Wisconsin Administrative Code › Department of Workforce Development › DWD 80-81 - Worker's Compensation › Chapter DWD 81 - Worker's compensation treatment guidelines › Section DWD 81.08 - Thoracic back pain

Current through June 24, 2024
(1) DIAGNOSTIC PROCEDURES FOR TREATMENT OF
				THORACIC BACK INJURY.
(a) A health care
				provider shall determine the nature of the thoracic back condition before
				initiating treatment.
(b) A health
				care provider shall perform and document an appropriate history and physical
				examination. Based on the history and physical examination, a health care
				provider shall assign the patient at each visit to the appropriate clinical
				category in subds. 1.to 3. A health care provider shall document the diagnosis
				in the medical record. For the purposes of subds. 2. and 3., "radicular pain"
				means pain radiating in a dermatomal distribution around the chest or abdomen.
				This section does not apply to fractures of the thoracic spine or thoracic back
				pain due to an infectious, immunologic, metabolic, endocrine, neurologic,
				visceral, or neoplastic disease process.
1.
				Regional thoracic back pain includes the diagnoses of thoracic strain, sprain,
				myofascial syndrome, musculoligamentous injury, soft tissue injury, and any
				other diagnosis for pain believed to originate in the discs, ligaments,
				muscles, or other soft tissues of the thoracic spine and that affects the
				thoracic region, including 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.
2. Radicular pain, with or without regional
				thoracic back pain, includes the diagnoses of thoracic radiculopathy,
				radiculitis, or neuritis; displacement or herniation of intervertebral disc
				with radiculopathy, radiculitis, or neuritis; spinal stenosis with
				radiculopathy, radiculitis, or neuritis; and any other diagnoses for pain
				believed to originate with irritation of a nerve root in the thoracic spine,
				including 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.
3.
				Thoracic 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.
(c) A health
				care provider may not order laboratory tests in the evaluation of a patient
				with regional thoracic back pain, or radicular pain, except for any of the
				following:
1. When a patient's history, age,
				or examination suggests infection, metabolic-endocrinologic disorders, tumorous
				conditions, systemic musculoskeletal disorders, such as rheumatoid arthritis or
				ankylosing spondylitis.
2. To
				evaluate potential adverse side effects of medications.
3. As part of a preoperative
				evaluation.
(d)
				Laboratory tests may be ordered at any time a health care provider suspects any
				of the conditions specified in par. (c), but a health care provider shall
				justify the need for the tests ordered with clear documentation of the
				indications.
(e) Medical imaging
				evaluation of the thoracic spine shall be based on the findings of the history
				and physical examination and may not be ordered prior to a health care
				provider's clinical evaluation of the patient. Medical imaging may not be
				performed as a routine procedure and shall comply with the guidelines in s.
				DWD
				81.05. A health care provider shall document the
				appropriate indications for any medical imaging studies obtained.
(f) A health care provider may not order
				electromyography and nerve conduction studies for regional thoracic back pain
				and radicular pain under par. (b) 1. to 3.
(g) A health care provider may not order the
				use of any of the following procedures or tests for the diagnosis of any of the
				clinical categories in par. (b) 1. to 3.:
1.
				Surface electromyography or surface paraspinal electromyography.
2. Thermography.
3. Plethysmography.
4. Electronic X-ray analysis of plain
				radiographs.
5. Diagnostic
				ultrasound of the spine.
6.
				Somatosensory evoked potentials and motor evoked potentials.
(h) A health care provider may not
				order computerized range of motion or strength measuring tests during the
				period of initial nonsurgical care, but may order these tests during a period
				of chronic management when used in conjunction with a computerized exercise
				program, work hardening program, or work conditioning program. During the
				period of initial nonoperative care computerized range of motion or strength
				testing may be performed but shall be done in conjunction with an office visit
				with a health care provider's evaluation or treatment, or physical or
				occupational therapy evaluation or treatment.
(i) A health care provider may order
				personality or psychological evaluations for evaluating patients who continue
				to have problems despite appropriate care. A treating health care provider may
				perform this evaluation or may refer the patient for consultation with another
				health care provider in order to obtain a psychological evaluation. These
				evaluations may be used to assess the patient for a number of psychological
				conditions that may interfere with recovery from the injury. Since more than
				one of these psychological conditions may be present in a given case, a health
				care provider performing the evaluation shall consider all of the following:
1. Is symptom magnification
				occurring?
2. Does the patient
				exhibit an emotional reaction to the injury, such as depression, fear, or
				anger, that is interfering with recovery?
3. Are there other personality factors or
				disorders that are interfering with recovery?
4. Is the patient chemically
				dependent?
5. Are there any
				interpersonal conflicts interfering with recovery?
6. Does the patient have a chronic pain
				syndrome or psychogenic pain?
7. In
				cases in which surgery is a possible treatment, are psychological factors
				likely to interfere with the potential benefit of the surgery?
(j) All of the following are
				guidelines for diagnostic analgesic blocks or injection studies and include
				facet joint injection, facet nerve block, epidural differential spinal block,
				nerve block, and nerve root block:
1. These
				procedures are used to localize the source of pain prior to surgery and to
				diagnose conditions that fail to respond to initial nonoperative
				care.
2. These blocks and
				injections are invasive and when done as diagnostic procedures only are not
				necessary unless noninvasive procedures have failed to establish the
				diagnosis.
3. Selection of
				patients, choice of procedure, and localization of the level of injection may
				be determined by documented clinical findings indicating possible pathologic
				conditions and the source of pain symptoms.
4. These blocks and injections may also be
				used as therapeutic modalities and are subject to the guidelines in sub.
				(5).
(k) Functional
				capacity assessment or evaluation is a comprehensive and objective assessment
				of a patient's ability to perform work tasks. The components of a functional
				capacity assessment or evaluation include neuromusculoskeletal screening, tests
				of manual material handling, assessment of functional mobility, and measurement
				of postural tolerance. A functional capacity assessment or evaluation is an
				individualized testing process and the component tests and measurements are
				determined by the patient's condition and the requested information. Functional
				capacity assessments and evaluations are performed to determine and report a
				patient's physical capacities in general or to determine work tolerance for a
				specific job, task, or work activity.
1. A
				functional capacity assessment or evaluation is not necessary during the period
				of initial nonoperative care.
2.
				Functional capacity assessment or evaluation is necessary in any of the
				following circumstances:
a. To identify the
				patient's permanent activity restrictions and capabilities.
b. To assess the patient's ability to do a
				specific job.
(L) Consultations with other health care
				providers may be initiated at any time by a treating health care provider
				consistent with standard medical practice.