interqual level of care 2018 index · nerve block pain pain syndrome reflex ... brachial plexus...

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 1 InterQual ® Level of Care 2018 Index Outpatient Rehabilitation & Chiropractic (ORC) Criteria The Index is an alphabetical listing of conditions and/or diagnoses designed to guide the user to the criteria subset where a specific condition or diagnosis may be found. The actual criteria may be worded differently from that of the listed condition or diagnosis. Index Words by Subset Subset Criteria/Diagnosis AMPUTATION, LOWER EXTREMITY: REHABILITATION AMPUTATION ANKLE CONGENITAL LIMB DEFICIENCY CONTRACTURE MANAGEMENT DESENSITIZATION DISARTICULATION EDEMA MANAGEMENT HEMI-PELVECTOMY HIP KNEE LOSS OF LIMB LOWER EXTREMITY

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Page 1: InterQual Level of Care 2018 Index · nerve block pain pain syndrome reflex ... brachial plexus cervical rib resection costoclavicular space embolectomy interscalene triangle retropectoralis

Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 1

InterQual® Level of Care 2018 Index

Outpatient Rehabilitation & Chiropractic (ORC) Criteria

The Index is an alphabetical listing of conditions and/or diagnoses designed to guide the user to the criteria subset where a specific condition or diagnosis may be found. The actual criteria may be worded differently from that of the listed condition or diagnosis.

Index Words by Subset

Subset Criteria/Diagnosis

AMPUTATION, LOWER EXTREMITY: REHABILITATION

AMPUTATION

ANKLE

CONGENITAL LIMB DEFICIENCY

CONTRACTURE MANAGEMENT

DESENSITIZATION

DISARTICULATION

EDEMA MANAGEMENT

HEMI-PELVECTOMY

HIP

KNEE

LOSS OF LIMB

LOWER EXTREMITY

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 2

Subset Criteria/Diagnosis

AMPUTATION, LOWER EXTREMITY: REHABILITATION (cont’d)

LOWER LIMB

PAIN CONTROL

PERIPHERAL NEUROPATHY

PHANTOM LIMB PAIN

SCAR MANAGEMENT

SOCK MANAGEMENT

SYMES

TRANSFEMORAL

TRANSTIBIAL

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

WALKING PROGRAM

AMPUTATION, UPPER EXTREMITY: REHABILITATION

AMPUTATION

DESENSITIZATION

DIGIT

DISARTICULATION

EDEMA MANAGEMENT

ELBOW

FINGER

FOREQUARTER

LOSS OF LIMB

PAIN MANAGEMENT

PASSIVE ARM

PHANTOM LIMB PAIN

PROSTHESIS

PROSTHETIC DEVICE

SHAPING

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 3

Subset Criteria/Diagnosis

AMPUTATION, UPPER EXTREMITY: REHABILITATION (cont’d)

SHOULDER

SHRINKAGE

STUMP

THUMB

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

TRANS HUMERAL

TRANS RADIAL

UPPER EXTREMITY

WRIST

CARDIAC:

REHABILITATION

ANGINA PECTORIS

ARTHERECTOMY

BALLOON ANGIOPLASTY

CARDIAC MONITORING

CARDIAC REHABILITATION

CARDIAC RISK ASSESSMENT

CARDIOVASCULAR DISEASE

CHEST PAIN

CORONARY ARTERY BYPASS GRAFT (CABG)

CORONARY ARTERY DISEASE (CAD)

EXERCISE TOLERANCE TEST

HEART DISEASE

HEART FAILURE

ISCHEMIA

MYOCARDIAL INFARCTION (MI)

NEW YORK HEART ASSOCIATION (NYHA) FUNCTIONAL CLASSIFICATION CLASS II

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 4

Subset Criteria/Diagnosis

CARDIAC:

REHABILITATION (cont’d)

NEW YORK HEART ASSOCIATION (NYHA) FUNCTIONAL CLASSIFICATION CLASS III

NON ST-ELEVATION MYOCARDIAL INFARCTION (NSTEMI)

PERCUTANEOUS CORONARY INTERVENTION (PCI)

ST-ELEVATION MYOCARDIAL INFARCTION (STEMI)

STENT INSERTION

STRESS TEST

CARPAL TUNNEL SYNDROME (CTS): REHABILITATION

CARPAL TUNNEL RELEASE

CARPAL TUNNEL SYNDROME (CTS)

COMPRESSION

COMPRESSION TEST

DECOMPRESSION

FINGER

HAND

IMPAIRED DEXTERITY

MEDIAN NERVE

NERVE CONDUCTION TEST

NERVE DAMAGE

NUMBNESS

PARESTHESIAS

PERIPHERAL NEUROPATHY

PHALEN TEST

SENSORY FIBERS

THENAR MUSCLE

THUMB

TINEL SIGN

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 5

Subset Criteria/Diagnosis

CARPAL TUNNEL SYNDROME (CTS): REHABILITATION (cont’d)

WRIST

CEREBROVASCULAR ACCIDENT (CVA):

REHABILITATION

ATAXIA

CEREBROVASCULAR ACCIDENT (CVA)

COGNITIVE IMPAIRMENT

CRANIOTOMY

FACIAL DROOP

FUNCTIONAL LIMITATION

HEMORRHAGIC STROKE

IMPAIRED COORDINATION

ISCHEMIC STROKE

LANGUAGE DISORDER

MOTOR WEAKNESS

NEUROLOGIC DYSFUNCTION

NEUROLOGICAL DEFICIT

PARALYSIS

SPEECH DISORDER

STROKE

SWALLOWING IMPAIRMENT

WEAKNESS

CERVICOGENIC HEADACHE:

