Skip to Top Main Navigation Skip to Left Navigation Skip to Content Area Skip to Footer
Topics:   A B C D E F G H I J K L M N O P Q R S T U V W X Y Z All


Advisories 2003-10 and 2003-10b are withdrawn. For further information, please see Commissioner's Bulletin B-0033-07.

SUBJECT: Use of the 4th Edition AMA Guides Regarding: Evaluation of Range of Motion Deficits in the Extremities; Assignment of Impairment Rating for Spinal Fusion(s); Use of Cross-Index Grid for the Lower Extremity as a Teaching Tool; and Impairment Rating Based on Condition at Maximum Medical Improvement (MMI).

To further clarify this advisory, additional language has been added in Section (2)(c). In applying the 4th Edition of the AMA Guides in the assignment of impairment ratings, health care providers may wish to consider the following input from the Commission's Medical Advisor:

1. For evaluation of range of motion deficits in the extremities, the contra lateral uninvolved joint may serve as a comparative standard against which the impaired joint is measured. This will determine the actual loss of functional motion when compared to the "normal" side, if one exists.

Methods to complete this process may include rating both the uninvolved joint and the involved joint and subtracting the measurement of the involved joint from the rating obtained for the uninvolved joint; or, using the measurement of the uninvolved joint as the full range of motion standard, against which the ROM measurements are referenced.

2. Clarification of Rating for Spinal Fusion(s).

For spinal fusion, the impairment rating is determined by the preoperative x-ray tests for "motion segment integrity" (page 102, 4th Edition of the Guides to the Evaluation of Permanent Impairment). If preoperative x-rays were not performed, the rating may be determined using the following criteria:

a. One level uncomplicated fusion meets the criteria for DRE Category II, Structural Inclusions. This spinal abnormality is equivalent to a healed ''less than 25% Compression Fracture of one vertebral body".

b. Multilevel fusion meets the criteria for DRE Category IV, Structural Inclusions, as this multilevel fusion is equivalent to "multilevel spine segment structural compromise" per DRE IV.

c. Health care providers may utilize the range-of-motion or other methodology if indicated (as with any condition in the 4th Edition Guides) that most accurately reflects the impairment rating evident for each injured worker.

3. Use of the cross-index grid for the lower extremity is recommended as a teaching tool. The grid, which was developed as a visual tool to summarize the information contained in Section 3.2 of the 4th edition of the Guides to the Evaluation of Permanent Impairment, was originally published in the Guides Newsletter, January/February 1998 and later in The Guides Casebook, 1999; and then, more recently, in the 5th edition of the Guides to the Evaluation of Permanent Impairment, 2000. Use of the grid provides a quick reference to identify the various rating methods that may be used in rating the lower extremity.

4. In the Texas workers' compensation system, the injured employee's impairment rating is based on the employee's condition on the date of maximum medical improvement or the date of statutory maximum medical improvement, whichever is earlier.

Signed on this 24th day of February, 2004

Richard F. Reynolds, Executive Director

TWCC Staff
Medical Professional Associations
Carrier Representatives
Forms Notification List
Public Information List
TWCC website