Neurology and Neurosurgery: Clinical & Review Criteria Guidelines for Managing Care, 3rd Edition 2013
Apollo Managed Care, Inc., January 2013, Pages: 276
Evidence-based clinical and review criteria guidelines for outpatient and inpatient tests and procedures with indications, medical necessity coverage criteria, authoritative references and resources ++ Alzheimer disease & ADHD page clinical guidelines – both with extensive references and resource materials. 3rd edition, update 2013, 276 pages.
The events related to medical and surgical procedures lend themselves well to the application of guidelines, protocols or pathways to assist in understanding the medical/surgical care issues that either require an acute hospital level of care or that will lead to an increased length of stay (LOS) at an acute level of care. Many procedures that until recent years were routinely performed following inpatient admission are now performed in ambulatory surgery suites or in ‘day surgery' programs. An openness to consider whether a procedure needs inpatient care at all is really the first step in the resource utilization management evaluation process.
It is recommended that, for any common surgical procedure where the LOS is greater than expected, a day by day or shift by shift evaluation of the care delivered with an analysis of its medical necessity and adequacy be developed.
Some of the common factors that tend to prolong LOS for surgical patients that are not directly related to the specific procedure include:
1. Pre-operative factors
a) patient preparation as an outpatient
b) admission the day of surgery
c) patient expectations for LOS and events during the hospital care period of time
d) Discharge planning at or prior to admission.
2. Characteristics of the patient
a) Age
b) Family/significant other support and availability to provide care
c) Availability of required home care services in the community
d) co-morbid conditions (e.g., diabetes or congestive heart failure)
3. Complications related to the procedure(s) or multiple procedures
4. Foley catheter removal
5. Pain control - adequacy
6. Ambulation
7. Nutritional intake - oral
8. Fever evaluation and management
9. Use of home care or SNF services
10. Failure of the hospital system to provide needed services in a timely manner. (e.g., weekends tend to be down times for many needed radiology, lab, therapy and other services.)
11. Failure of the rounding physician to discharge at an appropriate time.
This report covers evidence-based clinical and review criteria guidelines for outpatient and inpatient tests and procedures with indications, medical necessity coverage criteria, authoritative references and resources. In addition it includes alzheimer disease & ADHD page clinical guidelines, both with extensive references and resource materials.
Aneurysm, intracranial
- Aneurysm, intracerebral, screening indications
- Aneurysm embolization, intracranial
Antibody testing for neurologic disease
Autism and other pervasive developmental disorders - clinical guideline
Back and Neck Disorders or Pain – refer to the Skeletal-Muscular section that follows
CNS/Brain Tumors
Cervical spine/spinal cord acute injuries
Convectin-enhanced intraparenchymal delivery of drugs to the brain
Electrical Stimulation Therapies in Neuromuscular Disorders
- Deep brain/thalamic electrical stimulation for intractable tremors (Parkinson's, dystonias, other tremors) refer to the Parkinson's section that follows
- Facial nerve paralysis (Bell's palsy)
- Cerebral palsy
- Spinal cord injury
- Stroke and other CNS Disorders
- Cranial electrical stimulation/electrosleep therapy
Neurology/Neurosurgery Studies – refer to guidelines throughout this and Radiology chapters for additional tests and diagnostic procedures
- Autonomic Nervous System Function Testing
- Brain death – diagnosis
- Electroencephalogram (EEG) – std., ambulatory, sleep-deprived, surgical,
- Brain mapping (quantitative EEG)
- Electrocorticography (EcoG)
- EMG studies – also refer to the following Neurofeedback guideline
-- Electromyelogram (EMG)/Nerve Conduction Velocity (NCV)
-- Surface EMG, Spinoscopy
-- Electromyography, Anal or Urethral External Sphincter
- Epiduroscopy
- Neuromuscular junction testing by repetitive stimulation
- Neuropsychological testing
- Sensory Nerve Testing
Perception Threshold/Sensory Nerve Conduction Threshold (SNCT)
Sensory/Somatosensory Evoked Potentials
- Visual and Auditory Evoked Response Tests
Guillain-Barre syndrome (GBS): Therapy
Headaches, migraine, tension, other
- Cervico-occipital and cluster headaches – related procedures
- Cranial Electrical Stimulation
- Dihydroergotamine (DHE); Histamine desensitization therapies
- Neuroimaging Studies for Headaches –Refer to the Radiology section
Multiple Sclerosis (MS) – Diagnosis and Therapy
Multiple Sleep Latency Test (MSLT)
NeuroControl Freehand System
Neurofeedback Training
Neuropsychological Testing (NPT) – refer to the preceding guideline in the Neurology Studies section
Percutaneous Neurotomy for Chronic Cervical Pain
Sensory stimulation for coma patients
Spasticity – Neurosurgical procedures
- Selective peripheral denervation (Bertrand procedure) for spastic torticollis
- Neurosurgical management of spasticity
Spinal tap/lumbar puncture (LP), diagnostic
Stereotactic cingulotomy
Stereotaxic Depth Electrode Implantation
Sympathetic therapy for chronic pain management – refer to DME chapter for guideline
Sympathectomy, Thoracoscopic
Carpal Tunnel Syndrome (CTS)
- Conservative therapy
- Low Level Laser Therapy for the Treatment of Carpal Tunnel Syndrome (CTS)
