ࡱ> NPM` bjbjss .0,,,,$P<1(> +1-1-1-1-1-1-1$H3h5nQ1Q1f1>>>.+1>+1>>K./ MkS,0".o0|101.6R6(/6/p"@>XlQ1Q14 1$ (( ICD-9 Code: 722.8 Narrative: Postlaminectomy Syndrome Other Names: Failed Back Syndrome ODG Ohio Specific Disability Outcomes: 30th Percentile 50th Percentile All Claims including Surgical Cases 365 365  HYPERLINK "http://www.odg-twc.com/bp/722.htm" \l "722.8" ODG RTW Best Practices: Condition SeveritySurgical ProcedureSedentary Work: <10 lbClerical/Light Work:<20 lbsManual Work:<50 lbsHeavy Work: >50 lb4 days14 days Description: Ongoing symptoms referred to low back that have not been sufficiently relieved by back surgery or symptoms that recur after surgery without intervening injury. This condition requires prior surgery (usually disectomy, laminectomy, or fusion) for another allowed condition and reflects chronic (usually for more than one year) ongoing symptoms despite efforts to treat the symptoms. BWC Required Diagnostics: BWC criteria. Prior surgery as described above Ongoing symptoms not sufficiently relieved by back surgery Adequate evaluation to diagnose and treat cause of symptoms. Most likely requires file review or IME to determine and offer recommended treatment options Common Treatment Procedures (CPT Codes): Trial of physical modalities TENS Unit Consultations Interdisciplinary pain program Variety of pain management procedures may have been tried Epidural steroid injections HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "Epiduroscopy"Epiduroscopy Spinal Cord Stimulator trial Physical Therapy Guidelines: 10 visits over 8 weeks (usually after post-surgical therapy attempt at rehabilitation) Additional authorization based on clinical course Chiropractic Treatment Guidelines: 14-16 visits over 12 weeks Additional authorization based on clinical course Common Surgical Procedures: Fusion may be considered if instability present Variety of pain management procedures Common Restrictions: Restrictions lessen (less restrictive) with improvement of symptoms. Sedentary: Lifting with knees (with a straight back, no stooping) not more than 5 lbs up to 3 times/hr; squatting up to 4 times/hr; standing or walking with a 5-minute break at least every 20 minutes; sitting with a 5-minute break every 30 minutes; no extremes of extension or flexion; no extremes of twisting; no climbing ladders; driving car only up to 2 hrs/day. Clerical/Light:Lifting with knees (with a straight back) not more than 25 lbs up to 15 times/hr; squatting up to 16 times/hr; standing or walking with a 10-minute break at least every 1-2 hours; sitting with a 10-minute break every 1-2 hours; extremes of flexion or extension allowed up to 12 times/hr; extremes of twisting allowed up to 16 times/hr; climbing ladders allowed up to 25 rungs 6 times/hr; driving car or light truck up to a full work day; driving heavy truck up to 4 hrs/day. Early Case Management: 20 days Essential Case Management: 37 days Common Case Management Issues: Early Clinical Status Planned Treatment Work Restrictions and whether Restricted Duty Work Available Placement in alternative job or accommodation to limit lifting, bending, and usually twisting of the lower back Additional Services Necessary