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. Amebiasis
  2. Antisocial Personality Disorder
  3. Attention Deficit Disorder in Adults
  4. Avoidant Personality Disorder
  5. Behçet's Disease
  6. Blastomycosis
  7. Botulism
  8. Brain Injury
  9. Brucellosis
  10. Chagas Disease
  11. Chancroid
  12. Cholera
  13. Chromoblastomycosis
  14. Coccidioidomycosis
  15. Concussion
  16. Cryptococcosis
  17. Dengue Fever
  18. Dysentery
  19. Ebola Virus Disease
  20. Echinococcosis
  21. Equine Encephalitis
  22. Erysipelas
  23. Erysipeloid
  24. Escherichia coli
  25. Filariasis
  26. Food Poisoning
  27. Gas Gangrene
  28. Giardiasis
  29. Gonorrhea
  30. Herpes Simplex
  31. Histoplasmosis
  32. Joint Disorders
  33. Kaposi's Sarcoma
  34. Lacerations
  35. Laminectomy or Laminotomy
  36. Laryngitis
  37. Legionnaires' Disease
  38. Lung Biopsy
  39. Lung Collapse
  40. Lung Excision
  41. Lyme Disease
  42. Malaria
  43. Malunion and Nonunion of Fracture
  44. Measles
  45. Methicillin Resistant Staphylococcus Aureus (MRSA)
  46. Migraine Headache
  47. Mononucleosis
  48. Mumps
  49. Muscle Injury
  50. Myocarditis, Acute
  51. Nasal Polyps
  52. Nasal Septal Perforation
  53. Nerve Injury
  54. Neuralgia, Neuropathy, Neuritis, and Radiculitis
  55. Neutropenia
  56. Occupational Asthma
  57. Occupational Therapy
  58. Operations on Muscle, Tendon, and Fascia of Hand
  59. Osteoarthritis
  60. Osteoporosis
  61. Pain, Chronic
  62. Peptic Ulcer Disease
  63. Pericarditis, Acute
  64. Pharyngitis, Acute
  65. Physical Therapy
  66. Pleural Biopsy
  67. Pleural Empyema
  68. Pleurisy
  69. Pneumoconiosis
  70. Pneumocystis Jiroveci Pneumonia
  71. Pneumonia
  72. Polio
  73. Post-concussion Syndrome
  74. Post-polio Syndrome
  75. Pott Disease
  76. Pronator Syndrome
  77. Pulmonary Edema
  78. Pulmonary Function Tests
  79. Rabies
  80. Raynaud Phenomenon
  81. Reduction of Fracture or Dislocation
  82. Renovascular Hypertension
  83. Repair, Cerebral Aneurysm
  84. Repetitive Strain Injury
  85. Respiratory Failure
  86. Rhinoscleroma
  87. Rocky Mountain Spotted Fever
  88. Rubella
  89. Ruptured Biceps Tendon (Traumatic and Nontraumatic)
  90. Sarcoidosis
  91. Sick Sinus Syndrome
  92. Sickle Cell Anemia
  93. Siderosis
  94. Silicosis
  95. Sinusitis
  96. Skin Graft
  97. Skin or Subcutaneous Tissue Biopsy
  98. Sprains and Strains
  99. Sprains and Strains, Shoulder and Upper Arm
  100. Sprains, Acromioclavicular Joint
  101. St. Louis Encephalitis
  102. Subarachnoid Hemorrhage (Non-traumatic)
  103. Subdural Hemorrhage
  104. Suture of Skin and Subcutaneous Tissue
  105. Synovectomy
  106. Synovial Cyst
  107. Synovitis
  108. Syphilis