Facility Name Office Injury Date 06/15/2017. NPI Member/Claim # Birth Date 04/17/1968

Transcription

1 Chiropractic Report Report Date : 03/13/19 12:53 PM CST Claim Claimant Provider Customer Jacksonville Full Name Member20 Larry Facility Name Office Injury Date 06/15/2017 NPI Member/Claim # X CHIRO14 Birth Date 04/17/1968 Full Name Provider12 Angela Review Type Single Case Address Address,, ' Episode Of Care Injury Date : 06/15/2017 Within Guideline Outside Guideline Duration Allowed Actual Duration EOC Billed Amount Amount % MD Amount Amount % Days Weeks Visit Weeks Visit Diagnosis Anatomical Region ICD ICD Description Cervical Spine M54.13 Radiculopathy, cervicothoracic region Cervical Spine M99.11 Subluxation complex (vertebral) of cervical region Service Units CPT/HCPCS CPT Description Units $ % $ % OFFICE/OUTPATIENT VISIT, NEW OFFICE/OUTPATIENT VISIT, EST ULTRASOUND THERAPEUTIC EXERCISES Service Units

2 CPT/HCPS CPT Description Billed Certified Recommendation 1 04/12/ OFFICE/OUTPATIENT VISIT, NEW Exam CPT coding level is excessive for diagnosis; down code exam code to /14/ /17/ /19/2018

3 5 04/22/ /25/ /27/ /01/ /04/2018

4 10 05/06/ ULTRASOUND Unable to auto certify; number of units in episode of care 11 05/09/ ULTRASOUND Unable to auto certify; number of units in episode of care 12 05/13/ ULTRASOUND Unable to auto certify; number of units in episode of care 13 05/15/2018

5 99213 OFFICE/OUTPATIENT VISIT, EST Auto Certified ULTRASOUND Unable to auto certify; number of units in episode of care Unable to auto certify; number of rehab units of service 14 05/18/ THERAPEUTIC EXERCISES Unable to auto certify; number of rehab units of service 15 05/22/ THERAPEUTIC EXERCISES Unable to auto certify; number of rehab units of service 16 05/25/ THERAPEUTIC EXERCISES Unable to auto certify; number of rehab units of service 17 05/28/ THERAPEUTIC EXERCISES Unable to auto certify; number of rehab units of service 18 06/06/ THERAPEUTIC EXERCISES Unable to auto certify; number of rehab units of service 19 06/10/ Unable to auto certify date of service; number of visits THERAPEUTIC EXERCISES Unable to auto certify date of service; number of visits

6 20 06/14/ Unable to auto certify date of service; number of visits THERAPEUTIC EXERCISES Unable to auto certify date of service; number of visits 21 06/17/ Unable to auto certify date of service; number of visits THERAPEUTIC EXERCISES Unable to auto certify date of service; number of visits 22 06/22/ Unable to auto certify date of service; number of visits THERAPEUTIC EXERCISES Unable to auto certify date of service; number of visits 23 06/28/ Unable to auto certify date of service; number of visits THERAPEUTIC EXERCISES Unable to auto certify date of service; number of visits Literature References Cervical Spine : M Radiculopathy, cervicothoracic region Cervical Spine : M Subluxation complex (vertebral) of cervical region Recommend home cervical patient-controlled traction (using a seated over-the-door device or a supine device, which may be preferred due to greater forces) for patients with radicular symptoms, in conjunction with a home exercise program. Do not recommend institutionally based powered traction devices. See also the Low Back Chapter, where Traction is Not recommended. Note: Powered traction devices, such as VAX-D, DRX and Lordex, are considered a form of traction. Several studies have demonstrated that home cervical traction can provide symptomatic relief in over 80% of patients with mild to moderately severe (Grade 3) cervical spinal syndromes with radiculopathy. (AetNA, 2004) (Olivero, 2002) (Joghataei, 2004) (Shakoor, 2002) Patients receiving intermittent traction performed significantly better than those assigned to the no traction group in terms of pain, forward flexion, right rotation and left rotation. (Zylbergold, 1985) Other studies have concluded there is limited documentation of efficacy of cervical traction beyond short-term pain reduction. In general, it would not be advisable to use these modalities beyond 2-3 weeks if signs of objective progress towards functional restoration are not demonstrated. (Kjellman, 1999) (Gross-Cochrane, 2002) (Aker, 1999) (Bigos, 1999) (Browder, 2004) This Cochrane review found no evidence from RCTs with a low potential for bias that clearly supports or refutes the use of either continuous or intermittent traction for neck disorders. (Graham, 2008) The Pronex and Saunders home cervical traction devices are approved for marketing as a form of traction. Although the cost for Pronex or Saunders is more than an over-the-door unit, they are easier to use and less likely to cause aggravation to the TMJ. Therefore, these devices may be an option for home cervical traction. (Washington, 2002) For

