/ ~ HAND.AND WRIST:. Carpal Tunnel Syndrome (354.0).ORTHO-6 Ganglion (727.4).ORTIfO-7 JOINTS Joint Replacement, Prosthesis (81)...

Transcription

1 ORTHOPEDICS. :::::./

2 J. ) / MUSCULOSKELETAL, ARTHRITIS AND RELATED DISORDERS TABLE OF CONTENTS I. LETTER II. CONDITIONS " II.A GENERAL CONDITIONS ORTHO-1 II.S SPECIFIC CONDITIONS Amputation, see. ICD-9-CM for specifics.' ortho-1 Bursitis (727.2).ORTHO-2 Fractures (829.0) '-ORTHO-3 Stress Fractures (733.1).ORTHO-3 Injury (959.9), see external causes in ICD-9-CM, ORTHO-3 Ligaments ( ).ORTHO-4 Sprains/Strains ( ).ORTHO-4 Tendinitis (726.9) SPECIFIC CONDIIONS:, ORTHO-4 FOOT - Bunions/Bunionectomy (727.1).ORTHO-5 HAND.AND WRIST:. Carpal Tunnel Syndrome (354.0).ORTHO-6 Ganglion (727.4).ORTIfO-7 JOINTS Joint Replacement, Prosthesis (81)...ORTHO-8 Osteo-Arthritis KNEE (Degenerative Joint Disease) (715.9) ORTHO-9 Anterior Cruciate Ligament Injury (844.2) and Repair (80) ORTHO-12 Chondromalacia (717.7).ORTHO-10 Non-Ligament Injuries of the Knee (717) ORTHO-11 Ligament Injuries of the Knee, Other (844.9) and Repair (80)..ORTHO-12 SHOULDER Dislocation of Shoulder (831), Recurrent (718.31) ORTHO-13 Impingement Syndrome (726.2)!Repair (836.3) ORTHO-14 - Rotator Cuff Injury (726.1)/Repair (83.63) ORTHO-14 SPINE Back Pain (847).. Cervical Spine Injury, Soft Tissue (Whip Lash) (847.0) ORTHO-15 Intervertebral Disk; Herniated, ruptured, prolapsed (722.2) ORTHO-16 MU5cle Strain (847).ORTHO ORTHO-15 c:> (v

3 Neck Pain (123.1) ORTHO-15 Radiculitis or Neuritis (124.4).ORTHO-l5 Scoliosis, Harrington Rod (131.30) ORTHO-11, 15 Spinal Stenosis (124.0).ORTHO-16 Spondylolisthesis (156.12)/Spondylolysis (156.11)...ORTHO-l8 Sprain (841).ORTHO-1S OTHER Cancers of the Bone (110).ORTHO-19 Fibrous Dysplasia (133.29).ORTHO-20 Osteoporosis (1.33).ORTHO-21 Paget's Disease of the Bone (131.0)..ORTHO-22 III. ADDENDUM ", r '--

4 J AMPUTATIONS (84.91) I Each application reviewed by I MRS and qualification Is dependent upon Individual's functional capacity, medical needs, and climate restriction, if any. RESTRICT- IONS/ 1., CLEAR CLEARWITH, MEDICAL INFORMATION NEEDED: GenericInformation 5/4/93 Orthopedics ORTHO-1

5 BURSITIS (727.3) One episode, period > 3 mos. ago. -+ N/F 1) Current i-+ 2) Recurrent N/F CLEAR CLEAR WITH RESTRICT- IONS/ 1) Asymptomatic period of > 3 mos. or treatment completed and orthopedist considers minimalriskto recur. 2) Bursitisfree,periodof > 3 mos. MEDICAL INFORMATION NEEDED: Generic Information OrthOped1C ORTHO-2,. 5/4/93

