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Workers' compensation -- Treatment parameters:  Neck pain



By condition

Regional neck pain
Regional neck pain includes referred pain to the shoulder and upper back. Regional neck pain includes the diagnoses of cervical strain, sprain, myofascial syndrome, musculoligamentous injury, soft tissue injury, and other diagnoses for pain believed to originate in the discs, ligaments, muscles, or other soft tissues of the cervical spine and which affects the cervical region, with or without referral to the upper back or shoulder, including, but not limited to, ICD-9-CM codes 720 to 720.9, 721 to 721.0, 721.5 to 721.90, 722.3 to 722.30, 722.4, 722.6, 722.9 to 722.91, 723 to 723.3, 723.5 to 723.9, 724.5, 724.8, 724.9, 732.0, 737 to 737.9, 738.4, 738.5, 739.1, 756.1 to 756.19, 847 to 847.0, 920, 922.3, 925, and 926.1 to 926.12.

Cervical radiculopathy

Static
Radicular pain, with or without regional neck pain, with no or static neurologic deficit. This includes the diagnoses of brachialgia; cervical radiculopathy, radiculitis, or neuritis; displacement or herniation of intervertebral disc with radiculopathy, radiculitis, or neuritis; spinal stenosis with radiculopathy, radiculitis, or neuritis; and other diagnoses for pain in the arm distal to the shoulder believed to originate with irritation of a nerve root in the cervical spine, including, but not limited to, the ICD-9-CM codes 721.1, 721.91, 722 to 722.0, 722.2, 722.7 to 722.71, 723.4, and 724 to 724.00. In these cases neurologic findings on history and examination are either absent or do not show progressive deterioration.

Progressive
Radicular pain, with or without regional neck pain, with progressive neurologic deficit, which includes the same diagnoses as subitem (2); however, in these cases there is a history of progressive deterioration in the neurologic symptoms and physical findings, including worsening sensory loss, increasing muscle weakness, and progressive reflex changes.

Myelopathy
Cervical compressive myelopathy, with or without radicular pain, is a condition characterized by weakness and spasticity in one or both legs and associated with any of the following:  exaggerated reflexes, an extensor plantar response, bowel or bladder dysfunction, sensory ataxia, or bilateral sensory changes.

By treatment

General principles

  • Psychological evaluation 5221.6205 subpart 1G

  • Consultation 5221.6205 subpart 1J

  • Conservative care first, if possible 5221.6205 subpart 2B (1)

  • Limits on passive treatment 5221.6205 subpart 3A

  • Health care provider's responsibility to evaluate:

    • diagnosis 5221.6205 subpart 2A

    • treatment efficacy 5221.6205 subpart 9

  • Repeat surgery 5221.6205 subpart 6B

  • Management of chronic back pain 5221.6205 subpart 2B (3) and 5221.6205 subpart 7

Diagnostic procedures

  • Laboratory testing 5221.6205 subpart 1B

  • Medical imaging 5221.6205 subpart 1C and 5221.6100

  • EMG/NCV 5221.6205 subpart 1D

  • Diagnostic blocks 5221.6205 subpart 1H

  • FCE 5221.6205 subpart 1I

Therapies

  • Chiropractic manipulation/adjustment 5221.6205 subpart 3C

  • Osteopathic manipulation/adjustment 5221.6205 subpart 3C

  • Use of heat/cold

    • in clinic 5221.6205 subpart 3D (1)

    • at home 5221.6205 subpart 3D (2)

  • Electrical stimulation

    • in clinic 5221.6205 subpart 3E (1)

    • at home 5221.6205 subpart 3E (2)

  • Traction

    • in clinic 5221.6205 subpart 3F (1)

    • at home 5221.6205 subpart 3F (2)

  • Acupuncture 5221.6205 subpart 3G

  • Manual therapies 5221.6205 subpart 3H

  • Iontophoresis 5221.6205 subpart 3I

  • Phonophoresis 5221.6205 subpart 3I

  • Spinal braces 5221.6205 subpart 3K

  • Therapeutic exercise

    • in clinic 5221.6205 subpart 4D (1)

    • at home 5221.6205 subpart 4D (2)

  • Trigger point injections 5221.6205 subpart 5A (1)

  • Facet injections 5221.6205 subpart 5A (2)

  • Nerve blocks 5221.6205 subpart 5A (3)

  • Epidural injections 5221.6205 subpart 5A (4)

  • Denervation of facet joints 5221.6205 subpart 5B

  • Prolotherapy 5221.6205 subpart 5C

  • Botulium toxin injections 5221.6205 subpart 5C

  • Medications 5221.6205 subpart 10

  • Hospitalization 5221.6400 subpart 1

  • Decompression surgery 5221.6205 subpart 6 and 5221.6500 subpart 2A

  • Fusion surgery 5221.6205 subpart 6 and 5221.6500 subpart 2C

  • Post-operative physical therapy 5221.6205 subpart 6A

  • Spinal cord stimulators 5221.6205 subpart 6C (1)

  • Intrathecal drug delivery systems 5221.6205 subpart 6C (2)

 

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