Reed Group DisabilityGuidelines™ (powered by MDGuidelines and ACOEM) is your one-stop portal for return-to-work and treatment guidelines!

Content Sources

Medical Disability Advisor (MDA)
American College of Occupational and Environmental Medicine Practice Guidelines (ACOEM APGi)
ACOEM Practice Guidelines Version 3 (ACOEM V3)
 

Crosswalks

ACOEM version 3: ICD-9/10-CM to CPT®
California MTUS: ICD-9/10-CM to CPT®
Colorado: ICD-9/10-CM to CPT®
Louisiana: ICD-9/10-CM to CPT®
Montana: ICD-9/10-CM to CPT®
New York: ICD-9/10-CM to CPT®
 

State Guidelines

California (MTUS)
Colorado Treatment Guidelines
Connecticut Treatment Guidelines External Link
Delaware Treatment Guidelines External Link
Kentucky Treatment Guidelines External Link
Louisiana Treatment Guidelines
Maine Treatment Guidelines External Link
Massachusetts Treatment Guidelines External Link
Minnesota Treatment Guidelines External Link
Mississippi Treatment Guidelines External Link
Montana Treatment Guidelines External Link
New York Treatment Guidelines
Rhode Island Treatment Guidelines External Link
South Dakota Treatment Guidelines External Link
VA/DoD Clinical Practice Guidelines
Washington Treatment Guidelines
West Virginia Treatment Guidelines External Link
Wisconsin Treatment Guidelines External Link
 

Indexes for Medical Disability Advisor

Anatomical Regions (MDA)
Diagnostic Categories (MDA)
Medical Specialists (MDA)
ICD-9-CM Codes
Job Titles
Leave of Absence Advisor

Welcome to Reed Group DisabilityGuidelines™!

When Presley Reed, MD first envisioned these seminal guidelines as "presenting common standards that can be shared by doctors, patients, and employers," the World Wide Web was impossible to foresee. Today, the internet provides the fundamental communication platform to realize Dr. Reed’s original vision.

With Reed Group DisabilityGuidelines™, we introduce The Medical Disability Advisor and ACOEM as the basis for a growing collection of content and tools that we consider vital to all stakeholders in the return to work process. We have many goals for this site: to infuse occupational medicine into the mainstream of physician education and practice; to provide innovative tools

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Meet Our Medical Advisory Board

Reed Group's Medical Advisory Board members are among the foremost contributors to the current knowledge in occupational medicine.

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Foreword to The Medical Disability Advisor (version 7)

The Medical Disability Advisor, now a part of the DisabilityGuidelines suite, provides the disability-duration guidelines. The first six editions of The Medical Disability Advisor have established it as the best known, most used, and most accurate data source for esimtating disability duration, and thus return to work time for many diseases and injuries. The new version 7 improves further on this established product by adding additional sections on Risk, Capacity, and Tolerance, both in the clinical text and, at times, below the disability duration tables. In addition, the usual re-inspection and revision of the medical topics, along with their durations, have been performed.

Probably the best model to use in considering an individual's readiness for return to work involves the consideration of "risk," "capacity," and "tolerance." (1)

"Risk" is a basis for physician-imposed activity restrictions. Most return-to-work forms sent to physicians have a line on which the physician can state "restrictions" that may pose a risk to the individual or to others (e.g. co-workers, the general motoring public, etc.). Risk, in this regard, means the person should not do something, even though he/she may actually be capable of doing the activity. For example, individuals with uncontrolled seizure disorders are not permitted to work as commercial airline pilots or bus drivers based on risk. The concept of "risk" most closely conforms to the "Minimum" column of disability duration in the consensus tables in this edition.

"Capacity" is the basis for physician described activity limitations, and means the individual is not yet physically capable of an activity. Many of the return to work forms sent to physicians have a line on which the physician can state "limitations" based on capacity evaluation. For example, after a wound into the biceps muscle mass of the arm, an individual may not yet have the strength to permit lifting a certain amount of weight; or after a fracture of the shoulder, an individual may not yet have enough shoulder motion for his/her hand to reach the overhead control on a factory press. In the disability duration tables the "Optimum" column indicates when the average person with the average speed of recovery and few comorbidities will return to work.

"Tolerance" is the issue with which doctors, employers, employees, and insurers struggle. Tolerance is the ability to put up with the symptoms (like pain or fatigue) that accompany doing work tasks in order to gain the rewards of work (income, self-esteem, health benefits of work, etc.). Tolerance means the ability to tolerate the symptoms produced by doing an activity the individual clearly can do. Tolerance is not a scientific concept, and tolerance is not scientifically measurable. Early after major injury or surgery physicians have fair agreement on work guidelines based in tolerance issues, but for chronic problems studies have shown physicians cannot agree on work guidelines based in tolerance issues. People (patients) consider factors like income and finances, job satisfaction, need for employer provided health insurance benefits, availability of disability or workers’ compensation insurance to maintain income, ability to switch to physically easier careers, etc. when deciding whether the rewards of working are to them worth the "cost" of working.

This method, which effectively brings into consideration the main elements that involve work loss, works well in conjunction with the MDA disability duration tables.

