DWD 81.07(1)(b)4.4. Cervical compressive myelopathy, with or without radicular pain, is a condition characterized by weakness and spasticity in one or both legs and associated with any of the following: exaggerated reflexes, an extensor plantar response, bowel or bladder dysfunction, sensory ataxia, or bilateral sensory changes.
DWD 81.07(1)(c)(c) A health care provider may not order laboratory tests in the evaluation of a patient with regional neck pain, or radicular pain, except for any of the following:
DWD 81.07(1)(c)1.1. When a patient’s history, age, or examination suggests infection, metabolic-endocrinologic disorders, tumorous conditions, or systemic musculoskeletal disorders, such as rheumatoid arthritis or ankylosing spondylitis.
DWD 81.07(1)(c)2.2. To evaluate potential adverse side effects of medications.
DWD 81.07(1)(c)3.3. As part of a preoperative evaluation.
DWD 81.07(1)(d)(d) Laboratory tests may be ordered at any time a health care provider suspects any of the conditions specified in par. (c), but a health care provider shall justify the need for the tests ordered with clear documentation of the indications.
DWD 81.07(1)(e)(e) Medical imaging evaluation of the cervical spine shall be based on the findings of the history and physical examination and may not be ordered prior to a health care provider’s clinical evaluation of the patient. Medical imaging may not be performed as a routine procedure and shall comply with the guidelines in s. DWD 81.05. A health care provider shall document the appropriate indications for any medical imaging studies obtained.
DWD 81.07(1)(f)(f) Electromyography and nerve conduction studies are always inappropriate for the regional neck pain diagnoses in par. (b) 1. to 4. Electromyography and nerve conduction studies may be an appropriate diagnostic tool for radicular pain and myelopathy diagnoses in par. (b) 2. to 4., after the first 3 weeks of radicular or myelopathy symptoms. Repeat electromyography and nerve conduction studies for radicular pain and myelopathy are not necessary unless a new neurologic symptom or finding has developed which in itself would warrant electrodiagnostic testing. Failure to improve with treatment is not an indication for repeat testing.
DWD 81.07(1)(g)(g) A health care provider may not order the use of any of the following procedures or tests for the diagnosis of any of the clinical categories in par. (b) 1. to 4.:
DWD 81.07(1)(g)1.1. Surface electromyography or surface paraspinal electromyography.
DWD 81.07(1)(g)2.2. Thermography.
DWD 81.07(1)(g)3.3. Plethysmography.
DWD 81.07(1)(g)4.4. Electronic X-ray analysis of plain radiographs.
DWD 81.07(1)(g)5.5. Diagnostic ultrasound of the spine.
DWD 81.07(1)(g)6.6. Somatosensory evoked potentials and motor evoked potentials.
DWD 81.07(1)(h)(h) A health care provider may not order computerized range of motion or strength measuring tests during the period of initial nonsurgical management, but may order these tests during the period of chronic management when used in conjunction with a computerized exercise program, work hardening program, or work conditioning program. During the period of initial nonsurgical management, computerized range of motion or strength testing may be performed but shall be done in conjunction with an office visit with a health care provider’s evaluation or treatment, or physical or occupational therapy evaluation or treatment.
DWD 81.07(1)(i)(i) A health care provider may order personality or psychological evaluations for evaluating patients who continue to have problems despite appropriate care. A treating health care provider may perform this evaluation or may refer the patient for consultation with another health care provider in order to obtain a psychological evaluation. These evaluations may be used to assess the patient for a number of psychological conditions that may interfere with recovery from the injury. Since more than one of these psychological conditions may be present in a given case, a health care provider performing the evaluation shall consider all of the following:
DWD 81.07(1)(i)1.1. Is symptom magnification occurring?
DWD 81.07(1)(i)2.2. Does the patient exhibit an emotional reaction to the injury, such as depression, fear, or anger, that is interfering with recovery?
DWD 81.07(1)(i)3.3. Are there other personality factors or disorders that are interfering with recovery?
DWD 81.07(1)(i)4.4. Is the patient chemically dependent?
DWD 81.07(1)(i)5.5. Are there any interpersonal conflicts interfering with recovery?
DWD 81.07(1)(i)6.6. Does the patient have a chronic pain syndrome or psychogenic pain?
DWD 81.07(1)(i)7.7. In cases in which surgery is a possible treatment, are psychological factors likely to interfere with the potential benefit of the surgery?
DWD 81.07(1)(j)(j) All of the following are guidelines for diagnostic analgesic blocks or injection studies and include facet joint injection, facet nerve block, epidural differential spinal block, nerve block, and nerve root block.
DWD 81.07(1)(j)1.1. These procedures are used to localize the source of pain prior to surgery and to diagnose conditions that fail to respond to initial nonsurgical management.
DWD 81.07(1)(j)2.2. These blocks and injections are invasive and when done as diagnostic procedures are not necessary unless noninvasive procedures have failed to establish the diagnosis.
DWD 81.07(1)(j)3.3. Selection of patients, choice of procedure, and localization of the level of injection shall be determined by documented clinical findings indicating possible pathologic conditions and the source of pain symptoms.
DWD 81.07(1)(j)4.4. These blocks and injections may also be used as therapeutic modalities and are subject to the guidelines in sub. (5)