- Carpal Tunnel Release
Transient Ischemic Attack (TIA) – Hospitalization indications
Trigeminal Neuralgia – Radiofrequency Ablation, Other therapies
Parkinson's disease
- Deep brain/thalamic electrical stimulation for intractable tremors (Parkinson's, dystonias, other tremors)
- Pallidotomy for the treatment of Parkinson's disease
- Fetal tissue Cell (mesencephalic, adrenal-brain and fetal xenograft) transplantation for the treatment of Parkinson's disease
- Thalamotomy for movement disorders
Seizures/Epilepsy – diagnosis and management
- Electroencephalographic biofeedback for intractable seizures
- Surgical evaluation for intractable seizure disorders – Grid Monitoring
- Vagus Nerve Stimulation for the treatment of refractory seizures, depression
Diabetic Neuropathy – refer to the preceding neurological testing section
- Peripheral neuropathy with loss of protective sensation (LOPS)
- H-wave stimulation for diabetic peripheral neuropathy with LOPS
- Surgical decompression for diabetic neuropathy
Cognitive Rehabilitation (CR)
Sensory or auditory Integration Therapy/Training (
Constraint-induced movement therapy (CIMT)
Head Injury – assessment and management (
Hippotherapy/Therapeutic Horseback Riding/Equestrian Therapy
Hypothermia following acute brain injury
Induced Lesions of Nerve Tracts, Medicare NCD
Intra-operative Electromyographic Monitoring of Cranial Nerves
Intraoperative Neurophysiologic Monitoring
Invasive Intracranial Pressure Monitoring
Shunt, subcutaneous lumbar
Stroke prevention – Angioplasty of intracerebral arteries
Stroke units
Thalamotomy for movement disorders
Ulnar Nerve Transposition, Decompression or Release
Vagus Nerve Stimulation for the treatment of depression, seizures
Vestibular – refer to ENT chapter
Videopupillography/Tropicamide Drop Test Alzheimer's Disease
Ziconotide Intrathecal Infusion (Prialt®) for Severe Chronic Pain
Neurology/Neurosurgery Referral Guideline Links
Neurology/Neurosurgery Notes
Back and Neck Pain – Evaluation and Procedures;
Back and Neck Pain – Evaluation and Procedures; Refer to Apollo's Medical Review Criteria for Managing Care, DME chapter for additional related guidelines
- Low back pain – evaluation and management introduction (‘acute', ‘slow to recover')
- Algorithm for ‘slow to Recover' back pain evaluation
- Anterior Spinal Surgery, Endoscopic/Minimally Invasive
- Artificial/Prosthetic Intervertebral Discs/Disc replacement
- Cervical Spine – refer to related guidelines throughout this section
-- Cervical pain, acute, without preceding trauma – guideline
-- Cervical nerve root entrapment – surgical indications
-- Cervical Laminoplasty
-- Spinal Instability, cervical – lateral screw fixation
- Chymopapain Chemonucleolysis
- Endoscopic/Minimally Invasive Anterior Spinal Surgery- refer to Anterior Spinal Surgery
- Epidural injections – steroids, nerve blocks – refer to spinal stenosis and the Anesthesiology section: Nerve blocks
- Epidural adhesions – neurolysis
- Facet Denervation: Neurotomy, Rhizotomy, or Articular Rhizolysis
-- Facet Denervation: Percutaneous Radiofrequency
- Implantable Infusion Pumps for Chronic Severe Back Pain
- Intervertebral Discs/Disc replacement – refer to ‘Artifical/prosthetic intervertebral discs'
- Intradiscal Electrothermal Therapy (IDET)
- Laminectomy
- Laser assisted spinal endoscopy
- Machines to treat low back pain
- Magnets for the treatment of chronic low back pain
- Microdiscectomy, Percutaneous Lumbar Discectomy, automated
- Neuroreflexotherapy (NRT)
- NucleoplastyTM
- Percutaneous vertebroplasty/kyphoplasty
- Postural Reconstruction Physiotherapy
- Prolotherapy
- Scoliosis – Therapies
- Spinal fusion/arthrodesis
- Spinal Instability, lumbo-sacral – Pedicle screw fixation
- Spinal stenosis
-- Interspinous distraction or dynamic stabilization for spinal stenosis (X-stop or Dynesys)
- Surface electrical muscle stimulation for juvenile scoliosis- refer to guideline in DME chapter
- Trigger Point Injections
- Vertebroplasty, kyphoplasty – refer to percutaneous
Neuroradiology Guidelines
Spine – diagnostic radiology – Refer to CT and MRI sections that follow and the Skeletal-muscular chapter related topics
- Low back pain imaging studies
- Myelography and Cisternography
- Discography
- Scoliosis in children – indications for radiography
- Videofluoroscopy of the spine (Motion X-rays, Dynamic Spinal Visualization)
- Epidurogram/Epiduroscopy
- Cervical spine; Diagnostic radiology; post-trauma
Skull x-rays- post-trauma
Diagnostic Arteriography/Angiography/Venography – Indications
- Cervicocerebral angiography
MRI/CT Overview
CT Overview
- Whole body CT Scans
- CT angiography (CTA)
- Computerized Tomography (CT or CAT) including headaches, extracranial head, brain, and thoracic scans; High-resolution CT (HRCT)for Pulmonary Studies
MRI Overview including Standing and Sitting MRIs
- MRI – Brain
- MRI – Orbit, Face, and Neck
- MRI – Spine
- Magnetic Resonance Angiography (MRA) including Venography Neurovascular Imaging (update
- Magnetic Resonance Neurography/Peripheral Nerves (MRN)
- Magnetic Resonance Spectroscopy (MRS)/Nuclear Magnetic Resonance (NMR)
- Magnetic Source Imaging (MSI)/Magnetoencephalography (MEG)
Neuroimaging Studies for Headaches, Other
Resources: Neuroimaging
Alzheimer's Disease 2007 – 55 page clinical guideline – contents list on page 2 of guideline
ADHD 2007 – 53 page clinical guideline – contents list on page 2 of guideline
References & Resources for Clinical Review Guideline Topics – Autism, Asperger, PDD
Neurology and Neurosurgical web site resources
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