DWD 81.07(5)(b)3.3. All of the following guidelines apply to nerve root blocks:
DWD 81.07(5)(b)3.a.a. Time for treatment response is within one week.
DWD 81.07(5)(b)3.b.b. Maximum treatment frequency may permit repeat injection no sooner than 2 weeks after the previous injection if there is a positive response to the first injection. No more than 3 blocks per patient visit.
DWD 81.07(5)(b)3.c.c. Maximum treatment is 2 blocks to any one site.
DWD 81.07(5)(b)4.4. All of the following guidelines apply to epidural injections:
DWD 81.07(5)(b)4.a.a. Time for treatment response is within one week.
DWD 81.07(5)(b)4.b.b. Maximum treatment frequency is once every 2 weeks if there is a positive response to the first injection. If subsequent injections demonstrate diminishing control of symptoms or fail to facilitate objective functional gains, then injections shall be discontinued. Only one injection per patient visit.
DWD 81.07(5)(b)4.c.c. Maximum treatment is 3 injections.
DWD 81.07(5)(c)(c) For purposes of this paragraph, “lytic or sclerosing injections” include radio frequency denervation of the facet joints. These injections may only be given in conjunction with active treatment modalities directed to the same anatomical site. All of the following guidelines apply to lytic or sclerosing injections:
DWD 81.07(5)(c)1.1. Time for treatment response is within one week.
DWD 81.07(5)(c)2.2. Maximum treatment frequency, may repeat once for any site.
DWD 81.07(5)(c)3.3. Maximum duration is 2 injections to any one site.
DWD 81.07(5)(d)(d) Prolotherapy and botulinum toxin injections are not necessary in the treatment of neck problems.
DWD 81.07(6)(6)Surgery, including decompression procedures and arthrodesis.
DWD 81.07(6)(a)(a) A health care provider may perform surgery only if it meets the specific guidelines of subs. (11) to (14) and s. DWD 81.12 (1).
DWD 81.07(6)(b)(b) In order to optimize the beneficial effect of surgery, postoperative therapy with active and passive treatment modalities may be provided, even if these modalities had been used in the preoperative treatment of the condition. In the postoperative period the maximum treatment duration with passive treatment modalities in a clinical setting from the initiation of the first passive modality used, except bedrest or bracing, is as follows:
DWD 81.07(6)(b)1.1. Eight weeks following decompression or implantation of a spinal cord stimulator or intrathecal drug delivery system.
DWD 81.07(6)(b)2.2. Twelve weeks following arthrodesis.
DWD 81.07(6)(c)(c) Repeat surgery shall also meet the guidelines of subs. (11) to (14) and s. DWD 81.12 (1).
DWD 81.07(6)(d)(d) The surgical therapies in subds. 1. and 2. have very limited application and require a personality or psychosocial evaluation that indicates the patient is likely to benefit from the treatment.
DWD 81.07(6)(d)1.1. Spinal cord stimulator may be necessary for a patient who has neuropathic pain and has had a favorable response to a trial screening period.
DWD 81.07(6)(d)2.2. Intrathecal drug delivery system may be necessary for a patient who has somatic or neuropathic pain and has had a favorable response to a trial screening period.
DWD 81.07(7)(7)Chronic management. Chronic management of neck pain shall be provided according to the guidelines in s. DWD 81.13.
DWD 81.07(8)(8)Durable medical equipment.
DWD 81.07(8)(a)(a) A health care provider may direct the use of durable medical equipment only as specified in pars. (b) to (e).
DWD 81.07(8)(b)(b) Cervical collars, braces or supports, and home cervical traction devices may be necessary within the guidelines of sub. (3) (f) and (k).
DWD 81.07(8)(c)(c) For patients using electrical muscle stimulation at home, the device and any required supplies are necessary within the guidelines of sub. (3) (e).
DWD 81.07(8)(d)(d) Exercise equipment for home use, including bicycles, treadmills, and stairclimbers are necessary only as part of an approved chronic management program. This equipment is not necessary during initial nonoperative care or during reevaluation and surgical therapy. If the employer has an appropriate exercise facility on its premises with the prescribed equipment, the insurer may mandate the use of that facility instead of authorizing purchase of equipment for home use.
DWD 81.07(8)(d)1.1. ‘Indications.’ The patient is deconditioned and requires reconditioning that may be accomplished only with the use of the prescribed exercise equipment. A health care provider shall document specific reasons why the exercise equipment is necessary and may not be replaced with other activities.