Wisconsin Administrative Code › Department of Workforce Development › DWD 80-81 - Worker's Compensation › Chapter DWD 81 - Worker's compensation treatment guidelines › Section DWD 81.07 - Neck pain

Current through June 24, 2024
(1) DIAGNOSTIC PROCEDURES FOR TREATMENT OF
				NECK INJURY.
(a) A health care provider shall
				determine the nature of the neck 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 the health care
				provider shall assign the patient at each visit to the appropriate clinical
				category in subds. 1.to 4. 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 distal to the shoulder. This section does not apply to
				fractures of the cervical spine or cervical pain due to an infectious,
				immunologic, metabolic, endocrine, neurologic, visceral, or neoplastic disease
				process.
1. 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 that affects the cervical region, with or without referral to the upper
				back or shoulder, 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
				neck pain, with no or static neurologic deficit 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 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.
3. Radicular pain, with or without regional
				neck pain, with progressive neurologic deficit, includes the same diagnoses as
				subd. 2., except 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.
4. 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.
(c) A health care provider may not order
				laboratory tests in the evaluation of a patient with regional neck 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, or 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 cervical 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) Electromyography and nerve conduction
				studies are always inappropriate for the regional neck pain diagnoses in par.
				(b) 1. to 4. Electromyography and nerve conduction studies may be an
				appropriate diagnostic tool for radicular pain and myelopathy diagnoses in par.
				(b) 2. to 4., after the first 3 weeks of radicular or myelopathy symptoms.
				Repeat electromyography and nerve conduction studies for radicular pain and
				myelopathy are not necessary unless a new neurologic symptom or finding has
				developed which in itself would warrant electrodiagnostic testing. Failure to
				improve with treatment is not an indication for repeat testing.
(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 4.:
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 management, but may order these tests during the
				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 nonsurgical management, 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 nonsurgical
				management.
2. These blocks and
				injections are invasive and when done as diagnostic procedures 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 shall
				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 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 a patient's
				physical capacities in general or to determine and report work tolerance for a
				specific job, task, or work activity.
1.
				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 accepted medical practice.