Current through Reg. 49, No. 38; September 20, 2024
(a) As used in
this section:
(1) the term "doctor" means
either the treating doctor or a referral doctor, as defined by §
180.22(c)
and (e) of this title (relating to Health
Care Provider Roles and Responsibilities);
(2) "substantial change in activity
restrictions" means a change in activity restrictions caused by a change in the
injured employee's medical condition which either prevents the injured employee
from working under the previous restrictions or which allows the injured
employee to work in an expanded and more strenuous capacity than the prior
restrictions permitted (approaching the injured employee's normal
job);
(3) "change in work status"
means a change in the injured employee's work status from one of the three
choices listed in subsection (a)(4) of this section to another of the choices
in that subsection; and
(4) the
term "work status" refers to whether the injured employee's medical condition:
(A) allows the injured employee to return to
work without restrictions (which is not equivalent to maximum medical
improvement);
(B) allows the
injured employee to a return to work with restrictions; or
(C) prevents the injured employee from
returning to work.
(b) If authorized under their licensing act,
a treating doctor may delegate authority to complete, sign, and file a work
status report to a licensed physician assistant or a licensed advanced practice
registered nurse as authorized under Texas Labor Code §
408.025(a-1).
The delegating treating doctor is responsible for the acts of the physician
assistant and the advanced practice registered nurse under this
subsection.
(c) The doctor,
delegated physician assistant, or delegated advanced practice registered nurse
shall file a Work Status Report in the form and manner prescribed by the
division.
(d) The doctor, delegated
physician assistant, or delegated advanced practice registered nurse shall be
considered to have filed a complete Work Status Report if the report is filed
in the form and manner prescribed by the division, signed, and contains at
minimum:
(1) identification of the injured
employee's work status;
(2)
effective dates and estimated expiration dates of current work status and
restrictions (an expected expiration date is not binding and may be adjusted in
future Work Status Reports, as appropriate, based on the condition and progress
of the injured employee);
(3)
identification of any applicable activity restrictions;
(4) an explanation of how the injured
employee's workers' compensation injury prevents the injured employee from
returning to work (if the doctor believes that the injured employee is
prevented from returning to work); and
(5) general information that identifies key
information about the claim (as prescribed on the report).
(e) The doctor, delegated physician
assistant, or delegated advanced practice registered nurse shall file the Work
Status Report:
(1) after the initial
examination of the injured employee, regardless of the injured employee's work
status;
(2) when the injured
employee experiences a change in work status or a substantial change in
activity restrictions; and
(3) on
the schedule requested by the insurance carrier, its agent, or the employer
requesting the report through its insurance carrier, which shall not exceed one
report every two weeks and which shall be based upon the doctor's, delegated
physician assistant's, or delegated advanced practice registered nurse's
scheduled appointments with the injured employee.
(f) The Work Status Report filed as required
by subsection (e) of this section shall be provided to the injured employee at
the time of the examination by hand delivery or electronic transmission if the
injured employee agrees to receive the report by electronic transmission, and
shall be sent, not later than the end of the second working day after the date
of examination, to the insurance carrier and the employer.
(g) In addition to the requirements under
subsection (e) of this section, the treating doctor, delegated physician
assistant, or delegated advanced practice registered nurse shall file the Work
Status Report with the insurance carrier, employer, and injured employee within
seven days of the day of receipt of:
(1)
functional job descriptions from the employer listing available modified duty
positions that the employer is able to offer the injured employee as provided
by §
129.6(a)
of this title (relating to Bona Fide Offers of Employment); or
(2) a required medical examination doctor's
Work Status Report that indicates that the injured employee can return to work
with or without restrictions.
(h) Filing the Work Status Report as required
by subsection (g) of this section does not require a new examination of the
injured employee.
(i) The doctor,
delegated physician assistant, or delegated advanced practice registered nurse
shall file the Work Status Report as follows:
(1) A report filed with the insurance carrier
or its agent shall be filed by electronic transmission;
(2) A report filed with the employer shall be
filed by electronic transmission if the doctor, delegated physician assistant,
or delegated advanced practice registered nurse has been provided the
employer's facsimile number or email address; otherwise, the report shall be
filed by personal delivery or mail; and
(3) A report filed with the injured employee
shall be hand delivered to the injured employee or delivered by electronic
transmission if the injured employee agrees to receive the report by electronic
transmission, unless the report is being filed pursuant to subsection (g) of
this section and the doctor, delegated physician assistant, or delegated
advanced practice registered nurse is not scheduled to see the injured employee
by the due date to send the report. In this case, the doctor, delegated
physician assistant, or delegated advanced practice registered nurse shall file
the report with the injured employee by electronic transmission if the doctor,
delegated physician assistant, or delegated advanced practice registered nurse
has been provided the injured employee's facsimile number or email address;
otherwise, the report shall be filed by mail.
(j) Notwithstanding any other provision of
this title, a doctor, delegated physician assistant, or delegated advanced
practice registered nurse may bill for, and an insurance carrier shall
reimburse, filing a complete Work Status Report required under this section or
for providing a subsequent copy of a Work Status Report which was previously
filed because the insurance carrier, its agent, or the employer through its
insurance carrier asks for an extra copy. The amount of reimbursement shall be
$15. A doctor, delegated physician assistant, or delegated advanced practice
registered nurse shall not bill in excess of $15 and shall not bill or be
entitled to reimbursement for a Work Status Report which is not reimbursable
under this section. Doctors, delegated physician assistants, or delegated
advanced practice registered nurses are not required to submit a copy of the
report being billed for with the bill if the report was previously provided.
Doctors, delegated physician assistants, or delegated advanced practice
registered nurses billing for Work Status Reports as permitted by this section
shall do so as follows:
(1) CPT code "99080"
with modifier "73" shall be used when the doctor, delegated physician
assistant, or delegated advanced practice registered nurse is billing for a
report required under subsections (e)(1), (e)(2), and (g) of this
section;
(2) CPT code "99080" with
modifiers "73" and "RR" (for "requested report") shall be used when the doctor,
delegated physician assistant, or delegated advanced practice registered nurse
is billing for an additional report requested by or through the insurance
carrier under subsection (e)(3) of this section; and
(3) CPT code "99080" with modifiers "73" and
"EC" (for "extra copy") shall be used when the doctor, delegated physician
assistant, or delegated advanced practice registered nurse is billing for an
extra copy of a previously filed report requested by or through the insurance
carrier.
(k) As provided
in §
126.6(g)
of this title (relating to Order for Required Medical Examinations), a doctor
who conducts a required medical examination in which the doctor determines that
the injured employee can return to work immediately with or without
restrictions shall file the Work Status Report required by this section, but
shall do so in accordance with the requirements of §126.6(g).
