FOR CASE MANAGERS

FOR CASE MANAGERS

Functional Capacity Evaluation

Description

A functional capacity evaluation is a test created to measure a patient’s function post-injury. The evaluation is a 4-hour test designed to compare baseline data, document existing impairments, and determine a patient’s current functional limitations. It is designed to help a physician determine return-to-work or disability status. The FCE consists of various tests to determine lifting/carrying capabilities in various positions. The evaluation tests functional activities of bending, crouching, kneeling, shoulder reach, overhead reach, climbing stairs, balancing, ladder climb, crawling, and walking. There is also a validity score to determine validity of the client’s performance during the evaluation.

Items Needed

  • Script/Request for FCE from physician
  • Recent Medical History
  • Job Description/Job Site Analysis
  • Any Imaging Findings
  • For Workers’ Comp Claims
      Claim Information
      • Insurance Company Name
      • Adjuster Information (i.e., Name, Phone & Fax Number, E-mail Address)
      • Billing Information
      • Authorized 1010 form if already obtained
  • Signed Cancellation/No Show Policy (Workers’ Comp/Attorney Claims) —must be signed and returned in order to keep scheduled FCE date
    • I:\DOCS\SCOTT\Website\Information\FCEs\FCE-CX No Show.pdf
    • 1st Cancellation/No Show: $400.00
      2nd Cancellation/No Show: $800.00
    • Cancellations and No Show not differentiated in our current fee schedule.
    • **The purpose of this policy is to assure the attendance of the patient. It is applied in the case that the patient does not show up for the scheduled appointment or if the test is cancelled with less than 24 hours of notice.**

Referral Questions

  • I:\DOCS\SCOTT\Website\Information\FCEs\FCE Referral.pdf
  • Perform a GENERAL FCE to determine patient’s current capabilities (to determine if client can return to any occupation
    • Include work classification/PDL
    • Include specific functional limitations
  • Perform a FIT-FOR-DUTY FCE to determine patient’s ability to return to work in a specific position (job description required)
    • Is the client returning to same position/same employer?
    • Is a functional job description provided by the employer?
    • Is a job site analysis required prior to the FCE?
    • Is transitional duty available?
  • Also include the following:
    • Effort testing
    • Recommendations for future care
    • Recommendations for future employment

How to Schedule