Ortho
5/24/99

Soft Tissue Injuries
•	accurate Dx
•	conveyed appropriately to insurance company
•	Dx codes—ICD-9-CM (identify clinical disease)
•	traumatic—start in 800
•	847.0—whip lash, sprain/strain
•	need to be accurate in description since the codes cover a large area
•	mild, moderate or severe does not relate to the symptoms for sprain/strain
•	Levels of care
1.	Relief care—pt management directed toward reducing symptoms and improving function to a tolerable level—palliative care, no work to correct the problem
2.	Therapeutic care:  pt management directed to further reduce symptomatology and improve function.  This level of care should enable a pt to perform most normal daily activities w/o frequent exacerbation of symptoms
3.	Rehabilitative care: pt management directed toward improved function by restoring optimal strength and flexibility to the musculoskeletal system.  The goal of this phase is to return the pt to pre-clinical status through education and therapy
4.	Supportive care: pt management directed toward support of an unstable condition which includes periodic monitoring and Tx to reduce the frequency and severity of anticipated exacerbations.  The need for supportive care is seen in cases where injury or illness result in a permanent, unstable condition or disability, and the pt is therefore unable to return to pre-clinical status—not always due to a traumatic experience
•	have to go through the first three levels before one can decide if a pt will have permanent damage
•	maximum medical improvement
•	Tx time is determined by the doctor and the pt
•	reimbursement is determined by the pt and insurance
•	critical judgement needs to be made w/payment from an insurance company
•	keep in mind that a pt may only have certain levels of care in mind and that is all that they want

Ortho Lab Cervical
1.	spinal percussion—helps ID location of pain, ligamentous and musculature injuries
2.	O'Donoghue's maneuver
3.	Foraminal Compression—p 37 in Evans, gradually perform, nerve root irritation at level of IVF—radiculopathy tingling (paresthesia), dermatomal pattern, myotomal weakness
4.	Jackson Compression—lateral bending w/compression
5.	Maximum Cervical Compression—done by the pt, rotate and hyperextend
6.	Cervical Distraction
7.	Spurling's

Review VBAI
1.	George's
2.	Hautant's
3.	Underburg
4.	De Kleyn's
5.	Hallpike