Minnesota Department of Labor and Industry

Workers' compensation -- Treatment parameters:  Upper extremity disorders



By condition

Epicondylitis
Epicondylitis. This clinical category includes medial epicondylitis and lateral epicondylitis, ICD-9-CM codes 726.31 and 726.32.

Tendonitis of forearm, wrist and hand
Tendonitis of the forearm, wrist, and hand. This clinical category encompasses any inflammation, pain, tenderness, or dysfunction or irritation of a tendon, tendon sheath, tendon insertion, or musculotendinous junction in the upper extremity at or distal to the elbow due to mechanical injury or irritation, including, but not limited to, the diagnoses of tendonitis, tenosynovitis, tendovaginitis, peritendinitis, extensor tendinitis, de Quervain's syndrome, intersection syndrome, flexor tendinitis, and trigger digit, including, but not limited to, ICD-9-CM codes 726.4, 726.5, 726.8, 726.9, 726.90, 727, 727.0, 727.00, 727.03, 727.04, 727.05, and 727.2.

Nerve entrapment syndromes of the upper extremity
Nerve entrapment syndromes. This clinical category encompasses any compression or entrapment of the radial, ulnar, or median nerves, or any of their branches, including, but not limited to, carpal tunnel syndrome, pronator syndrome, anterior interosseous syndrome, cubital tunnel syndrome, Guyon's canal syndrome, radial tunnel syndrome, posterior interosseous syndrome, and Wartenburg's syndrome, including, but not limited to, ICD-9-CM codes 354, 354.0, 354.1, 354.2, 354.3, 354.8, and 354.9.

Muscle pain syndromes
Muscle pain syndromes. This clinical category encompasses any painful condition of any of the muscles of the upper extremity, including the muscles responsible for movement of the shoulder and scapula, characterized by pain and stiffness, including, but not limited to, the diagnoses of chronic nontraumatic muscle strain, repetitive strain injury, cervicobrachial syndrome, tension neck syndrome, overuse syndrome, myofascial pain syndrome, myofasciitis, nonspecific myalgia, fibrositis, fibromyalgia, and fibromyositis, including, but not limited to, ICD-9-CM codes 723.3, 729.0, 729.1, 729.5, 840, 840.3, 840.5, 840.6, 840.8, 840.9, 841, 841.8, 841.9, and 842.

Shoulder impingement syndromes
Shoulder impingement syndromes, including tendonitis, bursitis, and related conditions. This clinical category encompasses any inflammation, pain, tenderness, dysfunction, or irritation of a tendon, tendon insertion, tendon sheath, musculotendinous junction, or bursa in the shoulder due to mechanical injury or irritation, including, but not limited to, the diagnoses of impingement syndrome, supraspinatus tendonitis, infraspinatus tendonitis, calcific tendonitis, bicipital tendonitis, subacromial bursitis, subcoracoid bursitis, subdeltoid bursitis, and rotator cuff tendinitis, including, but not limited to, ICD-9-CM codes 726.1 to 726.2, 726.9, 726.90, 727 to 727.01, 727.2, 727.3, 840, 840.4, 840.6, 840.8, and 840.9.

Traumatic sprains or strains of the upper extremity
Traumatic sprains or strains of the upper extremity. This clinical category encompasses an instantaneous or acute injury, as a result of a single precipitating event to the ligaments or the muscles of the upper extremity including, without limitation, ICD-9-CM codes 840 to 842.19. Injuries to muscles as a result of repetitive use, or occurring gradually over time without a single precipitating trauma, are considered muscle pain syndromes under subitem (4). Injuries with complete tissue disruption are not subject to this parameter.

By treatment

General principles

  • Psychological evaluation 5221.6300 subpart 1H

  • Consultation 5221.6300 subpart 1K

  • Conservative care first, if possible 5221.6300 subpart 2B (1)

  • Limits on passive treatment 5221.6300 subpart 3A

  • Health care provider's responsibility to evaluate

    • diagnosis 5221.6300 subpart 2A

    • treatment efficacy 5221.6300 subpart 9

  • Repeat surgery 5221.6300 subpart 6B

  • Management of chronic pain 5221.6300 subpart 2B (3) and 5221.6300 subpart 7

Diagnostic procedures

Laboratory testing 5221.6300 subpart 1B

Medical imaging 5221.6300 subpart 1C and 5221.6100 subpart 1

EMG/NCV 5221.6300 subpart 1D

Diagnostic blocks 5221.6300 subpart 1I

FCE 5221.6300 subpart 1J

Therapies

  • Chiropractic manipulation/adjustment 5221.6300 subpart 3C

  • Osteopathic manipulation/adjustment 5221.6300 subpart 3C

  • Use of heat/cold

    • in clinic 5221.6300 subpart 3D (1)

    • at home 5221.6300 subpart 3D (2)

  • Electrical stimulation

    • in clinic 5221.6300 subpart 3E (1)

    • at home 5221.6300 subpart 3E (2)

  • Acupuncture 5221.6300 subpart 3F

  • Iontophoresis 5221.6300 subpart 3G

  • Phonophoresis 5221.6300 subpart 3G

  • Manual therapies 5221.6300 subpart 3H

  • Splints, braces 5221.6300 subpart 3I

  • Therapeutic exercise

    • in clinic 5221.6300 subpart 4D (1)

    • at home 5221.6300 subpart 4D (2)

  • Trigger point injections 5221.6300 subpart 5A

  • Soft tissue injections 5221.6300 subpart 5B

  • Injections for median nerve entrapment at the carpel tunnel 5221.6300 subpart 5C

  • Medications 5221.6300 subpart 10

  • Hospitalization 5221.6400 subpart 1

  • Surgery 5221.6300 subpart 6< and 5221.6500 subpart A

  • Post-operative physical therapy 5221.6300 subpart 6A

   
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