ࡱ> JLI` bjbjss .. <=,h~~~~~~~+++++++$-hA0v+b~~bb+~~+   b ~~+ b+  P)|*~\ NkSl")+ ,0=,)00$*0*8~" ~~~++ ~~~=,bbbb d ICD-9 Code: 724.01 Narrative: Spinal stenosis, thoracic region This code does not include foraminal stenosis (724.8) which is stenosis of the exit route of the spinal nerve itself as opposed to the spinal cord. Other Names: thoracic spinal stenosis; thoracic central canal stenosis; aggravation of pre-existing spinal stenosis of thoracic region or aggravation of pre-existing central canal stenosis of thoracic region Ohio Specific Disability Outcomes: 30th Percentile 50th Percentile All Claims including Surgical Cases 51 119  HYPERLINK "http://www.odg-twc.com/bp/724.htm" \l "724.0" ODG INFORMATION IN ODG APPEARS TO BE RELATED TO LUMBAR SPINAL STENOSIS. THORACIC SPINAL STENOSIS IS LESS COMMON, PARTICULARLY IN WORKERS COMPENSATION. RTW Best Practices: Condition SeveritySurgical ProcedureSedentary Work: <10 lbClerical/Light Work:<20 lbsManual Work:<50 lbsHeavy Work: >50 lbMildNone1 day14 days14-28 daysSurgical Decompression35 days70 daysIndefinite Description: Narrowing of the space around the spinal cord due to a congenital or developmental abnormality or because of degenerative changes that occur naturally with aging. In work comp, usually the result of the injury worsening or contributing the narrowing such as herniation of the disc. Main symptom is pain in one or both legs worsened by walking or standing erect. BWC Required Diagnostics: Usually CT scan or MRI to diagnose condition Usually requires file review or IME to diagnose and determine causality Common Treatment Procedures (CPT Codes): Work and activity restrictions Trial of physical therapy Epidural steroid injections If symptoms persist or severe, may require surgical decompression Physical Therapy Guidelines: 10 visits over 8 weeks Additional therapy may be necessary post-surgery Chiropractic Treatment Guidelines: Common Surgical Procedures: Spinal Decompression (Relative uncommon in comparison to lumbar and cervical spinal stenosis.) 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: 15 days Essential Case Management: 28 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 allow flexion of back or avoiding extension 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/Anticipate permanent restrictions requiring accommodation 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 Neurosurgeon, Orthopedist, or PM&R 8@ " # $ ^ _ Ŵ|j|jaS?&jhh$A5CJUaJjh$A5CJUaJh`c5CJaJ#h`ch 5B*CJH*aJph h`ch`c5B*CJaJph h`ch 5B*CJaJph+h`ch 56B*CJOJQJaJph h`ch 5B*CJaJphh2!h 5CJaJhsH:h CJaJh CJaJh 5CJaJh$A5CJaJh*5CJaJ@ " # e f g  # 6 M i } $Ifgd$A@&gd gd gd$A_ ` c d e f g e f >?XYtu^dr"stҽҵҵҵҪҖҍҀxkxhth$A5B*phh$AB*phhSh$A5B*phh*5CJaJh*CJaJhsH:h$A5CJaJhsH:h$ACJaJh$ACJaJh ,h$A5CJaJh*5CJaJh$A5CJaJh$A5CJaJhh$A0J5CJaJjh$A5CJUaJ) 8//// $Ifgd$Akd$$Iflֈ #n  t0H$644 la /kd|$$Iflֈ #n  t0H$644 la $Ifgd$A /kd3$$Iflֈ #n  t0H$644 la $Ifgd$A f g ?YuAB^s & Fgd$A & Fgd$A & Fgd$A & Fgd$A@&gd gd$AstB *GH & Fgd$A & Fgd$A & Fgd$A & Fgd$A@&gd gd$AtH廯hh ,h$A5CJaJhYh$ACJaJh13CJaJhh$ACJaJhKh$A5CJaJh$ACJaJh$A5CJaJh135CJaJH]sgd$A & Fgd$A,1h/ =!"#$% DyK  yK Dhttp://www.odg-twc.com/bp/724.htm724.0$$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 55@@@ $ANormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List j@j $A Table Grid7:V06U@6 $A Hyperlink >*B*phZY@Z  Document Map-D M CJOJQJ^JaJ.@"#efg#6Mi}fg ?YuAB^s t  B    * G H]s00@0@0000000#0#0#00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000 0g 0g0g0 0 0 0 000 0 00000 0B0B00000t 0t 0t 0 0  0  0  0  0  0  0 0  0  0  0  0  0 0  0  0  0  0  0  0  0 0 0 efgAB^s t  B    * G H]s{00{00{00@0{00@0{00@0{00{00{00{00{00{00{00{00{00{00{00{00{00{00{00{00{0U0{0U0@0@0@0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0 @0 00 _ t  sH #_cXP"PT"9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace t3`fg ut  * Hs/VxB,l1K',4._Rl~;~ͬh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHxB,;~',4Rl~l1/                                                      *$A`cmpu 13#6Mi}@d4\@@UnknownGz Times New Roman5Symbol3& z Arial3z Times5& z!Tahoma?5 z Courier New;Wingdings"hFf0x 0x $24 2QHX)?$A2ICD-9 Code: 724Gregory M. 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