ࡱ> RTQ` *bjbjss .6*,L74p^33333335h;8n333330r2d S8lSFN124074b188(r28r2t"3374$ (( ICD-9 Code: 846.0 846.8 Narrative: Sacroiliac Sprains/Strains (Note: 846 is an invalid code at BWC. Use 846.0 846.8. Information provided for 846.0-846.8 in ODG is listed under 846.) Ohio Specific Disability Outcomes: 30th Percentile 50th Percentile All Claims including Surgical Cases 3 5  HYPERLINK "http://www.odg-twc.com/bp/846.htm" \l "846" ODG  HYPERLINK "http://www.sofamordanek.com/health-spinal.html" SPINAL ANATOMY RTW Guidelines Condition SeveritySurgical ProcedureSedentary Work: < 10 lbsClerical/Light Work: < 20 lbsManual Work: <50 lbsHeavy Work: >50 lbsMildNone0 days10 daysSevereNone0-3 days14-17 days35 daysMild characterized by some limitation of normal activity. Severe characterized by significant pain, significant limitation of activity, use of medications such as muscle relaxants and narcotics. Description: Injury to the ligament (sprain) or to the muscle (strain) of the sacral region. Usually accompanied by tearing of the tissue and symptoms of pain and limited motion. BWC Required Diagnostics: None. Common Treatment Procedures (CPT Codes): Work restrictions with reduction in restrictions with improvement Medications NSAIDs/Muscle Relaxants/Narcotics Trial of Physical Therapy/Osteopathic Manipulation/Narcotics MRI if failure to improve after 3-4 weeks or for neurological findings Specialist Consult if failing to improve after 4 weeks or for neurological findings Physical Therapy Guidelines: 10 visits over 60 days after injury ( HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "PresumptiveApproval" Presumptive Authorization) Additional therapy may be necessary based on clinical course Chiropractic Treatment Guidelines: 10 visits over first 60 days after injury (Presumptive Authorization) Additional services may be necessary based on clinical course Common Surgical Procedures: None. Usually requires an additional allowance to the claim.  HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "IDET" IDET may be appropriate after 6 months due to no additional allowance appropriate  HYPERLINK "J:\\Field Med\\ALL USERS\\RTW and Job Modifications\\Lumbar Restrictions and Modifications.xls" 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. Manual (Light/Medium) Work: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: 18 days Common Case Management Issues: Early Clinical Status Planned Treatment Work Restrictions and whether Restricted Duty Work Available Additional Services Necessary Diagnostic or Consultation Follow-up Clinical Status Diagnostic Studies Consultations Why Unable to Return to Work Additional Allowances to the Claim Address any Barriers If not progressing as expected Identify any reason for failing to improve as expected Any need for diagnostic studies/consults Any need for ergonomic analysis/job modifications Address any barriers Additional Allowances Consider IME by spine specialist or PM&R   $%/?@5 6 7 o 幰wiwXJAh./!5CJaJjh./!5CJUaJ hBh5B*CJaJphhB5B*CJaJph#hBh5B*CJH*aJph hBh5B*CJaJph+hBh56B*CJOJQJaJphh5CJaJhCJaJhRehePCJaJhnX5CJaJhnXCJaJhePCJaJhWCJaJhW5CJaJh ,5CJaJ@ 6 v w  6 > L X ` $IfgdN=*@&gdgd*o p q t u v w x e f t u Ǿypg^R^J?hC dhC dCJaJhC dCJaJhC dheP5CJaJheP5CJaJhji{5CJaJhW5CJaJh./!hRe5CJaJhRehRe0J5CJaJ&jhRehRe5CJUaJhRe5CJaJjhRe5CJUaJhnX5CJaJh./!5CJaJh./!h./!0J5CJaJjh./!5CJUaJ&jh./!h./!5CJUaJ` a f k r s :1111 $IfgdN=*kd$$IflֈqZ <,"(P t044 las { | } 1kd6$$IflֈqZ <,"(P t044 la $IfgdN=* 1kd$$IflֈqZ <,"(P t044 la $IfgdN=* $IfgdN=* u v * + :88888kd$$IflֈqZ <,"(P t044 lau v ) * D E I J K u # $ * H j k [\]vwxyѻٯ٣٣ٛ٣ُٛuh٣hRehW0JCJaJ#j(hRehReCJUaJhReCJaJjhReCJUaJhKCJaJhWhW5CJaJhWh ,5CJaJhiPh ,CJaJhWh ,CJaJhePCJaJhWCJaJhW5CJaJh ,5CJaJh ,h ,5CJaJ(+ K L u $ k y ^_{X$ & FgdiP & FgdK & FgdW & F & FgdW & FgdW@&gd V]{  WXYZĸԆ}ofRoDohRehiP0J5CJaJ&jhRehRe5CJUaJhRe5CJaJjhRe5CJUaJhMC5CJaJhKhKCJaJhRehK0JCJaJ#jhRehReCJUaJhReCJaJjhReCJUaJh ,CJaJhC dCJaJhKCJaJh ,5CJaJh_7CJaJhWCJaJhWhWCJaJ."'()*}uumbVbh ,h_75CJaJhYh_7CJaJhsCJaJhYCJaJhKhKCJaJhePCJaJhKhK5CJaJhY5CJaJhKCJaJhK5CJaJhiPhiPCJaJhiPCJaJh_7CJaJhe`5CJaJhN=*5CJaJhe`he`CJaJhe`B*phhiP5CJaJV "#By & Fgd_7 & Fgd_7gd_7gdY & FgdY & FgdY@&gdh^hgd_7y()*gd_7 & Fgd_7,1h/ =!"#$% DyK  yK Dhttp://www.odg-twc.com/bp/846.htm846DyK yK ^http://www.sofamordanek.com/health-spinal.html$$If!vh5555P55#v#v#v#vP#v:Vl t5555P5$$If!vh5555P55#v#v#v#vP#v:Vl t5555P5$$If!vh5555P55#v#v#v#vP#v:Vl t5555P5$$If!vh5555P55#v#v#v#vP#v:Vl t5555P5DyK  yK J../ALL USERS/MEDICAL DEFINITIONS.docPresumptiveApprovalDyK  yK J../ALL USERS/MEDICAL DEFINITIONS.docIDETDyK yK ../ALL USERS/RTW and Job Modifications/Lumbar Restrictions and Modifications.xls@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List j@j  , Table Grid7:V06U@6 ./! 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