Qtr 1 Physician IRR 2017 MSK (Spine Surg) case study # 4
HAP/ COMMERCIAL eviCore Guidelines
37 year old male patient with prior authorization request for Total Cervical Disc Arthroplasty CPT 22856.
This patient has a> 1 year history of bilateral hand numbness and tingling as well as severe neck pain stemming from an injury in 2008.
He has participated in physical therapy and has been under the care of a physiatrist with only temporary relief.
Physical examination findings suggest diminished left sided strength (4+/5) in all muscle groups and ipsilateral upper extremity pain with lateral cervical bending. Reflexes are 2+ bilaterally without clonus or Hoffman’s sign. A normal stance is noted with gait but difficulty with tandem walking.
MRI demonstrates severe central cord compression at C4-C5 from a disc protrusion with osteophytes.
Negative Tobacco history. No disability index test was provided.
The treating surgeon’s assessment and plan: Cervical Myelopathy with a proposed treatment of cervical disc arthroplasty.
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