MM slash DD slash YYYY
Wesley will add this Physician to a list ASAP.
Here's a description of what each option means. Please choose the option that best describes how you feel overall since your surgery.
- Excellent: No pain, No restriction of mobility, Return to normal work and level of activity
- Good: Occasional nonradicular pain, Relief of presenting symptoms, Able to return to modified work
- Fair: Some improved functional capacity, Still handicapped and/or unemployed
- Poor: Continued objective symptoms of root involvement, Additional operative intervention needed at index level irrespective of length of postoperative follow-up
Glascow Pain Scale
Injections to be performed today
Social Status
Upper Extremity Motor Strength
Lower Extremity Motor Strength:
Hidden
Imaging Review Report
Hidden
Hidden
Hidden
Hidden
Assessment
- The patient’s lumbar symptoms including numbness, tingling, and weakness radiating down from the low back and into the buttocks and posterior thigh and calf into the toes are easily triggered with any activity but particularly by prolonged standing, carrying a heavy, weight, prolonged forward flexion. The patient is only able to get slow partial relief of symptoms with rest by sitting or lying down.
By history, the patients leg symptoms are often accompanied by sensory symptoms involving loss of sensation, parethesias, & dysethesias. According to the patient's description, these sensory symptoms seem to be following the dermatomal distribution of her above-described radiculopathy. The quality of the patient's patient is deep aching and shooting and seems to follow a dermatomal pattern suggesting that it is radicular in nature. Physical examination did reveal decreased sensation to light touch, vibration, and pin prick.
By history, the patient's symptoms are typical of lumbar spinal stenosis since the back and leg symptoms are brought on and exacerbated by standing and walking. In addition, rest and changes in position, including sitting down and leaning forward often alleviate the lower extremity symptoms. The diagnosis lumbar spinal stenosis is also supported by the patient's improved ability to walk with use of an aid in a more flexed position, such as a shopping cart or walker. Furthermore, the patient's symptoms are increased by upright and extended posture, which is known to accentuate central and foraminal stenosis. - By history, the patients arm symptoms are often accompanied by sensory symptoms involving loss of sensation, parethesias, & dysethesias. According the patient's description, these sensory symptoms seem to be following the dermatomal destribution of her above described radiculopathy. The quality of the patient's patient is deep aching and shooting and seems to follow a dermatomal pattern suggesting that it is radicular in nature.
The patient states that there are certain activities and head positions that increase or decrease symptoms. The patients symptoms are somewhat suggestive of an acute disc herniations and sudden narrowing of the neural foramen since the patient complaina of increased pain with neck positions that cause foraminal narrowing (eg, extension, lateral bending, or rotating toward the symptomatic side).
In addition, the patients reports a reduction in their radicular symptoms by abducting their shoulder and placing their hand behind their head. This relief in symptoms is thought to occur by decreasing tension at the nerve root.
I also think that the patient's symptoms are typical of cervical radiculopathy given the insidious onset of neck and arm discomfort. The discomfort ranges from a dull ache to a severe burning pain. Typically, pain is referred to the medial border of the scapula, and one of the patient's chief complaint is shoulder pain. As the radiculopathy progresses, the pain radiates to the upper or lower arm and into the hand, along the sensory distribution of the nerve root that is involved. - The patient suffers from lumbar radiculopathy with sensory deficits and pain and pain induced weakness. According to Evidence-Based Consensus Treatment Guidelines for Multidisciplinary Spine Care recognized and published by a number of national organizations and health insurance carriers, and the 2016 InterQual Medical necessity criteria for surgical procedures the patient’s lumbar discectomy, foraminotomy, and/or laminotomy is medically necessary because the patient has unremitting lumbar radiculopathy and progressive weakness secondary to nerve root compression in setting of failed non-operative treatment including PT and NSAIDs for the required minimum time period of 6 weeks.
The patient tells me that there have been multiple acute onsets of an excruciating disabling pain of an otherwise chronic disease course over a longer period of time which in the case the patient has been going on for months acutely and years chronically. The patient is in pain practically every day and has described the pain as aching, cramping, fearful, gnawing, heavy, hot or burning, sharp, shooting, at times sickening, splitting, stabbing, and often as punishing or cruel, throbbing, and most of the time as tiring and exhausting.
The patient describes a significant Limitation of Activities of Daily Living (ADLs) including bathing, dressing, grooming, oral care, toileting, transferring, walking, climbing stairs, eating, shopping, cooking, managing medications, using the phone, handwriting and typing, housework, doing laundry, driving, and managing finances. In addition, there are some concerning patient safety issues with the patient’s mobility and control of motor function, which produces a higher fall risk.
