Toxicology Exam : The Medical Necessity Of Opioids, Addiction, Or Poor Pain Control
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1. Toxicology exam
Regarding Toxicology exam; CA MTUS Chronic Pain Medical Treatment Guidelines state that a urine analysis is recommended as an option to assess for the use or the presence of illegal drugs, to assess for abuse, to assess before a therapeutic trial of opioids, addiction, or poor pain control in patients under on-going opioid treatment. Since the opioids have been non-certified; the medical necessity of UDS has not been established. Recommend non-certification.
2. follow up appointment in 4 weeks
Regarding follow-up in 4 weeks; ODG states that evaluation and management (E&M) outpatient visits to the offices of medical doctor(s) play a critical role in the proper diagnosis and return to function of an injured worker, to monitor the patient’s progress, and make any necessary modifications to the treatment plan. 01/13/16 Progress Report noted that the patient has persistent neck, bilateral shoulder, mid back, bilateral upper extremity, lower back, and bilateral knee pain. The exam revealed that there were tenderness and muscle spasms about the thoracic spine. ROM of the cervical spine, thoracic spine and lumbar spine was decreased in all planes. There was tenderness over the bilateral upper cervical facet regions. Considering pain and functional limitations in multiple body parts, it seems medically necessary to monitor the patient and make any necessary adjustments to his treatment plan. Recommend certification.