

page, followed by a benchmark cost from the Medicare Fee Schedule.

Using the CPT Index

By using the CPT Index to search, you arrived at the same guidelines page for

the diagnosis of Lumbago.

Now you will learn what all this information means and how you will use it.

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How to Use the InformationUnderstanding the ODG Content

Now that you have found what you are looking for –

How do you use this information?

The ODG guidelines will provide plenty of useful information to help you manage your claims. Click

below to find out how.

Duration Guidelines

The key is to understand what everything means, or

“how it is defined”.

Depending on your position, ODG may be used differently.

We’ll go over each of the highlighted areas in detail.

RTW Summary Guidelines

The first section is the RTW Summary Guidelines, for those who just want to eyeball a target or range

Notice the two Checkpoints, Midrange and At-Risk.

This table indicates the time at which 50% and 90% of cases

return-to-work, for two datasets: lost-time Claims (cases out more

than 7 days), and All Absence data (everyone who missed work)

Minimum = Always Zero

Midrange Dates = Expected Range

At-Risk Dates = Red Flag / Maximum

RTW Best Practice GuidelinesThe next section we will go over is the

RTW “Best Practice” Guidelines

This table is used when more job and medical details are

available on a claim.

This table provides expected duration based on factors such as:

• Severity

• Type of treatment or surgery

• Type of job

• Co-morbid conditions

Capabilities & Activity Modifications for Restricted Work

Job factors in the Best Practice Guidelines may correspond to the

Activity Modifications below

For example: Note a severe lumbar sprain is ready for clerical/modified work

at 0-3 days, and appropriate activity modifications follow. These remain in

place until 14-17 days when the case is ready for manual work

Other Valuable FeaturesODG provides a variety of other features that may help you:

Links to the Procedure Summaries from ODG Treatment, where possible therapies are summarized with recommendations for use (if applicable),

Direct link to ODG Treatment Index,

Link to other sources such as Merck, State Guidelines, etc,

Causality Likelihood (percent of claims that are work-related in nature),

Average Hospital Costs and Length of Stay (for cases admitted to hospital),

CM Triage (priority indicators: Level 1, 2 or 3),

PT and Chiropractic Guidelines (frequency and duration of care),

Workers’ Comp Costs (medical, indemnity and total costs at each quartile, with means – excellent for setting reserves)

Other Valuable FeaturesAge Adjustment Factors (multipliers that can be used to

adjust the Summary and Best Practice Guidelines)

The Back-Up Data Follows:

•RTW Claims Data by decile (10% of claims back to work in 10 days, 20% in 12 days, etc). Both occupational and non-occupational are included.

•RTW Post-Surgery by decile.

•Integrated Disability Data (both occ. and non-occ.) distribution on all cases (not just claims).

•Strictly occupational data from OSHA

NOTE: The back-up data is here to support your recommendations. But you don’t need to worry

about interpreting it. That has been done for you in the Summary and Best Practice Guidelines.

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ODG Treatment in Workers’ Comp

(Found Under Section A of the Contents Page)

From the Contents Page…

Returning to the Contents Page, we

will now review ODG Treatment.

ODG Treatment is found under Section A and will be most useful to workers’ comp providers, reviewers

and nurse case managers.

Using your mouse, click on the link to access the ODG Treatment Guidelines.

Hint!

ODG Treatment Index

ODG Treatment covers conditions likely to be seen in workers’ comp –

99% of WC costs.

Based on a comprehensive and

ongoing medical literature review.

Each Chapter includes the date of last update.

Chapters are based on body part (plus Burns, CTS, Fitness for Duty, Hernia, Pain, Mental)

ODG Treatment Index (ODG/TWC)

Scrolling down...

Notice the Patient Information Index

Using your mouse, click on Low Back to access

the ODG-TWC.

Treatment GuidelinesThis is the Low Back

chapter of ODG TreatmentIn each Chapter, there are

three major sections

The Treatment Protocols section goes over the

pathways for ideal cases.

Codes for Auto-Approval maps CPT codes to ICD9 codes for auto-approval

The Procedure Summary is the most important feature. It lists

every possible therapy and summarizes the medical evidence,

with recommendations for use Let’s begin with taking a look at Treatment Protocols.

Click on the link to proceed.

Hint!

Treatment ProtocolThe information provided in the Treatment Protocol is useful

and well-supported by objective medical evidence. It is a visit-by-visit case plan for

“ideal cases”, used primarily for clinical practice by the treating

physician.

This section integrates the RTW “Best Practice” Guidelines for

disability duration

We will now return to the top of the Low Back chapter and

look at the next section Click on the forward button when

ready.

ODG Treatment

The next slide will go over the section on Codes for

Automated Approval for the condition of Low Back.

This section lists the number of CPT treatments that can be

“auto-approved” for each ICD9.

Using your mouse, click on the Codes for Auto-Approval.

Hint!

Codes for Auto-Approval

This section maps CPT procedure codes to the ICD9 diagnosis codes based on the ideal treatment plan.

ALERT: Not all cases will fit this ideal protocol. Using the Procedure Summary is critical. Care

should not be denied based on the Treatment Protocols or Codes for Auto-Approval. Only the Procedure Summary can be used to deny care.

These procedures can be auto-approved until this point.

ODG Treatment

The last section we will go over is the Procedure

Summary for Low Back.

The Procedure Summary lists every possible therapy and

summarizes the medical evidence and provides VERY

IMPORTANT details for Utilization Management.

Using your mouse, click on the Procedure Summary section.

Hint!

Procedure SummaryThe Procedure Summary lists all

possible therapies and diagnostic tests, then summarizes the medical evidence

with recommendations for use

Each entry is clear, beginning with either “Recommended…”, “Not recommended…” (or in some cases, “Under Study”).

Recommendations are linked to the supporting medical evidence,

provided in abstract form.

To view the entire list, you will need to scroll down.

Procedure Summary

In the Procedure Summary you’ll find summaries of the effectiveness of

virtually every treatment, procedure, or imaging test. If you want learn more

about the evidence behind each recommendation, you have the option

of clicking on the reference links…

Procedure Summary

For an example of the reference links, see below:

Using your mouse, click on the reference link for Tulder-Cochrane, 2000 (in color).

Clicking on a reference link will open up a summary & the

evaluation of that reference.

Hint!

Link from Procedure Summary

The reference link will take you to the abstract

and evaluation of the medical study.

Take a look at the highlighted area supporting ODG.

The abstract will tell you all about the study (where it was published,

objective, results, conclusions, etc).

Note: References are provided to back-up your recommendations, but you don’t have to worry about them

or use them if you don’t need to.

You’re Done!

• This completes your self-paced training module.

• Thank you for participating.

• For additional assistance, please use the ODG Helpdesk:E-mail address: ODG@worklossdata.com

Or call: 1-800-488-5548