Neurosurgery & Pain Specialists of the Carolinas
O. Del Curling, Jr., MD, MBA
Evaluation and Management of Cranial, Spinal, Peripheral Nerve, and Related Painful Conditions and Injuries
PLEASE NOTE THAT THIS SITE IS NO LONGER UPDATED--PLEASE VISIT OUR NEW WEB SITE AT :
Information for Case Managers and Schedulers Page
Dr. Curling offers a broad array of new patient evaluations, tailored to various needs and situations. Basically, non-medicolegal cases can be seen for a general neurosurgical consult (NP0) and the appropriate medical issues will be addressed and further follow up and treatment offered as appropriate. These visits can be filed on private health insurance (or personal pay for uninsured). Note carefully, however, that if scheduled for this level of service, Dr. Curling will specifically not address any medicolegal issues (work status, ratings, causality, etc.). Therefore, if being referred for a denied workers' comp claim, MVA, etc. and the requesting party is in need of such information or potentially will require Dr. Curling to serve as an expert witness regarding the issues of the case, then a higher level of service must be requested. If the patient/claimant has been injured and/or is actively involved in a medicolegal claim (workers' comp, MVA or other personal injury, etc.), then three levels of service are available. If the patient is within 6 months of the date of injury at the time of scheduling request to our office, Dr. Curling will schedule an Early Intervention Evaluation (NP1), which will include a comprehensive evaluation of all appropriate medical and medicolegal issues and will usually be followed by further evaluation and treatment in our office, if determined to be necessary (and pending approval of the treatment plan by the appropriate party). If it has been greater than 6 months since the date of injury, the patient/claimant can be scheduled for an Independent Medical Evaluation (NP3). Unique to North Carolina workers' compensation claims, a fourth type of initial visit is available--Additional Opinion on Rating (NP2). These latter two visits are scheduled as an "evaluation only", and further treatment is not usually offered, unless felt to be necessary and appropriate and agreed upon by all involved parties following review of the report of the evaluation. Prepayment and a signed Memorandum of Understanding will be required to schedule any medicolegal case. The four types of new patient appointments with Dr. Curling are summarized below:
NP level 0 All non-medicolegal cases; appropriate consult code (99244, 99245, etc.); payment at time of service; evaluation and treatment
NP level 1 Medicolegal cases--within 6 months of DOI (date of injury) at time of request; code EV100 (for NC W/C) or 99499 (for non-NC cases); prepayment; evaluation and treatment (pending approval of treatment plan)
NP level 2 Medicolegal case--Additional opinion on rating; code EV100 (for NC W/C); prepayment; evaluation only
NP level 3 Medicolegal case--IME (independent medical evaluation); code EV100 (for NC W/C) or 99499 (for non-NC cases); prepayment; evaluation only
Please note that the NP1 level of visit (less than 6 months since DOI) is aimed at improving the level of service that is often seen in workers' compensation and other medicolegal cases, hopefully leading to a more expeditious and efficient resolution of these cases for the carrier, while providing a more pleasant and effective course of evaluation and treatment for the patient. Rather than the typical course of working up the ladder and bouncing from provider to provider, from ER to primary care, to urgent care, to physiatrist, to orthopedist, to physiatrist, to spinal orthopedist, to neurosurgeon, and back again, the goal is to get the spine (and brain) injured patient directly to a neurosurgeon at the outset. If surgical treatment is clearly indicated, Dr. Curling can facilitate expeditious referral to another operating spinal surgeon for that procedure. However, if non-surgical treatment appears initially to be most appropriate (as is the case in the majority of situations), then Dr. Curling will offer to coordinate care, ideally moving the patient expeditiously to MMI. He will participate in referral for any appropriate testing or treatment and will schedule follow up visits at appropriate intervals to "maintain control" and keep an eye on the "big picture" as the patient flows through the system. While many services can be provided in the office of Neurosurgery & Pain Specialists, for services not presently available (e.g., MRI, physical therapy), Dr. Curling will assist with scheduling and have the patient return to his office for follow up after the referral.
Please note that all new patient appointments for medicolegal cases (worker's comp, personal injury, disability, etc.) referred greater than 6 months after DOI are scheduled with Dr. Curling as independent medical evaluations (IMEs), with the exception of NC workers' compensation claims referred specifically only for additional opinion on rating. Whether the evaluation is being requested for the purpose of obtaining a second surgical opinion, additional opinion on a rating (for non NC W/C claims), or to address causality issues, work status, or other specific issues, all such appointments will be scheduled as an IME. Dr. Curling approaches all patients with the same degree of attention and thoughtfulness, irrespective of the issue involved (or of the referral source). Even if the evaluation is "just for a second opinion on a rating", in order to conduct an appropriate and accurate impairment assessment, it must be first determined if the patient is indeed at MMI before that rating can be rendered. Being able to determine that a patient is at MMI requires a thorough understanding of the correct diagnosis, as well as an assessment of whether or not appropriate diagnostic studies and treatment options have been rendered in the case. Therefore, although the subsequent report of the evaluation may only address the rating (or other requested issues), the same thorough process has been carried out as would have been done to assess all of the appropriate issues--including diagnosis, prognosis, diagnostic and treatment recommendations, work status, work restrictions, causality, MMI, and PPI.