The "Maximum" column of the disability duration table reflects current physician consensus of what the vast majority of individuals will tolerate. From the data set of actual observed durations, probably 90% or more of individuals have already returned to work by the time listed in the "Maximum" column. There will be some individuals who will not return to work in their prior career because of risk (e.g. heavy work with avascular necrosis of the femoral head), and some who permanently lack the capacity for their former career (e.g., heavy work after a major heart attack that caused permanent congestive heart failure). Cases of this type will also be in the category of those who have not yet returned to their prior careers at the date listed in the "Maximum" column. Thus, for those who seem to have the capacity to return to their prior career with no serious risk issues, but have yet to return to work by the "Maximum" date listed, either multiple and serious co-morbidities, unusually low symptom tolerance, or malingering would logically be present. Thus physicians, employers and insurers would want to look closely at cases nearing the "Maximum" disability duration.

There is a large and growing body of scientific evidence that return to work usually provides significant overall health benefit, and staying off work needlessly results in poorer overall health outcomes.(2) Thus, employers, employees (patients), and insurers all benefit from individuals returning to work in usual time periods.

As medical care improves, the disability durations for many conditions have shortened, and this is reflected in the current revisions to the consensus tables, as well as in the data sets that helped influence the revisions. This is particularly noticeable in the case of minimally invasive surgery (e.g. arthroscopic surgery instead of open joint surgery, laparoscopic surgery instead of open abdominal surgery, etc.).

1. Talmage JB, Melhorn JM. A Physician’s Guide to Return to Work. AMA Press, Chicago, 2005
2. Waddell GA, Burton AK. Is Work Good for Your Health and Well Being? The Stationery Office, London, 2006

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Revised Topics
  1. Abdominal Aortic Aneurysm
  2. Abrasions
  3. Abscess, Lung
  4. Abscess, Palmar
  5. Acquired Immune Deficiency Syndrome
  6. Acute Respiratory Distress Syndrome
  7. Adhesive Capsulitis of Shoulder
  8. Allergic Rhinitis
  9. Amputation, Finger or Thumb
  10. Anemia
  11. Aneurysmectomy
  12. Aortic Aneurysm
  13. Aortic Dissection
  14. Aortic Insufficiency
  15. Aortic Valve Stenosis
  16. Arrhythmia
  17. Arteriovenous Aneurysm
  18. Arthritis, Infectious
  19. Arthroplasty, Elbow
  20. Arthroplasty, Shoulder
  21. Asbestosis
  22. Aseptic Meningitis
  23. Asthma
  24. Atrioventricular Block, Complete (Third-Degree)
  25. Atrioventricular Block, Incomplete (First-Degree)
  26. Atrioventricular Block, Incomplete (Second-Degree)
  27. Atrophy, Muscular
  28. Avascular Necrosis
  29. Biceps Tendinitis
  30. Bone Scan
  31. Bone Spur
  32. Bone Tumors (Benign and Malignant)
  33. Brachial Neuropathy
  34. Brain Abscess
  35. Brain Injury
  36. Bronchiectasis
  37. Bronchitis, Acute
  38. Bronchitis, Chronic
  39. Bronchoscopy
  40. Buerger's Disease
  41. Bundle Branch Block
  42. Burn of Wrist and Hand
  43. Bursitis
  44. Byssinosis
  45. Cardiac Catheterization
  46. Cardiac Pacemaker Insertion
  47. Cardiac Stress Test
  48. Carotid Artery Occlusion
  49. Cellulitis
  50. Cerebral Aneurysm (Non-Ruptured)
  51. Cerebral Contusion, Closed
  52. Cerebral Hemorrhage
  53. Cerebrovascular Accident
  54. Cerebrovascular Disease
  55. Chronic Obstructive Pulmonary Disease
  56. Cluster Headache
  57. Common Cold
  58. Compartment Syndrome
  59. Complications of Devices, Implants, and Grafts
  60. Computerized Tomography
  61. Concussion
  62. Contusion
  63. Contusion, Upper Limb
  64. Coronary Angiography
  65. Crush Injury
  66. Depression, Major
  67. Discectomy
  68. Dislocation
  69. Embolectomy
  70. Embolectomy, Pulmonary
  71. Embolism, Pulmonary
  72. Emphysema
  73. Endarterectomy
  74. Epiglottitis
  75. Excision of Lesion or Tissue of Skin and Subcutaneous Tissue
  76. Excision of Nail, Nail Bed, or Nail Fold
  77. Fibromyalgia
  78. Fracture
  79. Fracture, Carpal Bones
  80. Fracture, Clavicle
  81. Fracture, Humerus, Distal
  82. Fracture, Humerus, Proximal
  83. Fracture, Scapula
  84. Ganglionectomy (Wrist)
  85. Heart Block
  86. Human Immunodeficiency Virus Infection
  87. Humidifier Fever
  88. Hyperbaric Oxygen Therapy
  89. Hypersensitivity Pneumonitis
  90. Hypertension
  91. Hypertensive Emergency
  92. Hypertensive Heart Disease
  93. Hypoglycemia
  94. Hysterectomy
  95. Incision of Skin and Subcutaneous Tissue, Drainage of Abscess
  96. Incision of Skin and Subcutaneous Tissue, Drainage of Cyst
  97. Infection
  98. Influenza
  99. Influenza, A H1N1
  100. Interstitial Pulmonary Fibrosis
  101. Iron Deficiency Anemia