The patient has had an extensive trail of non-operative measures including physical therapy for more than 6 weeks, chiropractic care, manipulation, self-directed exercise programs, acupuncture, biofeedback, and activity modifications for more than 6 weeks, weight loss, and unsuccessful trail of medical management with pain medication including NSAIDs for more than 4 weeks and narcotics. In addition, the patient has had a contraindication to continued non-surgical management including intolerance to NSAIDs affecting the patient’s liver, kidney, and heart function. Moreover, the patient had to make use of assistive devices.
The summary description of the patient’s physical examination shows decreased functioning in the context of the patient’s Activities of Daily Living due to disabling pain with decreased mobility and decreased range of motion, deformity, crepitus and tenderness of the affected spinal motion segments. Therefore, surgical treatment of the patient’s condition is appropriate and medically necessary. - The patient suffers from cervical radiculopathy with sensory deficits and pain and pain induced weakness. According to Evidence-Based Consensus Treatment Guidelines for Multidisciplinary Spine Care recognized and published by a number of national organizations and health insurance carriers, as well as the 2016 InterQual Medical Necessity Criteria for Appropriateness for Procedure, the patient’s cervical diskectomy, foraminotomy, and laminotomy is medically necessary because the patient has unremitting cervical radiculopathy and progressive weakness secondary to nerve root compression in setting of failed non-operative treatment including failed structured PT for more than 6 weeks, activity modification for more than 6 weeks, and a trail of NSAIDs for more than 6 weeks.
The patient tells me that there have been multiple acute onsets of excruciating disabling pain of an otherwise chronic disease course over a longer period of time which in the case the patient has been going on for months acutely and years chronically. The patient is in pain practically every day and has described the pain as aching, cramping, fearful, gnawing, heavy, hot or burning, sharp, shooting, at times sickening, splitting, stabbing, and often as punishing or cruel, throbbing, and most of the time as tiring and exhausting.
The patient’s cervical symptoms became first apparent with a change in walking pattern as it became jerky with increasing spasticity, and muscle weakness in the legs. The patient also reported numbness in the hands, and clumsiness when doing fine motor activities like writing or typing. The ability to grip and let go of items became also more difficult. In addition, the patient reported shoulder weakness and atrophy of the shoulder muscles.
The patient describes a significant Limitation of Activities of Daily Living (ADLs) including bathing, dressing, grooming, oral care, toileting, transferring, walking, climbing stairs, eating, shopping, cooking, managing medications, using the phone, handwriting and typing, housework, doing laundry, driving, and managing finances. In addition, there are some concerning patient safety issues with the patient’s mobility and control of motor function, which produces a higher fall risk.
The patient has had an extensive trail of non-operative measures including physical therapy for more than 6 weeks, chiropractic care, manipulation, self-directed exercise programs, acupuncture, biofeedback, and activity modifications for more than 6 weeks, weight loss, and unsuccessful trail of medical management with pain medication including NSAIDs for more than 4 weeks and narcotics. In addition, the patient has had a contraindication to continued non-surgical management including intolerance to NSAIDs affecting the patient’s liver, kidney, and heart function. Moreover, the patient had to make use of assistive devices.
The summary description of the patient’s physical examination shows decreased functioning in the context of the patient’s Activities of Daily Living due to disabling pain with decreased mobility and decreased range of motion, deformity, crepitus and tenderness of the affected spinal motion segments. Therefore, surgical treatment of the patient’s condition is appropriate and medically necessary. - I performed these injections today and would like to see the patient back in 2 weeks to discuss the response to the injection and make further recommendation on additional treatments if required.
- If the patient had a diagnostic injection and the patient could consider a decompression procedure should the injection be diagnostic but not therapeutic in the long run. If no long term relief is achieved and if the patient decides to move forward with surgery, I would like to see the patient back for a preop visit prior to the procedure.
- The patient had a diagnostic injection and therefore completed a conclusive correlative diagnostic work up between crossectional advanced imaging studies and response to the interventional diagnostic injection. The patient wants to move forward with the proposed decompression procedure. I would like to see the patient back for a preoperative visit as soon as OR time and insurance authorization can be secured.
- The patient had a therapeutic transforaminal epidural steroid injection done today. My hope is that the patient will continue to improve.
- The patient had a diagnostic injection without therapeutic pain relief. Therefore, the patient could consider a decompression procedure and the patient is considering a Laminoforaminotomy Microdiscectomy procedure.