Diagnostic or Consultation Possibility of Consultation or Surgery Follow-up Clinical Status Consultations Why Unable to Return to Work Address any Barriers If not progressing as expected Identify any reason for failing to improve as expected Any need for diagnostic studies/consults Ergonomic consultation/job modification Address any barriers Additional Allowances Consider IME by Neurosurgeon, Orthopedist, or PM&R 78[\`     ů{rd[Gd9dhFQqhFQq0J5CJaJ&jhFQqhFQq5CJUaJhFQq5CJaJjhFQq5CJUaJh *^5CJaJ h *^hU`5B*CJaJph#h *^hU`5B*CJH*aJph h *^hU`5B*CJaJph+h *^hU`56B*CJOJQJaJphh *^hU`5B*phhU`5CJaJhU`5CJaJh5CJaJh ,5CJaJhD5CJaJ8Z[\ 4 G Z q $Ifgd+o@&gdU`   3 b }  % ] ^ _ x ! } ~ R ƺرulah+h+CJaJh+5CJaJh+h ,5CJaJh+h+5CJaJhNw5CJaJh+h ,CJaJh+CJaJhDCJaJh ,5CJaJh ,h ,5CJaJh+o5CJaJh5CJaJhXn5CJaJh ,5CJaJh2!h2!5CJaJhD5CJaJ# 8//// $Ifgd+okd$$Iflֈ #n  t0H$644 la /kd|$$Iflֈ #n  t0H$644 la $Ifgd+o /kd3$$Iflֈ #n  t0H$644 la $Ifgd+o ^ _ ! ~  6 R Dvw & F & Fgd+ & Fgd+ & F & Fgd+@&gdU`R S CDuv45Z[\ĹĤěēĈui`WJhShb9;5B*phh[t5CJaJhb9;5CJaJhb9;h ,5CJaJhb9;hb9;CJaJhb9;CJaJh+h+CJaJh ,CJaJh+5CJaJh+h ,5CJaJh ,5CJaJh+h ,CJaJh+CJaJh,^h+0JCJaJ#jhzhzCJUaJh,^CJaJjh,^CJUaJ5[\56Z[z & Fgd2! & Fgd2!gd2!gd[tgdb9;h^hgdb9; & Fgd+ & Fgdb9;@&gdU` & Fgd+%4+456QY[yQϻᳪxxlh ,h[t5CJaJh ,h2!5CJaJhYh2!CJaJh\ CJaJhb9;CJaJhh2!CJaJh2!5CJaJh2!CJaJhKh[t5CJaJh[tCJaJh[t5CJaJh ,5CJaJhb9;5CJaJhthb9;5B*phhb9;B*phR/fgd[t & Fgd2! & Fgd2! & Fgd2!gd2! & Fgd2!,1h/ =!"#$% DyK  yK Dhttp://www.odg-twc.com/bp/722.htm722.8$$If!vh55n55 55#v#vn#v#v #v#v:Vl tH$655n55 55$$If!vh55n55 55#v#vn#v#v #v#v:Vl tH$655n55 55$$If!vh55n55 55#v#vn#v#v #v#v:Vl tH$655n55 55DyK  yK J../ALL USERS/MEDICAL DEFINITIONS.doc Epiduroscopy@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List j@j  , Table Grid7:V06U@6 FQq Hyperlink >*B*phFVF ,^FollowedHyperlink >*B* phZY@"Z U` Document Map-D M CJOJQJ^JaJ08Z[\ 4GZq^_!~6RDvw5[\   5 6 Z [ z R   / f 00000000000  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0  0 0 0 0 0_ 0_ 0_ 0_0_0 0 0 0 0 0 0 0 000 0 000 0w 0w0w0w0 0 0000\0\0\00 0 0 0 0[  0z [  0z [  0z [  0z [  0z [  0z [ 0[  0[  0 [  0 [  0 [  0 [ 0[  0[  0 [  0 [  0 [  0 [  0 [  0 [ 0[ 0[ 0[ 0[ _~vw5\  5 6 z R   / f {00{00@0{00{00{00{00{00{00{00{00{00{00{00{00{00{00{00{00{0U0{0U0@0@0@0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 00 0 @0 @0 @0 R    RXX _Hlt103648094 _Hlt103648095@@k8lD8``dd9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace К,.378Y 6w 4 6 Z [ z / ;4  Ӗo~18xB,PpFrK0wd>w;~ͬh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHxB,;~  K0wPp;o~1                                                               \ D2! ,;,'-b9; *^U`+ompFQq[t,^ +XnzNw4GZq@\4\@@UnknownGz Times New Roman5Symbol3& z Arial3z Times5& z!Tahoma?5 z Courier New;Wingdings"qhkFf  $24d 2QHX)? ,2 ICD-9 Code:Gregory M. Jewella71410(       Oh+'0  < H T`hpx ICD-9 Code:Gregory M. Jewell Normal.dota714105Microsoft Office Word@F#@r e@,kS ՜.+,D՜.+,8 hp|  BWC  ICD-9 Code: Titled 8@ _PID_HLINKSA F%../ALL USERS/MEDICAL DEFINITIONS.doc Epiduroscopy"http://www.odg-twc.com/bp/722.htm722.8  "#$%&'()*+,-./0123456789:;<>?@ABCDFGHIJKLORoot Entry FkSQData 1Table!F6WordDocument.0SummaryInformation(=DocumentSummaryInformation8ECompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q