Qtr 1 Physician IRR 2017 MSK (Spine Surg) case study # 5
NWH WI Medicare / eviCore Spine Guidelines
68 year old male with prior authorization request for Lumbar Laminectomy L2-3 and L4-5 CPT 63047
This patient has been followed for several years with low back and leg pain treated conservatively and with ESI in the distant past (2010, 2013, 2014).
Approximately 2 1/2 years ago (2015) he noticed that his right leg would go numb with walking. He also noted heat/flushing sensation down the buttocks, which is relieved by sitting down or leaning forward.
He was re-evaluated in June 2016 at which point an ESI was ordered and subsequently performed in July, August and September but only helped temporarily.
Physical examination suggested ROM of LS spine to be 15-90 degrees with steady hunched-forward gait, SLR negative bilaterally and sensation intact. Motor strength deficit was noted to be 4/5 in Right Knee Flexion.
MRI from 8/2013 showed spinal stenosis at L2/3 and L4/5.
Plain films from 6/2016 showed “stable diffuse idiopathic skeletal hyperostosis without dynamic instability and stable mild L4/5 disc narrowing.” MRI at same time showed severe canal stenosis at L2/3 and L4/5, changes at L2/3 progressive since prior exam.
A repeat MRI was performed 6/22/2016 which noted severe stenosis at L2-3 and L4-5.
ODI score submitted.
Last Assessment on 10/25/2016: Neurogenic Claudication and Spinal stenosis. He continued with conservative management
A request for the above surgery was then made on 1/26/2016 to include Lumbar decompression L4-5 & L2-3.
This quiz requires you to log in.
Please enter your Quia username and password. |
|
|
|