- I discussed the procedure in detail, expected outcomes and benefits which include a reduction of the patient's symptoms rather than complete resolution. Potential risks of the surgery were discussed with the patient which include but are not limited to blood loss, nerve, and vessel damage, paralysis, paraplegia, death, infection, dural leakage, foot drop, upper and lower extremity weakness, change in bladder and bowel function, bowel perforation, dysethetic leg pain, development of blood clots causing pulmonary embolism, use of non-FDA approved devices, failure of pain relief, need for more spinal surgery including spinal fusion surgery. The patient had a chance to ask questions, all of which were answered to the patient's satisfaction. Informed consent was obtained in the office.
- The patient is doing very well from the surgery. The incisional pain seems under control with the current regimen. I reviewed the medications with the patient and discussed utilization with the patient as well.
- The patient has a postoperative DRG irritation and may benefit from a transforaminal ESI at the surgical level(s). In addition, the patient may benefit from neurontin or lyrica. Physical therapy may also be indicated.
- I educated the patient on smoking cessation by explaining that quitting and staying away from cigarettes is difficult, but not impossible. BENEFITS OF QUITTING SMOKING — Smoking cessation has major and immediate health benefits for men and women of all ages. The earlier a person quits, the greater the benefits. People who quit smoking before age 50 reduce their risk of dying over the next 15 years by one-half, as compared to those who continue to smoke. Smoking cessation is important to the nonsmoking population since being exposed to second-hand cigarette smoke is responsible for a number of serious health conditions. Smoking may accelerate the aging of the spine, and negatively affect healing after spinal surgery.
Cardiovascular disease — Cigarette smoking doubles the risk of developing coronary heart disease, and smoking cessation can rapidly reduce this risk. One year after stopping smoking, the risk of dying from coronary heart disease is reduced by about one-half and continues to decline with time. In some studies, the risk of heart attack was reduced to the rate of nonsmokers within two years of quitting smoking.
Pulmonary disease — Smoking increases the risk of long-term lung diseases such as chronic obstructive pulmonary disease. While much of the lung damage caused by smoking is not reversible, stopping smoking can reduce further damage to lung function, and many smokers with a chronic cough and sputum (phlegm coughed up from the lungs) production note an improvement in these symptoms during the first 12 months after stopping smoking. (See "Patient information: Chronic obstructive pulmonary disease (COPD)”).
Cancer — Cigarette smoking is responsible for almost 90 percent of cases of lung cancer. Smoking cessation reduces the risk of lung cancer within five years of stopping, although former smokers still have a higher risk of lung cancer than people who have never smoked. - I would like to see the patient back in 2 weeks for a clinical reevaluation to review his medication utilization and to discuss further mobilization which may include physical therapy.
- At this point, the least agressive and most appropriate step is to order an transforaminal epidural steroid injection at L4/5, and L5/S1.
- I would like to see the patient for the injection.
- I performed the injections today and would like to see the patient back in 2 weeks for a clinical reevaluation to discuss her reponse to the injection with her.
- I would like to see her back 6 weeks from the surgery for a postoperative consultation with new films.
- I would like to see her back 3 months from the surgery for a postoperative consultation with new films.
Orders for Today's visit
Hidden
Injection Orders
Surgery Orders
MM slash DD slash YYYY
(Lumbar Discectomy, Percutaneous)
10. Lumbar disc herniation (unilateral symptoms) and nerve root compression by imaging
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Muscle strength < 3/5.
- This option does not lead to requested service.
- The rule is satisfied: you may stop here (Outpatient)
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
20. Radiculopathy post herniated disc surgery (unilateral symptoms) and nerve root compression by imaging.
- Patient needs Spine procedure for herniated disc by history to meet criteria.
- Patient needs Initial resolution of symptoms following surgery to meet criteria.
- Patient needs Recurrent radiculopathy at same level as previous surgery to meet criteria.
- This option does not lead to requested service.
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
Hemilaminectomy (Laminotomy) Discectomy, Lumbar
10. Discitis or epidural abscess by MRI
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Instability by imaging or decompressive surgery is anticipated to result in instability.
20. Lumbar disc herniation (unilateral symptoms) and nerve root compression by imaging
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Muscle strength < 3/5.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Worsening weakness or motor deficit on clinical re-evaluation.
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
30. Lumbar foraminal stenosis (unilateral symptoms) and nerve root compression by imaging
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Muscle strength < 3/5.
- This option does not lead to requested service.
- If option "Yes" selected, then the rule is satisfied; you may stop here (Outpatient)
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
40. Radiculopathy post herniated disc surgery (unilateral symptoms) and nerve root compression by imaging
- Patient needs Spine procedure for herniated disc by history to meet criteria.
- Patient needs Initial resolution of symptoms following surgery to meet criteria.
- Patient needs Recurrent radiculopathy at the same level as previous surgery to meet criteria.
- This option does not lead to requested service.