6 ,;. FRACTURES (829) I 1) Uncomplicated fractures of ankle, hand> 3 mos. post. 2) Uncomplicated fractures of tibia, femur, completely healed> 6 mos. 3) Uncomplicated compression fracture of spine, > 5 yrs ago" applicant < 65 yrs of age.. N/A. H 1) Complicatedfractures, 4 multipleor recurrent..-. 1) Uncomplicated fracturesof ankle,. fracturesor fractures.. hand< 3 mos.past. of spine, hip, skull, pelvis. - 2) Stressfractures. I 3) Compression fracture of spine, < 5 years ago. H 2) Uncomplicated fractures of tibia femur, completely healed, < 6 mos. 4 N/A CLEAR CLEAR WtTH RESTRtCTIONS MRB/MED ADVISOR RESTRICT- IONS/ 1) Individual review by Orthopedist and MAS review,ifneeded. 2&3) A/O severe disease, see underlying diagnosis.' 1) Healed 3 mos. 2) Healed> 6 mos. MEDtCAL tnformation NEEDED: Generic Information; Orthopedist evaluation needed. 10/31/94 Orthopedics OATHO-3

7 LIGAMENTS ( ); SPRAINS ( ); TENDONS (726.9); RECONSTnUCTION 'I' -+ 1) 'Pulled"ligament01 extremity: Post, 6 weeks asymptomatic - H 1) Recurrent tendonitis 1-+ 2) Singleepisode, I and2 yrs. asymptomatic period> 1 mo. H 3) Tendonitis,.pulled. tendon, "tennis elbow.; past. asymptomatic for 1 mo. H 4) Any surgical ligament repair post currently asymr' atlc, W..t., 1-+ 2) Surgicalrepair of shoulder, elbow, wrist between 6 mths., CLEAR CLEAR WITH -+1) Current, evaluation by Orthopedist (ligaments). -+2) Current, recurrent sprain, requiring brace -+ 3) Tendonitis current. -+ 4) Reconstruction, surgical repair, -+ NIA RESTRICT- IONS/ 1) Job placement avoids over use 01allectedtendon. 2) No strenous activity Involving upperextremltles. 1) Resolved and asymptomatic, for 6 wks., requiring no further FlU care. 2&3) Resolved and asymptomatic, for period> 1 mo., requiring no further F/U care. ('I 1'\.0\.09-4) For..t. r for lower extremities for shoulder, wrist, elbow, 6 mths;post surgery, " rthopedlc 4... '-

8 , nunions (727.1), nunionectomy (77.5) I -) 1) No pain with activity; surgery H not recommended. 2) Bunlonectomy> 3 mos., resumes full activity without pain. N/A -) 1) Pain,with activity. -) 2) Will require surgery within next 3 yrs. ' N/A,, CLEAR CLEARWITH, RESTRICT. IONS/ 1) Resolved 2) Post-surgery 3 mos; resumes full activities without pain. MEDICAL INFORMATION NEEDED: Generic Information; Orthopedist If symptomatic(symptomsanindicationfor surgery). PCf\'a\-\' 1- Orthopedics ORTHO-5

9 CARPAL TUNNEL SYNDROME (354.0) I -+ Singleepisode,period > 6 mos;asymptomatic, followingtreatment. -+ 1) RecurrentCarpalTunnel Syndrome. H 2) Symptomscontrolled,period > 6 mos.by useof splinting duringwork,sleeping. 1-+ Currentlyundertreatment 1-+ with activesymptomsof pain, numbnessand tinglingof lingersandhand. N/A, CLEAR, CLEAR WITH. RESTRICT. IONS/ 1 &2) Avoid repetitive wrist motion,suchas computer workor typing. Avoidassignmento work relatedwithcausingcarpal tunnelsyndrome:computer work,typing,constant. repetitivewristmotions. The 6 mos.posttreatment and asymptomatic CarpalTunnelSyndromemay betreatedwithlocalinjections of steroidsor surgery. MEDICAL INFORMATION NEEDED: GenericInformallon Funcllonalcapacityassessment. 5/4/93 ORTHO.6 OhOPedICS., f' \,.

10 J c GANGLION (727.43) I 1) Painless N/A Painful N/A 2) Resolved by needle decompression or surgery, period> 6 wks.post. f CLEAR f CLEAR WITH f RESTRICT - IONS/ Resolvedwithneedle decompression or surgery, period> 6 wks. Gangllons of the wrist are essentially harmless and usually painless. IIpainful,the gangllons are treated by needle decompression. If continuesto recur aftertreatment,surgeryis recommended.. MEDICAL INFORMATION NEEDED:. Generic Information 5/4/93 Orthopedics ORTHO-?