CASE MANAGEMENT CLOSURE INSTRUCTIONS The following list of closure codes is to be utilized for the case management closure form. The form is to be completed by the case manager upon the conclusion of lost time claims which require case management. The original two-sided copy should be submitted to the State of Tennessee, Department of Labor, Workers' Compensation Division. Every field must be completed including the physician's license number. The proper ICD 9 code should be used for each diagnosis, and the five digit AMA CPT code should be used for each procedure; the reverse side of the form has a checklist for many commonly used codes. CLOSURE CODES RTW Employee has returned to work successfully. RRW Employee has been released to work, but did not return to work. MMI Maximum medical improvement obtained. SP Employee has not yet returned to work, but is making satisfactory progress. CD Employee deceased. NC Case Manager is closing case without significant progress by employee. CR Closed at adjuster's request. American LegalNet, Inc. www.USCourtForms.com