For patients seen early in their course for consultation, further evaluation and treatment will usually be initiated, but only after approval by the requesting party or the appropriate representative (e.g., a case manager authorized to approve treatment). All IME and Additional Opinion on Rating patients are seen for "evaluation only" and no treatment will be initiated at the time of the initial appointment. However, in specific circumstances in which the IME patient/claimant is not felt to be at MMI, Dr. Curling may be available to facilitate obtaining additional studies and further non-operative treatment that may have been recommended to help achieve MMI. In these cases, treatment will not be initiated prior to completion of the IME report and review by all appropriate parties of the final recommendations contained therein. If following review of the report, additional treatment in this office is desired, then you may contact our office to determine if this can be arranged. As noted above, if the patient is felt by Dr. Curling to be a candidate for surgical treatment, he can assist with referral to an appropriate operating neurosurgeon (or other spinal surgeon) if requested.
Also note carefully that Dr. Curling strictly limits his practice to the realm of neurosurgery and related pain conditions. He does not perform general occupational injury evaluations, nor will he address issues that he deems to be outside of his area of expertise. If evaluation by another specialist is felt to be most appropriate, Dr. Curling will facilitate that referral if desired. If it is unclear whether an evaluation of a particular patient by Dr. Curling is appropriate, we would recommend that you contact us to discuss the specifics of the situation. While Dr. Curling does not routinely require that records be submitted for review prior to requesting an appointment, he may do so in these situations in order to determine the appropriateness of a referral.
Dr. Curling realizes the importance of communicating with case managers, adjustors, attorneys, and others involved with medicolegal cases. However, in order to complete the most objective evaluation possible while also encouraging the patient/claimant to feel comfortable and to enjoy the appropriate amount of privacy and confidentiality during the evaluation, Dr. Curling does not allow these individuals to accompany the patient during the evaluation. However, if you choose to accompany the patient to the appointment, he will gladly sit down with you and the patient immediately following the evaluation to review the initial findings and impressions and to address any questions that you may have. Please note that Dr. Curling's new patient appointments are lengthy, and probably quite a bit longer than those to which you are accustomed. As a general rule, if you wish, you can plan to arrive about 30 minutes after the scheduled appointment time for NP1 appointments and an hour after the scheduled appointment time for NP2 and NP3 visits in order to minimize your wait time while Dr. Curling is with the patient/claimant.
Dr. Curling generally does not honor requests that stipulate that the results of the evaluation are not to be shared with the claimant/patient. He considers that individual to be the most important participant in the process and considers such requests to be inappropriate.
Dr. Curling recognizes that all patients/claimants seen for evaluation of medicolegal claims are potentially cases that will require legal testimony at some point in the future. He is available for consultation with attorneys, deposition, or other sworn testimony upon request, and will attempt to work with the requesting attorneys to accommodate these needs should they arise. Time is actually allotted on his schedule each week for these activities.
It is Dr. Curling's goal to publish the reports of initial evaluations as expeditiously as possible following the appointment and ideally within 48 hours. Obviously, however, that is not always possible, particularly if additional information (either records or studies) is necessary in order to provide a complete and useful evaluation. However, in most cases, you can anticipate the report being released no later than 10 business days following the appointment date. If the necessary information is not available at the time of the appointment, preliminary impressions will be shared with the patient (and the case manager following the appointment if present) and the report will be produced after the additional information has been provided. If you have a genuine pressing deadline to receive a report (pending hearing, mediation, etc.), please relate that information to us, as Dr. Curling does make an effort to accommodate such requests.
Scheduling an evaluation
Adjuster (or other payor) approval and prepayment is required before any new medicolegal patient appointment will be confirmed on our schedule. To start the scheduling process, you should provide us with the general information regarding the case, including all contact information for the patient/claimant, case manager, attorneys, and adjustor. Our standard information request sheet that highlights the required information can be obtained by contacting our office and requesting that the form be faxed or emailed to you, or you may access the form via this website. For medicolegal cases (NP1, NP2, or NP3), click here for a Word version or here for a pdf version of a request form that can be completed and returned--either print and mail/fax/scan to email or complete on your computer, save, and email to the address noted on the form). Following receipt of that information in our office, we will fax or email our standard commitment letter and memorandum of understanding to the identified payor for the service, who must complete that memorandum and return it to us, along with prepayment for the evaluation. Once that information has been received in our office, the requesting party will be contacted to establish an appointment date and time. After an appointment time has been established, an information packet will be mailed to the patient from our office, which will include general information about the visit, a registration form, and directions to the office. For non-medicolegal cases (NP0), click here for a Word or pdf version that can be printed out, completed, and faxed, or here for a Word version that can be completed on your computer or device, saved, and emailed. For non-medicolegal cases, the patient will be contacted directly to proceed with scheduling and the requesting party/provider will be notified of the pending appointment.
Note that Dr. Curling will address all appropriate issues in his reports, as outlined in the commitment letter. If specific information is requested, it is important that all parties communicate with each other to ensure that you all have the same expectations for the evaluation, and that those expectations are conveyed in a cover letter.
There is a significant charge for no show or late cancellations; should such occur, the appointment will not be rescheduled until that payment has been received in our office. These policies are further detailed in the commitment letter.