Can a QME Evaluate Multiple Body Parts in One Examination?
Yes—with caveats. A Qualified Medical Evaluator may address more than one body part or body system during a single evaluation if each area falls within the physician’s licensed scope and clinical competency. However, the rules differ depending on whether you are the sole QME on the panel, the requested specialty, and whether the additional body parts would normally require a different specialty.
1. Same-Specialty, Multiple Body Parts
An orthopedic surgeon QME can evaluate shoulder, spine, knee, and ankle injuries in one sitting because they all reside within orthopedic medicine. The comprehensive report must apportion impairment by body region, but billing remains a single ML200 code. You may add the complexity modifier (–C) for “multiple body systems/regions,” increasing reimbursement by 25 %.
2. Different-Specialty Body Parts
- If panel specialty covers only one system: A family medicine QME cannot independently rate psychiatric or dental impairment; those require separate QMEs in psych or dental specialties.
- Option to request additional panels: When the existing QME lacks expertise in another body system integral to the claim, either party may petition the DWC Medical Unit for an additional panel in the needed specialty (CCR §31.7).
3. Agreed Medical Evaluator (AME) Flexibility
An AME—chosen jointly by both parties—can evaluate multiple specialties if both sides stipulate in writing that the physician is competent and the AME feels comfortable rendering opinions across those systems.
4. Documentation Requirements
- Identify every body part examined in the Panel QME Intro section.
- Provide separate impairment ratings per body part, with AMA Guides citations.
- Apportion disability across all relevant regions; don’t simply lump them into a single Whole-Person Impairment (WPI) figure.
5. Billing Tips
• Use ML200 + –C when multiple body systems within the same specialty are evaluated.
• Bill record review (–B) at $3 per page if total records exceed 200 pages.
• Never split a multi-region exam into two ML200 invoices—this triggers denials for duplicate billing.
For official guidance on multi-body-part evaluations and specialty limitations, see the DWC’s QME FAQ – Multiple Body Parts.