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
Anterior Cervical Discectomy and Fusion (ACDF)
10. Cervical disc herniation (unilateral symptoms) and nerve root compression by imaging
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
20. Cervical foraminal stenosis (unilateral symptoms) and nerve root compression by imaging
- Unilateral radiculopathy with motor deficit and Unilateral radiculopathy with sensory deficit together do not meet conditions.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminphen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home excercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
30. Discitis or epidural abcess by MRI
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Instability by imaging or decompressive surgery is anticipated to result in instability
40. Myelopathy (bilateral symptoms)
- This option does not lead to requested service.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Decompressive surgery is anticipated to result in instability.
Laminectomy (with Fusion), Lumbar
10. Cauda equina syndrome (urgent)
- This option does not lead to requested service.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Decompressive surgery is anticipated to result in instability Decompressive surgery is anticipated to result in instability.
20. Discitis or epidural abscess by MRI
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient dies not have Instability by imaging or decompressive surgery is anticipated to result in instability.
30. Lumbar spinal stenosis (bilateral symptoms) and spinal compression by imaging
- Patient needs Pain or paresthesias or numbness worse with walking to meet criteria.
- Patient needs Pain or paresthesias or numbness improved with forward flexion to meet criteria.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminophen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home exercise ≥ 12 weeks to meet criteria.
- Patient needs Activity modification ≥ 12 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has NSAIDs or acetaminophen ≥ 3 weeks, Physical therapy or home exercise ≥ 12 weeks, Activity modification ≥ 12 weeks.
40. Radiculopathy post herniated disc surgery (unilateral symptoms) and nerve root compression by imaging
- Patient needs Spine procedure for herniated disc by history to meet criteria.
- Patient needs Initial resolution of symptoms following surgery to meet criteria.
- Patient needs Recurrent radiculopathy at same level as previous surgery to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminophen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home exercise ≥ 6 weeks to meet criteria.
- Patient needs Activity modification ≥ 6 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
ALIF
10. Acute traumatic spine injury
- Patient needs Unstable vertebral fracture or dislocation by imaging to meet criteria.
- Patient needs No neurologic deficits to meet criteria.
- Patient needs Reduction and stabilization not achievable by closed means to meet criteria.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Unstable vertebral fracture or dislocation by imaging, No neurologic deficits, Reduction and stabilization not achievable by closed means.
20. Degenerative disc disease by MRI
- Patient needs Back pain interferes with ADLs to meet criteria.
- Patient needs No neurologic deficits to meet criteria.
- This option does not lead to requested service.
- Patient needs No psychiatric disorder by history or psychiatric disorder managed to meet criteria.
- Patient needs No cigarette smoking by history or smoke free period ≥ 3 months prior to surgery to meet criteria.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminophen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home exercise ≥ 6 months to meet criteria.
- Patient needs Activity modification ≥ 6 months to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
30. Nontraumatic instability or spondylolisthesis
- Patient needs Back pain interferes with ADLs to meet criteria.
- Patient needs No neurologic deficits to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs Sagittal plane translation > 3 mm to meet criteria.
- Patient needs Sagittal plane translation > 15% of vertebral body width to meet criteria.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminophen ≥ 3 weeks to meet criteria.
- Patient needs Physical therapy or home exercise ≥ 6 months to meet criteria.
- Patient needs Activity modification ≥ 6 months to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has completed NSAIDs or acetaminphen ≥ 3 weeks, Physical therapy or home excercise ≥ 6 weeks, Activity modification ≥ 6 weeks.
40. Nonunion after spinal fusion (pseudoarthrosis)
- Patient needs Spinal fusion performed ≥ 6 months to meet criteria.
- Patient needs Initial resolution of symptoms following surgery to meet criteria.
- Patient needs Pain at same level as previous surgery to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- Patient needs NSAIDs or acetaminophen ≥ 3 weeks to meet criteria.
- Patient needs Activity modification ≥ 12 weeks to meet criteria.
- Patient needs Physical therapy or home exercise ≥ 12 weeks to meet criteria.
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has NSAIDs or acetaminophen ≥ 3 weeks, Physical therapy or home exercise ≥ 12 weeks, Activity modification ≥ 12 weeks.
50. Primary bone or metastatic tumor of the lumbar spine
- This option does not lead to requested service.
- Patient needs Confirmed by biopsy to meet criteria.
- Patient needs Excision of lesion will cause vertebral instability to meet criteria.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has been Confirmed by biopsy, Excision of lesion will cause vertebral instability, Other clinical information.
60. Vertebral body destruction secondary to osteomyelitis
- This option does not lead to requested service.
- This option does not lead to requested service.
- The rule Interqual 2016 conditions are met as the patient has Imaging evidence of vertebral body destruction, Debridement will cause vertebral instability.
