Professional referrals
For Case Managers and Adjusters
What a spine referral to Academy Orthopaedics produces, what the office needs from you, and where the clinical role stops.
The most useful thing a referral can carry is a specific question. "Please evaluate" produces a general assessment. "Is the L5 radiculopathy consistent with the reported lifting mechanism, and is surgery indicated" produces an answer you can act on.
The second most useful thing is the imaging itself rather than the report.
What a referral produces
Five things in every report.
- 01
A documented mechanism
The reported mechanism of injury recorded as the patient described it, with the examination findings alongside. Where the account and the findings do not fit together, the note says so rather than smoothing it over.
- 02
Imaging read directly
Outside studies are reviewed from the images rather than from the radiologist's report. The report describes what is present; the surgical question is whether what is present explains the symptoms, and those are different assessments.
- 03
A diagnosis with reasoning attached
Which structure, which level, and whether the imaging and the examination agree. Where the source cannot be identified with confidence, the note states that rather than selecting the most visible finding.
- 04
Work status with the basis given
Restrictions specific enough to be actionable: what can be lifted, for how long, what should be avoided, and for what period. The clinical basis is stated so the restriction can be reviewed rather than simply accepted or disputed.
- 05
A treatment plan with a timeframe
What is being tried, what improvement would look like, and at what point the plan changes if it does not come. Open-ended treatment without a review point is not useful to anyone.
What to send
- Patient details and contact information
- Date and reported mechanism of injury
- Imaging on a disc or a share link, not reports alone
- Prior operative notes, where there has been previous surgery
- Current work status, if one has already been set
- Treatment to date, including therapy and injections, with dates
- The specific question you need answered
Where the clinical role stops
This is set out plainly so that expectations are aligned before a referral rather than after a report.
A physician documents findings, gives a diagnosis, describes what is and is not consistent with a reported mechanism, sets work restrictions based on the examination, and recommends treatment. Where a clinical opinion is appropriate, one is given.
Legal determinations of compensability are made under the relevant state's system by its decision-makers. Reports are not written to support a predetermined position, and restrictions are not adjusted to suit a party's preference. An accurate record is more useful to everyone involved, including in the cases where it is inconvenient, because an accommodating one does not survive scrutiny.
Jurisdiction
Academy Orthopaedics sees patients at offices across Illinois and at Crown Point, Indiana. The two states run different workers' compensation systems, including different rules on provider choice, so confirm which applies before assuming the Illinois process described underworkers' compensationgoverns a given case.
Questions from referring professionals
- How do I refer a patient?
- Contact the office directly. Provide the patient's details, the date and mechanism of injury, any imaging already performed and where it is held, and the specific question you need answered. A referral with a clear question attached gets a more useful report back than one without.
- What do you need with the referral?
- Imaging on a disc or a share link rather than reports alone, any prior operative notes, the current work status if one has been set, and a brief treatment history. Prior imaging is the most frequently missing item and the most frequently useful one, because comparing studies over time answers questions a single study cannot.
- What is the turnaround on a report?
- Timeframes are confirmed by the office when a referral is made, not promised in advance on a webpage. They depend on the office, the week, and what is being asked. If a report is needed by a specific date, say so at the point of referral.
- Does the practice perform independent medical examinations?
- That is a question for the office, because an IME is a different engagement from treating a patient and the two should not be confused. A treating physician documents findings and manages care. An independent examiner is engaged to give an opinion, usually on a defined question, without a treatment relationship.
- Will the practice provide a causation opinion?
- A clinical opinion can be given where one is appropriate, including what is and is not consistent with a reported mechanism. Causation as a legal matter is determined under the relevant state's system, not by this practice. A report will not be written to reach a predetermined conclusion in either direction.
- Can peer-to-peer discussion be arranged?
- Ask the office. Where a case is complex or a decision is contested, a direct conversation frequently resolves in ten minutes what several rounds of correspondence will not.
Are you the injured patient rather than a case manager? The pathway written for you is at injured patients.