7 decades, cervical traction has been applied widely for pain relief of neck muscle spasm or nerve root compression. It is a technique in which a force is applied to a part of the body to reduce paravertebral muscle spasms by stretching soft tissues, and in certain circumstances separating facet joint surfaces or bony structures. Cervical traction is administered by various techniques ranging from supine mechanical motorized cervical traction to seated cervical traction using an over-the-door pulley support with attached weights. Duration of cervical traction can range from a few minutes to 30 min, once or twice weekly to several times per day. In general, over-the-door traction at home is limited to providing less than 20 pounds of traction. See also Manual traction. Recent research: Recent studies have documented good results using traction to treat cervical radiculopathy with traction forces from 20 to 55 lbs (more than an over-the-door unit can provide). Cervical traction should be combined with exercise techniques to treat patients with neck pain and radiculopathy. (Raney, 2009) In comparing the intervertebral separation obtained with supine pneumatic traction (using the Saunders Cervical Traction Device) to seated traction (using an over-the-door home traction device), the supine device caused significantly greater separation vs. over-the-door traction. (Fater, 2008) In reviewing the current published evidence, this guideline concluded that cervical traction is recommended to treat cervical radiculopathy using greater than 20 lbs intermittent force. (Childs, 2008) ULTRASOUND Under study. There is little information available from trials to support the use of many physical medicine modalities for mechanical neck pain, often employed based on anecdotal or case reports alone. In general, it would not be advisable to use these modalities beyond 2-3 weeks if signs of objective progress towards functional restoration are not demonstrated. (Gross- Cochrane, 2002) (Aker, 1999) (Philadelphia, 2001) THERAPEUTIC EXERCISES Recommended. Low stress aerobic activities and stretching exercises can be initiated at home and supported by a physical therapy provider, to avoid debilitation and further restriction of motion, and further benefits are available when combined with strength training. (Rosenfeld, 2000) (Bigos, 1999) (Ylinen-JAMA, 2003) (de Jager, 2004) In this recent RCT, both strength and endurance training, including a 12-month home exercise program, substantially decreased perceived neck pain and disability, and there was a clear dose-response relationship, with declines in neck pain and disability correlating positively with the amount of specific training. (Nikander, 2006) For mechanical disorders of the neck, therapeutic exercises have demonstrated clinically significant benefits in terms of pain, functional restoration, and patient global assessment scales. If exercise is prescribed a therapeutic tool, some documentation of progress should be expected. While a home exercise program is of course recommended, more elaborate personal care where outcomes are not monitored by a health professional, such as gym memberships or advanced home exercise equipment, may not be covered under this guideline. (Philadelphia, 2001) (Colorado, 2001) (Bronfort, 2001) (Ernst, 2003) (Schonstein, 2003) (Schonstein-Cochrane, 2003) (Ylinen, 2003) (Ferrari, 2004) (Seferiadis, 2004) (Rodriquez, 2004) (Chiu, 2005) (Jensen, 2007) There was consistent evidence that exercises may be effective in preventing neck and back pain. (Linton, 2001) A recent Cochrane Review concluded that there was strong evidence of benefit favoring care with exercise combined with mobilization and/or manipulation. The evidence did not favor manipulation and/or mobilization done alone without exercise. (Gross-Cochrane, 2004) There is limited evidence for the effectiveness of manual therapy as an add-on treatment to exercises. (Verhagen, 2006) This RCT concluded that subjects with chronic neck pain should be treated by health professionals trained to teach both exercises and the appropriate use of a neck support pillow during sleep; either strategy alone did not give the desired clinical benefit. (Helewa, 2007) Supervised qigong or exercise therapy are effective methods to reduce long-term, nonspecific neck pain, according to the results of a randomized, controlled, multicenter trial reported in the 10/15/07 issue of Spine. A maximum of 12 treatments were given over a period of 3 months, and improvement was significant (> 50%) in both groups immediately after treatment, and this was maintained at 6- and 12-month follow-ups. (Lansinger, 2007) Specific neck muscle strength training is associated with a marked decrease in neck muscle pain during training and with a lasting effect after the training has ended, whereas general fitness training leads to only transient acute relief of pain. (Andersen, 2008) Randomized controlled intervention studies have found positive effects on neck/shoulder pain regarding specific neck/shoulder muscle strengthening exercises, whereas exercise interventions without such specificity failed to reduce such pain conditions. A 1-yr randomized controlled intervention trial was done with three groups: specific resistance training (SRT), all-round physical exercise (APE), and reference intervention (REF) with general health counseling and ergonomic interventions. Compliance was highest in SRT. SRT and APE caused increased shoulder elevation strength, were

