Often when a functional capacity evaluation (FCE) is ordered for an injured worker, an impairment rating (IR) is also requested. Impairment ratings are a relatively easy way to expand clinical services and increase your value to referral sources, yet they are often overlooked. Many clinicians do not fully understand the difference between FCEs and IR. Unknowns can be intimidating, but I will shed some light on this lesser-known service so you can confidently add impairment ratings to your suite of clinic services.

First, let’s start with some essential explanations of FCEs and IR.

WHAT IS A FUNCTIONAL CAPACITY EVALUATION (FCE)?

An FCE is a test to determine a patient’s level of function. It is roughly a 3 to 4-hour evaluation to evaluate a person’s ability to participate in work. However, other instrumental activities of daily living that support work performance may also be assessed. A comprehensive FCE should provide overall work abilities and tolerances for full-time work and will cover all work demands defined by the US Department of Labor in the Dictionary of Occupational Titles (DOT). A well-designed FCE tests strength using dynamic rather than isometric techniques. Proper lifting is taught prior to starting the lifting section of the test. The well-designed FCE involves a scoring system for determining an accurate level of work and projecting client abilities out to an 8-hour day. LEARN MORE about a well-designed FCE.

WHAT IS AN IMPAIRMENT RATING (IR)?

By contrast, an impairment rating is used to determine a patient’s level of impairment. 

A percent of limb or whole body impairment is assigned when the evaluation is performed on a patient. These impairment percentages are used in settling workers’ compensation cases. The American Medical Association (AMA) has developed a prescribed methodology for performing impairment ratings. This methodology is published in The AMA’s Guides to the Evaluation of Permanent Impairment. The “AMA Guide” covers the process of determining impairment in all body systems. However, the musculoskeletal and neurological impairments sections are the most relevant to physical and occupational therapists. The typical extremity musculoskeletal impairment involves medical history (including related surgical procedures), diagnostic imaging, and goniometric range of motion measures and then using tables and graphs in the “AMA Guide” to determine the percent impairment.

WHO CAN PERFORM THESE SERVICES?

For FCEs and IRs, each state varies in who can perform these services.

Physical therapists or occupational therapists most often perform FCEs. However, many states allow other physical medicine and rehabilitation clinicians, such as PTA, COTA, ATC, or Ex Phys, to perform FCEs in conjunction with a therapist.

Impairment ratings are a bit different. In some states, only physicians are allowed to perform them. However, many physicians are reluctant to perform IRs as they can be time-consuming from the physician’s perspective. Therefore, many orthopedic or neurosurgeons like to send this service to physical and occupational therapists who are well-suited to perform this service. In these cases, therapists make the measurements and assign the percentages, and the physician reviews and signs off on the report. The physician retains the option of adjusting the clinician’s recommendations higher or lower.

DO I NEED TRAINING?

If you care about your patients, your license, and your reputation, the answer is YES; you need training.

You could pull a bit of FCE testing protocol from here and a bit from there, slap it together, and call it a defensible, functional test. While that might get the job done, is it an accurate test?  Is it fair and objective truly determining a person’s physical abilities as they relate to work? Is it reliable, valid, and legally defensible? A lot is riding on these assessments. They not only affect pocketbooks but deeply affect the social fabric of the worker’s life. You want an FCE system with proven validity: one supported by peer-reviewed, published research, one that provides practical, in-depth training and class-A customer support. If you want to make sure you’re delivering an accurate functional capacity evaluation, contact ErgoScience today.

Regarding IRs, the AMA has multiple editions of their Guide to the Evaluation of Permanent Impairments (each state determines which Guide they use). It is certainly possible to open up the “AMA Guide” and teach yourself how to do impairment ratings. However, the time and energy you expend and the confusion that results may not be worth the money you would spend by going to a course. The IR procedures are not rocket science, but they can be somewhat confusing based on reading the text alone. ErgoScience offers affordable training courses lasting 6-8 hours. Get training in 4th, 5^th, or 6th editions.

MORE REASONS TO CONSIDER IMPAIRMENT RATINGS

Impairment ratings do not require expensive equipment or software, so the entrance into this subspecialty is relatively painless.

Impairment ratings are often needed and requested in conjunction with an FCE. Therefore, performing impairment ratings allows you to meet all the needs of physician-referred workers’ compensation cases.

Impairment ratings are typically billed using the same CPT code as you would for an FCE (97750 in most states). For an average evaluation, clinicians can bill 4-6 units depending on how complicated the patient’s disability may be. Worker’s compensation services are often reimbursed at a higher rate than other services, so adding IR to your suite or clinic offerings makes sense.

If you are treating workers’ compensation patients and performing Functional Capacity Evaluations, offering impairment ratings is an excellent service to add. Ready to get this service implemented in your clinic?