ࡱ> OQN` ,bjbjss .6,,<:/> .......$0h>3n.   .. . .+- S|pkS"m,. /0:/,383(-3-("Jbv(((.. (((:/      ICD-9 Code:  HYPERLINK "http://www.spineuniverse.com/displayarticle.php/article1440.html" 721.3 Narrative: Lumbosacral HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "Spondylosis"spondylosis without HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "Myelopathy"myelopathy Other Names: Lumbosacral arthritis; lumbosacral osteoarthritis; lumbosacral spondyloarthritis; lumbar facet arthritis; degenerative joint disease lumbar spine; DJD lumbar spine; facet arthropathy lumbar spine; degenerative changes facet joints lumbar spine; degenerative osteoarthritis; aggravation pre-existing arthritic or degenerative condition of lumbar spine listed above. (Note: Facet Syndrome is coded as 724.8) Ohio Specific Disability Outcomes: 30th Percentile 50th Percentile ODG Median All Claims including Surgical Cases 28 120 11  HYPERLINK "http://www.odg-twc.com/bp/721.htm" \l "721.3" ODG RTW Best Practices: Condition SeveritySurgical Procedure HYPERLINK "../RTW%20and%20Job%20Modifications/Lumbar%20Restrictions%20and%20Modifications.xls" Sedentary Work:  < 10 lbs HYPERLINK "../RTW%20and%20Job%20Modifications/Lumbar%20Restrictions%20and%20Modifications.xls" Clerical/Light Work: < 20 lbs HYPERLINK "../RTW%20and%20Job%20Modifications/Lumbar%20Restrictions%20and%20Modifications.xls" Manual Work:< 50 lbsMildNone1 day5-10 daysDescription: Natural aging process that may be aggravated or accelerated by work injury. Degeneration and inflammation of  HYPERLINK "http://www.back.com/anatomy-lumbar.html" vertebral (facet) joints of the lumbosacral region causing pain and stiffness. This can result in  HYPERLINK "http://www.back.com/causes-mechanical-stenosis.html" foraminal and central canal stenosis. BWC Required Diagnostics: Usually additional allowance to a claim due to new or ongoing symptoms Aggravation of pre-existing requires comparison of symptoms pre- and post-DOI and/or pathophysiology of the condition as rationale to support allowance in IME or file review Usually requires BWC file review or IME to support diagnosis and causality Usually absence of alternative explanation of symptoms, i.e., disc herniation. Usually narrowing of disc space on x-ray or arthritic changes on CT or MRI Common Treatment Procedures (CPT Codes): Usually conservative treatment (non-surgical) though symptoms may recur. Work restrictions HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "NSAID"NSAIDs/narcotics if severe Physical therapy/manipulation May need jobsite modification to avoid twisting or bending of the torso. Physical Therapy Guidelines: May consider up to 10 visits in first 60 days post injury (Presumptive Authorization) Additional authorization based on clinical course Chiropractic Treatment Guidelines: May consider up to 10 visits in first 60 days post injury (Presumptive Authorization) Additional