IMC Guidelines and Reimbursement - Neck

Sunday, August 18, 2002 | 0

My last three articles in this series discussed the IMC Guidelines relative to diagnosis and treatment of low back injuries. The IMC has published guidelines for neck injuries independently of the back, so they need to be reviewed as well.

The guidelines introduction tell the practitioner what is expected: "In the majority of injured workers with neck injuries recovery occurs within the first month of symptoms. Those who are not better at one month may need further diagnostic evaluation and consideration of other treatment options. The overall goal of the management of neck injuries in workers is to identify and correct both environmental and personal factors that may be causing or aggravating the injury, while providing appropriate management of disability so that it leads to a return to productive work."

Note the first sentencem - if the majority of your neck injury patients aren't recovering in a month, then you are going to have problems collecting your bills eventually.

As with the low back, there are three classes of symptom duration: acute (one month), subacute (one to three months), and chronic (three months). IMC treatment protocol follows these symptom duration classifications closely, and as with the low back, there are five initial clinical categories: 1) Conditions involving the bony spinovertebral axis such as cancer, infection or fracture; 2) Intraspinal pathology involving neurological conditions such as radiculopathy or myelopathy; 3) Arthritic or inflammatory conditions; 4) Mechanical conditions; or 5) Referred neck pain due to viscerogenic and/or other causes. The IMC also directs that the practitioner also look for other factors that might have an impact on the injured worker's symptoms or response to treatment , specifically stating as examples, "work, personal, psychosocial, and economic factors".

Again, the guidelines can't emphasize enough the importance of a thorough medical examination and detailed history taking. The physical and history guide decisions about diagnostic imaging, laboratory testing, and referral to a specialist. The history and physical will need to support your diagnostic and clinical decisions, so complete documentation of all aspects of the initial visit is important. You are establishing not only the course of the injured worker's receipt of medical services, but also the course of reimbursement for the services you provide.

The guidelines are specific about conditions that need to be considered in the clinical picture. They need not be repeated here, but should be reviewed on occasion to keep them fresh in your mind. One aspect that is probably under-appreciated by most clinicians (and patients and claims examiners too...) but which is prominently reviewed in the guidelines is the consideration of psychosocial factors. Note:

"Psychological work factors that are known to increase the reporting of a neck injury and lead to prolonged symptoms and disability include job dissatisfaction. If psychological distress is suspected from the history, pain drawing, and/or the physical examination such as the presence of several 'nonorganic' physical signs, the injured worker may be at risk for a delayed recovery or poor response to any surgical procedure."

Emphasis is placed on the clinician's ability to take not only a medical history, but a social history as well: "A history of previous neck injuries or surgery, failed previous treatments, prolonged or continuous litigation or disability claims, family or financial problems, or secondary gain may affect treatment response and prolong disability. Chronic pain, depression, and alcohol or substance abuse may prolong disability and influence the choices for therapy. Recreational and other non-work activities which might contribute to neck problems must also be considered in the evaluation and management of neck problems."

Finally, note that the IMC has directed that there are certain diagnostic methods that are inappropriate on a routine basis, i.e. don't do this stuff regularly: laboratory studies, plain x-rays for evaluation of injured workers with acute neck injuries except as indicated, CT, MRI, myelography, CT-myelography, and bone scan, discography, surface electromyography and computerized strength and range of motion testing.

We'll look at the treatment protocol in the next article. Remember, follow the guidelines, and your billing is more difficult to dispute. The biggest cost component, and growing, in workers' compensation is the medical. Physicians that want to get paid must be attentive to the requirements dictated by the governing bodies in workers' compensation.

Authored by Denyse Shaw of Comp Pro Insurance Services, matching vendors to the specific needs of administrators and carriers. She can be reached at 916-944-7870, or by e-mail at denysekshaw@earthlink.net.