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LC 4601 (California)

PostPosted: Mon Jun 13, 2011 3:27 pm
Does a a request in a "serious case" for a consultative physician under section 4601 one of the labor code fall under utilization review?

Re: LC 4601 (California)

PostPosted: Wed Jun 15, 2011 12:15 pm
by stevepsca
4601 refers to IW change of PTP...

For a referral/evaluation request...
The CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004), Chater 7 on Independent Medical Examinations and Consultations, (jpae 127), offers "The occupational health preactitioner may refer to other specialists if a diagnosis is uncertain or complex, whenpsychosocial factors are present, or when the plan or course of care may benefit from additional expertise". In addition ACOEM states on the same page a consultation is to aid in the diagnosis, prognosis, therapeutic management, determinatin of medical stability, and ermenent residulal and/or the examinee's fitness for return to work."

Use the above, sumbit a PR-2 to the CA/UR Dr for determination to medical necessity, and prior authorization of the referral.