authorization based on clinical course Common Surgical Procedures: None Some cases may consider  HYPERLINK "J:\\Field Med\\ALL USERS\\MEDICAL DEFINITIONS.doc" \l "Radiofrequency" radiofrequency ablation of facet joint 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: 14 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 torso. Avoid overhead and preferably above shoulder work 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 Any need for ergonomic analysis/job modifications Address any barriers Additional Allowances Consider IME by PM&R, Orthopedist, or neurosurgeon   [\]bc{|/ 0 1 ; < = > J pf]U]Ihh8 5CJaJh8 CJaJh8 5CJaJh8 5B*ph&jh[Jh[J5CJUaJh +h*0J5CJaJ&jh[Jh[J5CJUaJhZW~5CJaJjh +5CJUaJhgh*0J5CJaJ&jhghg5CJUaJhg5CJaJjhg5CJUaJh*5CJaJ= > 9 m n l Z j $Ifgd*gd*@ @&^@ `gd8 & F@&gd8 gd8 @&gd8 @ ^@ `gd*,     l m n o N IJIJĥqcZQZC:hg5CJaJjhg5CJUaJh*5CJaJh*5CJaJh]h]0J5CJaJ&jh]h]5CJUaJh]5CJaJjh]5CJUaJh8 5CJaJhjqh8 5B*ph#hjqh8 5B*CJH*aJph hjqh8 5B*CJaJph+hjqh8 56B*CJOJQJaJphh8 5B*phhh8 CJaJN O P a b l m P Q R _ `  >?@XY޾޾ǎzh[zh!h*0JCJaJ#j;h!h!CJUaJh!CJaJjh!CJUaJh*CJaJ&jbhghg5CJUaJ&jchghg5CJUaJhg5CJaJh*5CJaJhgh*0J5CJaJjhg5CJUaJ&jdhghg5CJUaJj k p u { | MDDDDD $Ifgd*kda$$IflrqZ <,"P t044 la MDDDDD $Ifgd*kd$$IflrqZ <,"P t044 la *qMHHB:: & Fgd*@&gd8 gd*kd$$IflrqZ <,"P t044 la  *pqij.VWu!̷̫̫̟xmaVhSh*CJaJhSh*5CJaJhvnh*CJaJh gh*0JCJaJ#j h[Jh[JCJUaJhZW~CJaJjh gCJUaJhvnh*5CJaJhz|h*5CJaJh*5CJaJh*CJaJh!h*0JCJaJjh!CJUaJ#jh!h!CJUaJ!j.wWXu!wab & Fgd* & Fgd* & Fgd*@&gd8 gd* & Fgd*789PQ`a+:189:UVX^`~+,xpe]h YCJaJhh*CJaJhNCJaJhKh*5CJaJhSh*CJaJhth*5B*phh*B*phhSh*5B*phh*5CJaJhz|h*CJaJhZW~h*0JCJaJ#j h[Jh[JCJUaJhZW~CJaJjhZW~CJUaJh*CJaJ9:^_`T<s & Fgd* & Fgd* & Fgd* & Fgd*@&gd8 gd*s, & Fgd*,1h/ =!"#$% DyK yK http://www.spineuniverse.com/displayarticle.php/article1440.htmlDyK  yK J../ALL USERS/MEDICAL DEFINITIONS.doc SpondylosisDyK  yK J../ALL USERS/MEDICAL DEFINITIONS.doc MyelopathyDyK  yK Dhttp://www.odg-twc.com/bp/721.htm721.3DyK yK ../RTW and Job Modifications/Lumbar Restrictions and Modifications.xlsDyK yK ../RTW and Job Modifications/Lumbar Restrictions and Modifications.xlsDyK yK ../RTW and Job Modifications/Lumbar Restrictions and Modifications.xls$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5DyK yK Phttp://www.back.com/anatomy-lumbar.htmlDyK yK hhttp://www.back.com/causes-mechanical-stenosis.htmlDyK  yK J../ALL USERS/MEDICAL DEFINITIONS.docNSAIDDyK  yK J../ALL USERS/MEDICAL DEFINITIONS.docRadiofrequency@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List j@j  , Table Grid7:V06U@6  + Hyperlink >*B*phFV@F FollowedHyperlink >*B*ph`d ZY@"Z 8 Document Map-D M CJOJQJ^JaJ,6=>9mnlZjkpu{|*qj  . w  W X u ! w a b 9:^_`T<s.000=00 0000n00 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 000 0 0 0 0 000 0  0  0  0  0 0 0 0X  0X 0X 0 0  0 0 0 0  0 0 00b 0b 000000 0` 0` 0` 0` 0` 0` 0`0` 0` 0` 0` 0` 0`0` 0` 0` 0` 0` 0` 0` 0`*  . 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