ࡱ> UWT` bjbjss .<,,,,4`T4L     Zf3333333$5h8n3v  vv3  3LLLv"  3Lv3LL|0|1  pkS,"0d2,304 188$181p"L33B 4vvvv $  ICD-9 Code: 722.52 Narrative: Degeneration of lumbar disc Other Names: Degenerative disc disease lumbar spine; DDD lumbar spine; disc desiccation lumbar spine;  HYPERLINK "C:\\Documents and Settings\\a71410\\My Documents\\MEDICAL DEFINITIONS.doc" \l "Spondylosis" discogenic spondylosis lumbar spine; aggravation of pre-existing of any of the prior condition of the lumbar spine. ODG Ohio Specific Disability Outcomes: 30th Percentile 50th Percentile All Claims including Surgical Cases 33 108  HYPERLINK "http://www.odg-twc.com/bp/722.htm" \l "722.52"  ODG RTW Best Practices: Condition SeveritySurgical ProcedureSedentary Work: <10 lbClerical/Light Work:<20 lbsManual Work:<50 lbsHeavy Work: >50 lbMildNone0-3 days28 daysIDET14 days28-84 days112-168 daysLaminectomy28 days70 days105 days to indefiniteLumbar Fusion56 days140 daysIndefinite Description: Natural aging process that may be aggravated or accelerated by work injury. Disc located in lumbar (lowback) region becomes thinner or narrower allowing the vertebrae to become more adjacent. May cause chronic or recurrent neck pain aggravated by movement or be completely asymptomatic.  HYPERLINK "http://www.spineuniverse.com/displayarticle.php/article42.html" http://www.spineuniverse.com/displayarticle.php/article42.html BWC Required Diagnostics: Usually additional allowance to a claim due to new or ongoing symptoms Usually requires BWC file review or IME to support diagnosis and causality particularly for allowance of aggravation of pre-existing Usually absence of alternative explanation of symptoms, i.e., disc herniation. Usually narrowing of disc space on x-ray or supportive findings on MRI or CT scan Common Treatment Procedures (CPT Codes): Usually conservative treatment (non-surgical) though symptoms may recur. Work restrictions  HYPERLINK "C:\\Documents and Settings\\a71410\\My Documents\\MEDICAL DEFINITIONS.doc" \l "NSAID" NSAIDs/narcotics if severe Physical therapy/manipulation May need jobsite modification to avoid twisting or bending of the low back and modification of the levels from which lifts are made. Physical Therapy Guidelines: Per ODG, 10-12 visits over 8 weeks Additional authorization based on clinical course Chiropractic Treatment Guidelines: Per ODG, 6 visits over 2 weeks with total of 18 visits over 18 weeks with evidence of functional improvement. Additional authorization based on clinical course Common Surgical Procedures: None If severe symptoms after conservative therapy, fusion may be tried. 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: 10 days Essential Case Management: 20 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 avoid repetitive or prolonged bending or twisting of low back. Avoid overhead and preferably above shoulder work due to extending of back. Additional Services Necessary Diagnostic or Consultation 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 PM&R, Orthopedist, or neurosurgeon  '.6:;G # $ ylVE h3hg5B*CJaJph+h3hg56B*CJOJQJaJphh3hg5B*phhg5CJaJhvnhgCJaJh\Khg0JCJaJ#jh\KhgCJUaJjhgCJUaJhgCJaJhg5CJaJh5CJaJh!5CJaJht5CJaJhvn5CJaJh45CJaJh ,5CJaJ;  B G H J K a t $IfgdXn@ @&^@ `gdg@&gdggd gdg @ ^@ `gdt    ? @ A E F H I J K ^ ` ˺xof]T]KBh!5CJaJhvn5CJaJh ,5CJaJhXn5CJaJh\K5CJaJh35CJaJhwWh\K0J5CJaJ&jdhwWhwW5CJUaJhwW5CJaJjhwW5CJUaJhg5CJaJ h3h35B*CJaJph h3hg5B*CJaJph h3hg5B*CJaJph#h3hg5B*CJH*aJph 8//// $IfgdXnkd+$$Iflֈ #       t0H$644 la   /kd$$Iflֈ #       t0H$644 la $IfgdXn    ' ( /kd $$Iflֈ #       t0H$644 la $IfgdXn( ) 5 = > F ] $IfgdXn] ^ _ m u v 8//// $IfgdXnkd~$$Iflֈ #       t0H$644 lav  /--kd$$Iflֈ #       t0H$644 la $IfgdXn   K L M N O i 45HپymemeYh\Khvn5CJaJhCJaJhvnhvn5CJaJhrh\K0J5CJaJ&j`hrh\K5CJUaJh\Kh\K5CJaJh\K5CJaJjh\K5CJUaJhvnh ,CJaJh4CJaJhtCJaJhvnCJaJhvn5CJaJh ,5CJaJh ,h ,5CJaJ! 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