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Workers' compensation -- Treatment parameters:  Low back pain



By condition

Regional low back pain
Regional low back pain, includes referred pain to the leg above the knee unless it conforms to an L2, L3, or L4 dermatomal distribution and is accompanied by anatomically congruent motor weakness or reflex changes. Regional low back pain includes the diagnoses of lumbar, lumbosacral, or sacroiliac:  strain, sprain, myofascial syndrome, musculoligamentous injury, soft tissue injury, spondylosis, and other diagnoses for pain believed to originate in the discs, ligaments, muscles, or other soft tissues of the lumbar spine or sacroiliac joints and which effects the lumbosacral region, with or without referral to the buttocks and/or leg above the knee, including, but not limited to, ICD-9-CM codes 720 to 720.9, 721, 721.3, 721.5 to 721.90, 722, 722.3, 722.32, 722.5, 722.51, 722.52, 722.6, 722.9, 722.90, 722.93, 724.2, 724.5, 724.6, 724.8, 724.9, 732.0, 737 to 737.9, 738.4, 738.5, 739.2 to 739.4, 756.1 to 756.19, 847.2 to 847.9, 922.3, 926.1, 926.11, and 926.12.

Lumbar radiculapthy

Static
Radicular pain, with or without regional low back pain, with static or no neurologic deficit. This includes the diagnoses of sciatica; lumbar or lumbosacral radiculopathy, radiculitis or neuritis; displacement or herniation of intervertebral disc with myelopathy, radiculopathy, radiculitis or neuritis; spinal stenosis with myelopathy, radiculopathy, radiculitis or neuritis; and any other diagnoses for pain in the leg below the knee believed to originate with irritation of a nerve root in the lumbar spine, including, but not limited to, the ICD-9-CM codes 721.4, 721.42.

Progressive
Radicular pain, with or without regional low back pain, with progressive neurologic deficit. This includes the same diagnoses as subitem (2), however, this category applies when there is a history of progressive deterioration in the neurologic symptoms and physical findings which include worsening sensory loss, increasing muscle weakness, or progressive reflex changes.

Cauda equina syndrome
Cauda equina syndrome, which is a syndrome characterized by anesthesia in the buttocks, genitalia, or thigh and accompanied by disturbed bowel and bladder function, ICD-9-CM codes 344.6, 344.60, and 344.61.

By treatment

General principles

  • Psychological evaluation 5221.6200 subpart 1G

  • Consultation 5221.6200 subpart 1J

  • Conservative care first, if possible 5221.6200 subpart 2B (1)

  • Limits on passive treatment 5221.6200 subpart 3A

  • Health care provider's responsibility to evaluate:

    • diagnosis 5221.6200 subpart 2A

    • treatment efficacy 5221.6200 subpart 9

  • Repeat surgery 5221.6200 subpart 6B

  • Management of chronic back pain 5221.6200 subpart 2B (3) and 5221.6200 subpart 7

Diagnostic procedures

  • Laboratory testing 5221.6200 subpart 1B

  • Medical imaging 5221.6200 subpart 1C and 5221.6100

  • EMG/NCV 5221.6200 subpart 1D

  • Diagnostic blocks 5221.6200 subpart 1H

  • FCE 5221.6200 subpart 1I

Therapies

  • Chiropractic manipulation/adjustment 5221.6200 subpart 3C

  • Osteopathic manipulation/adjustment 5221.6200 subpart 3C

  • Use of heat/cold

    • in clinic 5221.6200 subpart 3D (1)

    • at home 5221.6200 subpart 3D (2)

  • Electrical stimulation

    • in clinic 5221.6200 subpart 3E (1)

    • at home 5221.6200 subpart 3E(2)

  • Traction

    • in clinic 5221.6200 subpart 3F (1)

    • at home 5221.6200 subpart 3F (2)

  • Acupuncture 5221.6200 subpart 3G

  • Manual therapies 5221.6200 subpart 3H

  • Iontophoresis 5221.6200 subpart 3I

  • Phonophoresis 5221.6200 subpart 3I

  • Spinal braces 5221.6200 subpart 3K

  • Therapeutic exercise

    • in clinic 5221.6200 subpart 4D (1)

    • at home 5221.6200 subpart 4D (2)

  • Trigger point injections 5221.6200 subpart 5A (1)

  • SI injection 5221.6200 subpart 5A (2)

  • Facet injections 5221.6200 subpart 5A (3)

  • Nerve blocks 5221.6200 subpart 5A (4)

  • Epidural injections 5221.6200 subpart 5A (5)

  • Denervation of facet joints 5221.6200 subpart 5B

  • Prolotherapy 5221.6200 subpart 5C

  • Botulium toxin injections 5221.6200 subpart 5C

  • Medications 5221.6200 subpart 10

  • Hospitalization 5221.6400 subpart 2

  • Decompression surgery 5221.6200 subpart 6 and 5221.6500 subpart 2A

  • Fusion surgery 5221.6200 subpart 6 and 5221.6500 subpart 2C

  • Post-operative physical therapy 5221.6200 subpart 6A

  • Spinal cord stimulators 5221.6200 subpart 6C (1)

  • Intrathecal drug delivery systems 5221.6200 subpart 6C (2)

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