ImpairMaster Help Desk

A diagnosis-based impairment is any impairment that requires you to explicitly assign an impairment value based on various classes (or categories) where each class/category describes the conditions and severity of the patient's condition. The vast majority of impairments found in the AMA Guides are diagnosis-based with the exception of the musculoskeletal chapters and the eyes.

Entering a diagnosis-based impairment is a 3-step process:

• First determine which class (or category) best describes the patient's condition
• Select an impairment value from the allowed range for the selected class/category
• Construct the narrative description of the impairment

Example Case - Impairment Due to Surgically Treated Herniated Disk

The following example is taken from Example 15-3 in the AMA Guides 5th edition, page 386.

History:

Onset of back and left posterior thigh and leg pain while twisting in a flexed position when lifting a moderately heavy package. Initially presented with muscle spasm, a positive SLR on the side at 60DEG, a positive crossed SLR at 70DEG, and an absent left Achilles tendon reflex. Treatment with physical therapy did not produce significant improvement. Underwent surgical diskectomy 3 months after the injury. Improved and returned to work without restrictions after 4 months of rehabilitation.

Current Symptoms:

No pain at rest or numbness in the lower extremities 8 months after injury. Able to do most ADL but complains of back pain with heavy activity.

Physical Exam:

Full range of motion of the lumbar spine. Loss of the Achilles reflex but normal motor and sensory functions. SLR: negative.

Clinical Studies:

Original MRI: herniated disk at L5-S1. No additional studies have been done.

Diagnosis:

Left posterolateral herniated disk at L5-S1 with left S1 radiculopathy, partially resolved status postdiskectomy.

Using ImpairMaster:

Step 1: Select Lumbar Spine Diagnosis-Related Estimates

Step 2: Determine Category and Impairment

Click on the various category tabs to determine the appropriate category for the condition. Based on the current symptoms and the clinical studies, Category III best describes the patient's circumstances. The 2nd condition states "history of a herniated disk..." and also "... radiculopathy is now asymptomatic". 

Click on the "Category III" tab, then enter a value of 10 in the Impairment input field at the top. Click the "Continue to Narrative" button at the bottom of the window.

Step 3: Create the Impairment Narrative

The final step is to create the text that will appear in the exam. ImpairMaster shows you the various circumstances that are associated with the selected category. 

Find the circumstances that best describe the patient's condition, then click the down arrow to the left of the text. ImpairMaster will wrap the text in a paragraph that includes the impairment value as well as any citations back to the AMA Guides.

The generated text can be edited as much as necessary, but you cannot leave it blank. Feel free to enter any additional comments to the text.

If you need to start-over on the text, click the "Clear Narrative" button at the bottom of the text box.

When the text is complete, click the "Save Impairment" button to add the impairment to the report.