1. Official Disability Guidelines - Treatment in Workers’ Comp ODG
NOTE: To ensure success, right click and select “Full Screen”.
WELCOME!
This is a self-paced training module for the ODG website.
Work Loss Data Institute (WLDI)
169 Saxony Road, Suite 101
Encinitas, CA 92024
Phone:
 Click on the button at the lower right-hand corner to begin.

2. 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 minutes

3. 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.

4. ODG The Evidence-Based Authority on
Utilization Review and Disability Duration

5. Reasons for Using ODG Prospective Case Management
Setting Reserves / Claims Adjusting
Retrospective Benchmarking
Utilization Review / Management
Clinical Practice

6. How to Get Into the Website
ODG Access Information

7. Logging into the Site from Web
Begin by opening your Web browser (i.e. Internet Explorer):
Type in the address for the website
You will get a pop-up box, like the one below, for your log-in information:

8. Your Toolbar is located at the top of the page.
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).

9. From the Contents Page…
Section A contains the ODG Treatment Guidelines (most useful for UR / UM, nurses and doctors).
The Contents Page contains 3 types of guidelines.
Section B contains the ODG Disability Duration Guidelines (useful for all users).
In Section C, you will find Impairment Guides from IAIABC (not ODG).

10. How to Find What You’re Looking For
ODG Indexing Functions

11. From the Contents Page
Index options for duration guidelines are listed under Section B.
Starting with an example in Section B, there are 3 ways you can search for duration guidelines.
You can look up by ICD9 diagnosis code,
by keyword (i.e. name or body part)
or by the CPT procedure code.
We will begin by going over the ICD9 Index option.  Click anywhere on this page to proceed.

12. Using the ICD9 Index
In this example, say you’d like to find disability duration guidelines for ICD9 code
Hint!
 Starting from the Main Menu, use your mouse to click on ICD-9 Index to begin your search.

13. Using the ICD9 Index
By 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.

14. Using the ICD9 Index
The ICD9 codes are listed in numerical order and in ranges.
With the ICD9 Index, let’s open ICD9 code: 847.2
Hint!
 Using your mouse, click on the blue numerical range where the ICD9 code would fall.

15. Clicking on (800-999) will take you to this page of sub-categories.
Using the ICD9 Index
Clicking on ( ) will take you to this page of sub-categories.
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).

16.  Using your mouse, click on 847 to narrow your search down even more.
Using the ICD9 Index
The diagnosis code of would fall within the range of Sprains and Strains.
Hint!
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.

17. Select the diagnosis code 847.2 from the list.
Using the ICD9 Index
Hint!
Now all conditions that start with 847 are listed, with those that are most common found in Bold Face.
Select the diagnosis code from the list.

18. We will go over how to use each of these areas later in the module.
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.

19. How will you find duration guidelines for this condition?
Another Index Method
For example, your investigation reveals the claimant has a diagnosis of Lumbago.
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!
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.

20. Using the Keyword Index
The Keyword Index is alphabetical by keyword.
Let’s look for the condition Lumbago.
Hint!
 Using your mouse, click on the letter “L” from the list.

21. Using the Keyword Index
Keywords are listed alphabetically.
You will need to scroll down to the bottom of the list to find Lumbago.

22. Using the Keyword Index
Here’s the keyword “Lumbago.”
Conditions matching the keyword are listed by ICD9 code.
Hint!
Clicking on the ICD9 code will take you to the duration guidelines for that condition.
 Using your mouse, click on ICD9 code for Lumbago.

23. Using the Keyword Index
This page contains the duration guidelines for the diagnosis of Lumbago with the ICD9 code
We will go over how to use each of these areas later in the module.

24. Another Index Method
Use the CPT Index when looking for benchmark procedure costs from the Medicare fee schedule (Note: these are not treatment recommendations).
The last Index method for Section B is the CPT Index
For example, 97110
Hint!
 Starting from the Main Menu, use your mouse to click on CPT Index.

25. Using the CPT Search Function
By accepting the licensing agreement, you will come to this numerical list of procedural codes.
Procedural code begins with the #9 and would fall within the range as listed (90788 to 99556).
 Now, using your mouse, click on the “9” CPT Codes to proceed.
Hint!
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.

26. 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

27. Using the CPT Search Function
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.
Hint!
Lumbago is the medical condition we’re interested in.  Using your mouse, click on the ICD9 code for Lumbago to proceed.
Below the CPT code 97110, there is a list of conditions. Note: these are not necessarily recommended – refer to ODG Treatment (later) for recommendations.

28. 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.

29. How to Use the Information
Now that you have found what you are looking for – How do you use this information?
How to Use the Information
Understanding the ODG Content
The ODG guidelines will provide plenty of useful information to help you manage your claims.  Click below to find out how.

30. 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.

31. RTW Summary Guidelines
Notice the two Checkpoints, Midrange and At-Risk.
The first section is the RTW Summary Guidelines, for those who just want to eyeball a target or range
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

32. RTW Best Practice Guidelines
The 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

33. 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 days when the case is ready for manual work

34. Other Valuable Features
ODG 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)

35. Other Valuable Features
Age 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.

36. ODG Treatment in Workers’ Comp
(Found Under Section A of the Contents Page)

37. From the Contents Page…
Hint!
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.

38. 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)

39. ODG Treatment Index (ODG/TWC)
Scrolling down...
Notice the Patient Information Index
 Using your mouse, click on Low Back to access the ODG-TWC.

40. Treatment Guidelines
This is the Low Back chapter of ODG Treatment
In each Chapter, there are three major sections
Hint!
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.

41. Treatment Protocol
The 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.

42.  Using your mouse, click on the Codes for Auto-Approval.
ODG Treatment
Hint!
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.

43. Codes for Auto-Approval
These procedures can be auto-approved until this point.
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.

44.  Using your mouse, click on the Procedure Summary section.
ODG Treatment
Hint!
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.

45. To view the entire list, you will need to scroll down.
Procedure Summary
The 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”).
To view the entire list, you will need to scroll down.
Recommendations are linked to the supporting medical evidence, provided in abstract form.

46. 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…

47. For an example of the reference links, see below:
Procedure Summary
For an example of the reference links, see below:
Clicking on a reference link will open up a summary & the evaluation of that reference.
Hint!
 Using your mouse, click on the reference link for Tulder-Cochrane, 2000 (in color).

48. Link from Procedure Summary
The abstract will tell you all about the study (where it was published, objective, results, conclusions, etc).
Take a look at the highlighted area supporting ODG.
The reference link will take you to the abstract and evaluation of the medical study.
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.

49. You’re Done! This completes your self-paced training module.
Thank you for participating.
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