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Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice



5221.6040 Definitions

Subpart 1. Scope. The terms used in parts 5221.6010 to 5221.6600 have the meanings given them in this part.

Subp. 2. Active Treatment. "Active treatment" requires active patient participation in a therapeutic program to increase flexibility, strength, endurance, or awareness of proper body mechanics.

Subp. 3. Chronic pain syndrome. "Chronic pain syndrome" means any set of verbal or nonverbal behaviors that:

  1. involve the complaint of enduring pain;
  2. differ significantly from the patient's pre-injury behavior;
  3. have not responded to previous appropriate treatment;
  4. are not consistent with a known organic syndrome and
  5. interfere with physical, psychological, social, or vocational functioning.

Subp. 4. Condition. A patient's "condition" means the symptoms, physical signs, clinical findings, and functional status that characterize the complaint, illness, or injury related to a current claim for compensation.

Subp. 5. Emergency treatment. "Emergency treatment" means treatment that:

  1. could lead to serious physical or mental disability or death; if not immediately treated or
  2. is immediately necessary to alleviate severe pain.

Subp. 6. Etiology. "Etiology" is considered the cause of the patient's condition.

Subp. 7. Functional status. "Functional status" means the ability of an individual to engage in activities of daily living and other social, recreational, and vocational activities.

Subp. 8. Initial nonsurgical management or treatment. "Initial nonsurgical management or treatment" is initial treatment provided after an injury that includes passive treatment, active treatment, injections, durable medical equipment and/or medication.

Subp. 8a. Medical contrainidication. "Medical contraindication" means a condition that makes the use of a particular treatment or medication inadvisable because of an increased risk of harm to the patient.

Subp. 9. Medical imaging procedures. A "medical imaging procedure" is a technique, process, or technology used to create a visual image of the body or its function.

Subp. 10. Medically necessary treatment. "Medically necessary treatment" means those health services for a compensable injury that are reasonable and necessary for the diagnosis and cure or significant relief of a condition.

Subp. 11. Neurologic deficit. "Neurologic deficit" means a loss of function secondary to the nervous system.

Subp. 12. Passive treatment. "Passive treatment" include bedrest; thermal treatment; traction; acupuncture; electrical muscle stimulation; braces; manual and mechanical therapy; massage; and adjustments.

Subp. 13. Therapeutic injection. "Therapeutic injection" is any injection modality specified in parts 5221.6200, subpart 5; 5221.6205, subpart 5; 5221.6210, subpart 5; 5221.6300, subpart 5; and 5221.6305, subpart 2, item A. Therapeutic injections include trigger point injections, sacroiliac injections, facet joint injections, facet nerve blocks, nerve root blocks, epidural injections, soft tissue injections, peripheral nerve blocks, injections for peripheral nerve entrapment, and sympathetic blocks.

Statutory authority:  MS s 176.103; 176.83

History:  19 SR 1412; 35 SR 138

Posted:  Aug. 16, 2010

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