ODG Helpdesk Tip: The Difference Between Duration Values at the Diagnosis Vs. Claim Level
May 25, 2021 | Categories: ODG by MCG
One of the most frequently asked questions at the ODG Helpdesk is: “How do I find duration values for a diagnosis, and how does it differ between diagnosis vs. claim level when managing return-to-work (RTW)?” An example of determining the difference can be found below. Let’s use ICD-10 Code S33.5 for this example.
As the ODG Helpdesk walks users through the process of how to search their diagnosis, we tell them to select it and ODG will automatically pin searched ICD-10 terms under the Search bar (it will turn green). The information displayed under the Duration tab is at the diagnosis level.
We can easily see three letters “M” for Maximum, “A” for Average, and “B” for Best Practice. From the ODG database of over 10 million workers’ compensation and disability claims we can see that the diagnosis of S33.5 has an A or Average (i.e. typical) duration value of 21 days away from work, a B or Best Practice (i.e. target) return-to-work duration of 10 days, and an M or Maximum duration value of 29 days.
Where does this get tricky? Providers, case managers, and claims staff don’t treat or manage back strains, they treat people with back strains. In order to get more accurate duration values for specific claims, you can quickly and easily enter claim level information using the REFINE button to the right of the search bar.
The REFINE button allows you to enter in a specific job title, or job class, the state the claimant resides, age, date of injury, any comorbidities or confounding factors in the Refine Results section. In addition, ODG will list the most common factors based off your data, but you are not limited to those values.
As you can see in your Refine Results section, we’ve added additional information to show our claimant has multiple diagnoses or underlying conditions. To add this type of information, simply type the condition or diagnosis code in the search bar.
When you see a list of search results populated below, select your relevant ICD-10 code and ODG will automatically ‘pin it’ next to your primary diagnosis up top in green. After ODG has pinned your requested ICD-10 values, ODG will automatically recalculate the duration values for you.
PLEASE NOTE: When you enter multiple conditions, enter the primary diagnosis first, followed by the secondary or additional values. You can pin up to ten diagnoses and procedures.
In our example, we used a 54-year-old, registered nurse who resides in California and has a history of back strain, whiplash, and carpal tunnel syndrome. She presents with diabetes, obesity, and is a smoker.
We originally started with duration values at the diagnosis level with a Best Practice of 10 days (B), an Average duration of 21 days (A), and a Maximum duration of 29 days (M). After we’ve adjusted for claim-specific information, ODG is now showing a claim level Best Practice duration value of 37 days, 200 days for Average, and 391 days for Maximum for our registered nurse to return to work at full duty.
REMEMBER: The more information you can input into the system, the more accurate the information will project in return, and the better the chances to improve outcomes and benchmark.
– Suzanne Swirsky, ODG Account Manager
The information contained in this article concerns the ODG or MCG care guidelines in the specified edition and as of the date of publication, and may not reflect revisions made to the guidelines or any other developments in the subject matter after the publication date of the article.
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