Official Disability Guidelines
INTERVERTEBRAL DISC DISORDERS
(3-digit ICD9 722)

722  Intervertebral disc disorders

722.1  Displacement of thoracic or lumbar intervertebral disc without myelopathy

Return-To-Work Summary Guidelines
Midrange: 56 days	At-Risk: 141 days

Return-To-Work "Best Practice" Guidelines Disc bulge -- Mild cases with back pain, avoid strenuous activity: 0 days Herniated disc -- Initial conservative medical treatment, clerical/modified work: 0-3 days Initial conservative medical treatment, manual work: 28 days Initial conservative medical treatment, regular work if cause of disability: 84 days Discectomy, clerical/modified work: 28-42 days Discectomy, manual work: 56 days Discectomy, heavy manual work: indefinite Laminectomy, clerical/modified work: 28 days Laminectomy, manual work: 70 days Laminectomy, heavy manual work: indefinite Lumbar fusion, clerical/modified work: 56 days Lumbar fusion, manual work: 140 days Lumbar fusion, heavy manual work: indefinite

Capabilities & Activity Modifications for Restricted Work:
Clerical/modified work: Lifting with knees (with a straight back, no stooping) not more than 5 lbs up to 3 times/hr; squatting up to 4 times/hr; standing or walking with a 5-minute break at least every 20 minutes; sitting with a 5-minute break every 30 minutes; no extremes of extension or flexion; no extremes of twisting; no climbing ladders; driving car only up to 2 hrs/day.
Manual work:  Lifting with knees (with a straight back) not more than 25 lbs up to 15 times/hr; squatting up to 16 times/hr; standing or walking with a 10-minute break at least every 1-2 hours; sitting with a 10-minute break every 1-2 hours; extremes of flexion or extension allowed up to 12 times/hr; extremes of twisting allowed up to 16 times/hr; climbing ladders allowed up to 25 rungs 6 times/hr; driving car or light truck up to a full work day; driving heavy truck up to 4 hrs/day.
Description: Displacement of a disc in the upper or lower back which may put pressure on the adjacent spinal nerve causing pain and sometimes sensory loss.
Other names: Herniated disc, Herniated nucleus pulposus (HNP), Disc bulge, Disc rupture, Disc protrusion
ICD-10 Code(s): M51.1, M51.2
ODG Treatment Guidelines: ODG/TWC Index
Other Links: Click below for detailed information on this condition:
American Academy of Orthopaedic Surgeons | AHCPR Guideline | Merck Manual | Merck Home Edition | Treatment Options (AAFP) | State Guidelines
Medical Costs: $10,106 (average of 214,494 cases)
Procedure Codes: 00600 00670 22554 22830 22899 62290 63001 63003 63005 63011 63012 63015 63016 63017 63020 63030 63035 63040 63042 63043 63044 63045 63046 63047 63048 63075 63076 63077 63078 63090 63170 63172 63173 63180 63182 63185 63190 63191 63194 63195 63196 63197 63198 63199 63200 63250 63251 63252 63265 63266 63267 63268 63270 63271 63272 63273 63275 63276 63277 63278 63280 63281 63282 63283 63285 63286 63287 63290 63650 64475 64476 64480 64484 72100 72110 72146 72148 72158 95860 95861
CM Triage: Level 3 (long term planning), algorithms 3A
Physical Therapy Guidelines:
Allow for fading of treatment frequency (from up to 3 visits per week to 1 or less), plus active self-directed home PT
Medical treatment: 10 visits over 8 weeks
Post-surgical (fusion) treatment: 34 visits over 16 weeks
Chiropractic Guidelines:
Patient selection based on previous chiropractic success --
Trial of 6 visits over 2-3 weeks
With evidence of objective functional improvement, total of up to 18 visits over 6-8 weeks, avoid chronicity and gradually fade the patient into active self-directed care

Disability Duration Adjustment Factors by Age
Age Group	18-24	25-34	35-44	45-54	55-64	65-74
Adjustment Factor	0.66	0.74	1.07	1.10	1.35	1.64
At-Risk Days	93	104	151	155	190	231

RTW Claims Data (Calendar-days away from work by decile)
10%	20%	30%	40%	50%	60%	70%	80%	90%	100%	Mean
14	16	28	30	56	60	72	86	141	365	68.51

   CDC NCHS LOD (Length Of Disability, in days)*
   Median (mid-point)     29.0       Mean (average)        55.73
   Mode (most frequent)   2          Calculated rec.       29
                           Percent of Cases
                              (8686 cases)
                                                                      
 13.4                                                                 
      11.4                                                            
                                                                      
                 8.2                                               8.4
                                7.3                                   
                                               5.4                    
                                     4.6                              
            2.9                                                       
                                                                      
                      0.2  0.7            0.9       0.1  0.2  0.0     
  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___
    9   18   27   36   45   54   63   72   81   90   99  108  117 118+
                       Range of Days (up to)
   *CDC NHIS cases with no lost workdays: 3149 (36.3%)

Impact on Total Absence: Prevalence 2.7894% of total lost workdays; Incidence 23.71 days per 100 workers

   NHDS LOS (Hospital Length Of Stay, in days)*
   Median (mid-point)     4.0        Mean (average)        5.07
   Mode (most frequent)   3          Calculated rec.       4
                           Percent of Cases
                              (2265 cases)
                                                          
                   15.5 15.1                              
                                                          
         11.4 11.2           11.3                         
                                                       9.7
                                   8.7                    
                                        6.8               
                                                          
                                             4.0  3.2     
                                                          
                                                          
          ___  ___  ___  ___  ___  ___  ___  ___  ___  ___
            1    2    3    4    5    6    7    8    9  10+
                               Days
   *NHDS cases with no overnight stay: 37 (1.6%)