8 more effective than REF to decrease neck pain among those with symptoms at baseline, and prevent development of shoulder pain in those without symptoms at baseline. (Andersen2, 2008) A recent RCT concluded that adding specific neck stabilization exercises (using a maximum of 4 treatment sessions) to a general neck advice and exercise program did not provide significantly better clinical outcome overall in the physical therapy treatment of chronic neck pain, but participants in the specific exercise group were less likely to be taking pain medication at 6-week follow-up. The mean 6-week reduction in the Neck Pain and Disability Scale score was 20.2 for the specific exercise program and 15.7 for the general exercise program. (Griffiths, 2009) The best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain. (Hurwitz, 2009) Home exercises and manipulation are more effective than medication for relieving neck pain, both in the short and long term, according to results from a new RCT. The exercise group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home, for 5 to 10 repetitions of each exercise up to eight times a day. Researchers were surprised to see that home exercises were about as effective as the chiropractic sessions. (Bronfort, 2012) Recommended. Low stress aerobic activities and stretching exercises can be initiated at home and supported by a physical therapy provider, to avoid debilitation and further restriction of motion, and further benefits are available when combined with strength training. (Rosenfeld, 2000) (Bigos, 1999) (Ylinen-JAMA, 2003) (de Jager, 2004) In this recent RCT, both strength and endurance training, including a 12-month home exercise program, substantially decreased perceived neck pain and disability, and there was a clear dose-response relationship, with declines in neck pain and disability correlating positively with the amount of specific training. (Nikander, 2006) For mechanical disorders of the neck, therapeutic exercises have demonstrated clinically significant benefits in terms of pain, functional restoration, and patient global assessment scales. If exercise is prescribed a therapeutic tool, some documentation of progress should be expected. While a home exercise program is of course recommended, more elaborate personal care where outcomes are not monitored by a health professional, such as gym memberships or advanced home exercise equipment, may not be covered under this guideline. (Philadelphia, 2001) (Colorado, 2001) (Bronfort, 2001) (Ernst, 2003) (Schonstein, 2003) (Schonstein-Cochrane, 2003) (Ylinen, 2003) (Ferrari, 2004) (Seferiadis, 2004) (Rodriquez, 2004) (Chiu, 2005) (Jensen, 2007) There was consistent evidence that exercises may be effective in preventing neck and back pain. (Linton, 2001) A recent Cochrane Review concluded that there was strong evidence of benefit favoring care with exercise combined with mobilization and/or manipulation. The evidence did not favor manipulation and/or mobilization done alone without exercise. (Gross-Cochrane, 2004) There is limited evidence for the effectiveness of manual therapy as an add-on treatment to exercises. (Verhagen, 2006) This RCT concluded that subjects with chronic neck pain should be treated by health professionals trained to teach both exercises and the appropriate use of a neck support pillow during sleep; either strategy alone did not give the desired clinical benefit. (Helewa, 2007) Supervised qigong or exercise therapy are effective methods to reduce long-term, nonspecific neck pain, according to the results of a randomized, controlled, multicenter trial reported in the 10/15/07 issue of Spine. A maximum of 12 treatments were given over a period of 3 months, and improvement was significant (> 50%) in both groups immediately after treatment, and this was maintained at 6- and 12-month follow-ups. (Lansinger, 2007) Specific neck muscle strength training is associated with a marked decrease in neck muscle pain during training and with a lasting effect after the training has ended, whereas general fitness training leads to only transient acute relief of pain. (Andersen, 2008) Randomized controlled intervention studies have found positive effects on neck/shoulder pain regarding specific neck/shoulder muscle strengthening exercises, whereas exercise interventions without such specificity failed to reduce such pain conditions. A 1-yr randomized controlled intervention trial was done with three groups: specific resistance training (SRT), all-round physical exercise (APE), and reference intervention (REF) with general health counseling and ergonomic interventions. Compliance was highest in SRT. SRT and APE caused increased shoulder elevation strength, were more effective than REF to decrease neck pain among those with symptoms at baseline, and prevent development of shoulder pain in those without symptoms at baseline. (Andersen2, 2008) A recent RCT concluded that adding specific neck stabilization exercises (using a maximum of 4 treatment sessions) to a general neck advice and exercise program did not provide significantly better clinical outcome overall in the physical therapy treatment of chronic neck pain, but participants in the specific exercise group were less likely to be taking pain medication at 6-week follow-up. The mean 6-week reduction in the Neck Pain and Disability Scale score was 20.2 for the specific exercise program and 15.7 for the general exercise program. (Griffiths, 2009) The best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain. (Hurwitz, 2009) Home exercises and manipulation are more effective than medication for

