Free Webinar Series: Part 1 of 8: Master the Basics, Tuesday Tuesday, September 11th, 2018 1-2PM PDT

Blog: Daisy News

News, data, & insights about workers' comp billing

header_illustration_blogDaisyBill

Understanding DWC Forms PR-3 and PR-4

March 15, 2017 by Catherine Montgomery

The California Division of Workers’ Compensation (DWC) produces a full slate of standardized forms to cover all aspects of the workers’ compensation system – everything from medical treatment to audit complaints. Today, we’re honing in on the Primary Treating Physician (PTP) Reports PR-3 and PR-4. When the PTP determines that the injured employee's condition is both permanent and stationary, the PTP must issue either a PR-3 or PR-4 report to the claims administrator within 20 days from the date of examination of the injured employee.

Per California Code of Regulations § 9785, a condition becomes permanent and stationary when it hits “the point when the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment.”[1]

The DWC specifies that physicians may choose to submit their permanent and stationary reports in narrative form, rather than using the official DWC forms. Under all circumstances, this report must include specific information about the extent of the injury and the need for ongoing or future treatment.

Below, we break down the differences between the PR-3 and PR-4 reports. Choosing the correct report is often as simple as knowing the date of the injury.

PR-4 Report

The PR-4 report is used for injuries pursuant to the 2005 edition of the Permanent Disability Rating Schedule (PDRS) – in other words, you should choose the PR-4 report if the date of injury is on or after January 1, 2005.

In rare cases, injuries that occurred prior to 2005 can fall under the PDRS schedule – it all hinges on whether the date of a medical-legal or treating physician report verifying the permanence of the employee’s disability is before or after January 1, 2005. For more information, please consult the DWC’s FAQ page on this topic.

Per the Physician Fee Schedule, the PTP is to be separately reimbursed for the PR-4 report. The report is billed with California-specific code WC004. Effective March 1, 2017, the rates for this code are as follows:

WC004

Primary Treating Physician's Permanent and Stationary Report (Form PR-4): First page

$39.89

Primary Treating Physician's Permanent and Stationary Report (Form PR-4): Each additional page. Maximum of seven pages absent mutual agreement. ($187.13 Maximum Total)

$24.54

You can download the PR-4 form on the DWC website – but only if you use Internet Explorer and download the latest version of Adobe Reader. You may also access the PR-4 form via our website without any browser or software restrictions:

PR-3 Report

The PR-3 report is used for injuries pursuant to the 1997 edition of the Permanent Disability Rating Schedule (PDRS), and is therefore generally used for injuries that occurred on or before December 31, 2004.

Per the Physician Fee Schedule, the PTP is to be separately reimbursed for this report using California-specific code WC003. Effective March 1, 2017, the rates for this code are as follows:

WC003

Primary Treating Physician's Permanent and Stationary Report (Form PR-3): First page

$39.89

Primary Treating Physician's Permanent and Stationary Report (Form PR-3): Each additional page. Maximum of six pages absent mutual agreement. ($162.59 Maximum Total)

$24.54

You can download the DWC PR-3 form on the DWC website if you meet their browser and software restrictions. Alternatively, you may access the PR-3 form via our website:

Narrative PR-3 and PR-4 Reports

Should a physician choose to submit their reports in narrative form, they must meet certain stringent requirements. Section 10606 of the California Code of Regulations provides a list of 15 necessary components of narrative medical reports:

        “(1) the date of the examination;

(2) the history of the injury;

(3) the patient's complaints;

(4) a listing of all information received in preparation of the report or relied upon for the formulation of the physician's opinion;

(5) the patient's medical history, including injuries and conditions, and residuals thereof, if any;

(6) findings on examination;

(7) a diagnosis;

(8) opinion as to the nature, extent, and duration of disability and work limitations, if any;

(9) cause of the disability;

(10) treatment indicated, including past, continuing, and future medical care;

(11) opinion as to whether or not permanent disability has resulted from the injury and whether or not it is stationary. If stationary, a description of the disability with a complete evaluation;

(12) apportionment of disability, if any;

(13) a determination of the percent of the total causation resulting from actual events of employment, if the injury is alleged to be a psychiatric injury;

(14) the reasons for the opinion; and,

(15 ) the signature of the physician.”[2]

Medical-Legal Reports

Neither the PR-3 nor the PR-4 may be used by Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs) to report medical-legal evaluations. More information about medical-legal forms may be found here.


Want to learn more about the California workers’ comp system? Watch our webinar on the new reimbursable CPT Codes (99358 and 99359) for record review and other non-face-to-face services.

CPT CODES 99358 & 99359 WEBINAR


[1] Full text of CCR § 9785 here.

[2] Full text of CCR § 10606 here.

Search results for:

About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

intercom_chat_bubble_icon