Utilization Review Checklist
Work Disability Prevention and Management
Derived from the ACOEM Work Disability Prevention and Management Guideline, edition 11 April 2022, as adopted into the California MTUS 10 August 2023. CPT 97545, 97546, 99401, 99402, 96164. ICD-10 Z56.9, Z73.0, Z57.9, M54.5.
Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.
Procedures — the guideline treats each separately
Disability screening
Recommended.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence moderate
Indications
Any one of the following
Disability screening
“Individuals whose clinical course diverges from expected. Includes those with a confirmed diagnosis but fail to improve as expected.” — p. 11
Required:
Clinical course diverges from expected, or a confirmed diagnosis fails to improve or respond as expected to evidence-based treatments
“Individuals whose clinical course diverges from expected. Includes those with a confirmed diagnosis but fail to improve as expected.” — p. 11
Dose, Duration and Discontinuation(informational — not scored)
Required
A review interval and measure are stated, though the guideline sets no limit
“Disability screening is recommended for those whose clinical course diverges from expected” — p. 11
Recommended where the clinical course diverges from expected, or a confirmed diagnosis fails to improve as expected.
Education for prevention of work disability
Recommended. Education is recommended for patients at increased risk of disability.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence high · p. 13
Indications — required:
At increased risk of disability
“Education is recommended for patients at increased risk of disability.” — p. 13
Recommended at High confidence for all patients at increased risk of disability — one of the easiest requests in this set to support.
Exercise prescription for prevention of work disability
Recommended. An exercise prescription is recommended for primary, secondary, and tertiary prevention of work disability.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence high · p. 14
Indications — required:
Exercise prescription for primary, secondary or tertiary prevention of work disability
“An exercise prescription is recommended for primary, secondary, and tertiary prevention of work disability.” — p. 14
Recommended at High confidence for primary, secondary AND tertiary prevention — that is, at any stage.
Work-focused cognitive behavioural therapy
Recommended. Cognitive behavioral therapy (CBT), especially including a work-focus, is recommended for the prevention of work disability.
Strength of Evidence — Recommended, Evidence (C) · confidence moderate · p. 17
Indications — required:
Cognitive behavioural therapy with a work focus, for an impairing disorder sufficient to require treatment
“Cognitive behavioral therapy (CBT), especially including a work-focus, is recommended for the prevention of work disability.” — p. 17
Recommended on Evidence (C), and the guideline says a WORK FOCUS is generally preferable for return-to-work and stay-at-work purposes. Requesting 'CBT' without that focus asks for something the guideline treats differently.
Nurse case management
Recommended. Nurse case management (NCM) is selectively recommended for reducing work disability durations.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence moderate · p. 21
Indications — required:
Selective use of nurse case management to reduce work disability duration
“Nurse case management (NCM) is selectively recommended for reducing work disability durations.” — p. 21
Selectively recommended for reducing work disability durations.
Vocational rehabilitation
Recommended. Vocational rehabilitation is recommended for treatment of work disability.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence moderate · p. 24
Indications — required:
Chronic and stable presentation, for vocational rehabilitation
“Vocational rehabilitation is recommended for treatment of work disability.” — p. 24
Recommended, generally only for chronic and stable presentations.
Psychotherapy that does not specifically address work disability
No Recommendation. There is no recommendation regarding psychotherapies that do not specifically address work disability.
Strength of Evidence — No Recommendation, Insufficient Evidence (I) · confidence low · p. 18
Indications — required:
Psychotherapy that does not specifically address work disability
“There is no recommendation regarding psychotherapies that do not specifically address work disability.” — p. 18
No recommendation either way. The guideline supports work-FOCUSED treatment and is silent on psychotherapy for symptom reduction that does not address work disability. Framing matters to the answer.