9 relieving neck pain, both in the short and long term, according to results from a new RCT. The exercise group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home, for 5 to 10 repetitions of each exercise up to eight times a day. Researchers were surprised to see that home exercises were about as effective as the chiropractic sessions. (Bronfort, 2012) Recommended as an option. In limited existing trials, cervical manipulation has fared equivocally with other treatments, like mobilization, and may be a viable option for patients with mechanical neck disorders. However, it would not be advisable to use beyond 2-3 weeks if signs of objective progress towards functional restoration are not demonstrated. Further, several reports have, in rare instances, linked chiropractic manipulation of the neck in patients 45 years of age and younger to dissection or occlusion of the vertebral artery. The rarity of cerebrovascular accidents makes any association unclear at this time and difficult to study. (Hurwitz, 2002) (Rothwell, 2001) (Aker, 1999) (Kjellman, 1999) (Gross-Cochrane, 2002) (Ernst, 2003) (Haas, 2003) (Giles, 2003) (Haneline, 2003) (Haas, 2004) (Browder, 2004) (Scholten-Peeters, 2003) (Cote, 2005) (Vernon, 2005) A Cochrane Review concluded that there was strong evidence of benefit favoring multimodal care, and the common elements in this care strategy were mobilization and/or manipulation plus exercise. (Gross-Cochrane, 2004) In a recent high quality study, no recommendations were made for or against chiropractic manipulation for WAD patients due to limited evidence, in the form of three non-rcts published since Overall, mobilization appears to be the most effective non-invasive form of intervention for the treatment of both pain and cervical range of motion in the acutely injured WAD patient. (ConlinI, 2005) The best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain. (Hurwitz, 2009) Manipulation and home exercises are more effective than medication for relieving neck pain, both in the short and long term, according to results from a new RCT. The manipulation group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. The medication group was assigned to take NSAIDS, acetaminophen, plus opioids and muscle relaxants as necessary. The exercise group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home, for 5 to 10 repetitions of each exercise up to eight times a day. Researchers were surprised to see that home exercises were about as effective as the chiropractic sessions. In addition to their limited pain relief, the medications had another downside, people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later, with more systemic side effects. In addition, those on medications were not as empowered or active in their own care as those in the other groups. (Bronfort, 2012) But the UK evidence report concluded that thoracic manipulation/ mobilization is effective for acute/ subacute neck pain, while the evidence is inconclusive for cervical manipulation/ mobilization alone for neck pain of any duration. (Bronfort, 2010) Adverse effects: Recent evidence casts some doubt concerning a causal relationship for stroke, and there is a similar association between chiropractic services and subsequent vertebrobasilar artery stroke as also observed among patients receiving general practitioner services. (Haldeman, 2008) Previous studies had suggested more caution concerning the risks of cerebrovascular accidents. (Smith, 2003) (Malone, 2003) (Mitchell, 2004) (Hurwitz, 2004) Adverse reactions to chiropractic care for neck pain may be common and they appear more likely to follow cervical spine manipulation than mobilization. (Hurwitz, 2005) A recent structured review concluded that the exact incidence of vertebral artery dissection (VAD) and stroke following cervical spine manipulation therapy (CSMT) is unknown, but findings in different studies suggest that these complications are more common than reported in the literature. Since there is a large amount of evidence from many reports regarding an association between neurologic damage and cervical manipulation, and because there are no identifiable risk factors, anyone who receives CSMT can be at risk of neurologic damage. It is important for patients to be well informed before undergoing this kind of procedure and for physicians to recognize the early symptoms of this complication so that catastrophic consequences can be avoided. (Leon-Sanchez, 2007) The most serious problems, which some experts now describe as well-recognized, are vertebral artery dissections due to intimal tearing as a result of overstretching the artery during rotational manipulation. Most of the incidents reported in case series or surveys had not been previously reported, indicating that under-reporting may frequently be high. These data suggest that spinal manipulation is associated with frequent, mild and transient adverse effects as well as with serious complications that can lead to permanent disability or death. Special caution should be exercised when performing first-line cervical manipulation, and easily understandable information about risks should be included when informed consent is obtained. Therapists should avoid manipulative techniques at all levels of the cervical spine in the presence of any indirect sign of arteriosclerotic disease or in the presence of calcified arterial walls or tortuosities of the vessel. (Ernst, 2007) There was an association between chiropractic services and subsequent vertebrobasilar

10 artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke. (Haldeman, 2008) According to the AHA, although the incidence of cervical manipulative therapy (CMT) associated cervical artery dissections (CDs) in patients who have previously received CMT is not well established, and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine. (Biller, 2014) This systematic review revealed that the quality of the published literature on the relationship between chiropractic manipulation and cervical artery dissection (CAD) is very low. A meta-analysis of available data shows a small association between chiropractic neck manipulation and CAD. There was evidence for considerable risk of bias and confounding in the available studies. In particular, the known association of neck pain both with cervical artery dissection and with chiropractic manipulation may explain the relationship between manipulation and CAD. There is no convincing evidence to support a causal link, and unfounded belief in causation may have significant negative con