CHIROPRACTIC

CERVICALGIA

CERVICAL SPINE

CERVICOGENIC HEADACHE

HEAD

HEADACHE

HEAD PAIN

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 6

Subset Criteria/Diagnosis

CERVICOGENIC HEADACHE:

CHIROPRACTIC (cont’d)

NECK

TRIGGER POINT THERAPY

DE QUERVAIN’S TENOSYNOVITIS: REHABILITATION

DE QUERVAIN’S TENOSYNOVITIS

DORSAL COMPARTMENT

EXTENSOR COMPARTMENT

FINKELSTEIN’S TEST

FOREARM

SCAR MANAGEMENT

STENOSIS

TENDON SHEATH RELEASE

TENOSYNOVITIS

THUMB

WRIST

FRACTURES, LOWER EXTREMITY: REHABILITATION

ANKLE

DISPLACED FRACTURE

EXTERNAL FIXATION

FRACTURE

HIP

LOWER EXTREMTY

NON-DISPLACED FRACTURE

OPEN REDUCTION AND INTERNAL FIXATION (ORIF)

REDUCTION

STABLE FRACTURE

UNSTABLE FRACTURE

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Subset Criteria/Diagnosis

FRACTURES, UPPER EXTREMITY:

REHABILITATION

ELBOW

FOREARM

FRACTURE

HAND

OPEN REDUCTION AND INTERNAL FIXATION (ORIF)

REDUCTION

SHOULDER

STRESS FRACTURE

UPPER EXTREMITY

WRIST

GENERAL DECONDITIONING ATROPHY

COGNITIVE IMPAIRMENT

COGNITIVE RETRAINING

DECONDITIONED

DECREASED ENDURANCE

ENDURANCE

FUNCTIONAL CONDITION

FUNCTIONAL DECLINE

GAIT TRAINING

GENERAL DECONDITIONING

IMPAIRED BALANCE

LIMITED FLEXIBILITY

MUSCLE WEAKNESS

PROLONGED IMMOBILITY

REDUCED STABILITY

RISK OF FALLS

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 8

Subset Criteria/Diagnosis

HABILITATION AUTISM SPECTRUM DISORDER

CONGENITAL DISORDER

DEVELOPMENTAL DELAY

HABILITATION

NEURODEVELOPMENTAL DISORDER

NEUROLOGIC DISORDER

INSTABILITY/DISLOCATION, SHOULDER:

REHABILITATION

CLAVICLE

COLLAR BONE

DISLOCATION

DOUBLE JOINTED

GLENOID

HUMERUS

INSTABILITY

SCAPULA

SHOULDER

SHOULDER DISLOCATION

SHOULDER INSTABILITY

SHOULDER LOOSENESS

SUBLUXATION

LIGAMENTIOUS INJURY ANKLE:

REHABILITATION

ANKLE

ANKLE PAIN

ANKLE SPRAIN

ANTERIOR DRAWER TEST

ANTERIOR CALCANEOFIBULAR LIGAMENT (CFL)

ANTERIOR TALOFIBULAR LIGAMENT (ATFL)

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 9

Subset Criteria/Diagnosis

LIGAMENTIOUS INJURY ANKLE:

REHABILITATION (cont’d)

INSTABILITY

LIGAMENTOUS INJURIES

MANUAL STRESS TESTING

PLANTAR-FLEXED FOOT

POSTERIOR TALOFIBULAR LIGAMENT (PTFL)

TALAR TILT

LIGAMENTOUS INJURY, KNEE:

REHABILITATION

ANTERIOR CRUCIATE LIGAMENT (ACL)

INSTABILITY

KNEE

KNEE DISLOCATION

KNEE “GIVING WAY”

LATERAL COLLATERAL LIGAMENT (LCL)

LAXITY

LIGAMENTOUS INJURIES

MEDIAL COLLATERAL LIGAMENT (MCL)

MENISCAL INJURY

MULTILIGAMENTOUS INJURY

POSTERIOR CRUCIATE LIGAMENT (PCL)

POSTEROLATERAL COMPLEX

POSTERIOR DRAWER TEST

TEAR

VALGUS STRESS TEST

LYMPHEDEMA:

REHABILITATION

COMPLETE DECONGESTION THERAPY

COMPLEX LYMPHEDEMA THERAPY (CLT)

COMPRESSION GARMENTS

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Subset Criteria/Diagnosis

LYMPHEDEMA:

REHABILITATION (cont’d)

EDEMA

LYMPHATIC SYSTEM

LYMPHEDEMA

MANUAL COMPRESSION

MANUAL LYMPHATIC DRAINAGE

PNEUMATIC COMPRESSION

SWELLING

MAINTENANCE THERAPY:

REHABILITATION

CYSTIC FIBROSIS

DYSPHAGIA

PROGRESSIVE DEMENTIA

PROGRESSIVE NEUROMUSCULAR DISORDER

MENISCAL INJURY, KNEE:

REHABILITATION

ANTERIOR CRUCIATE LIGAMENT (ACL)

APLEY TEST

EGE TEST

FEMUR

KNEE

LATERAL MENISCUS

LOCKING

MCMURRAY TEST

MEDIAL MENICUS

MENISCAL INJURY

MENISCUS

PSEUDOLOCKING

TEAR

THESSALY TEST

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Subset Criteria/Diagnosis

MULTIPLE SCLEROSIS:

REHABILITATION

ATAXIA

BLADDER DYSFUNCTION

BOWEL DYSFUNCTION

COGNITIVE IMPAIRMENT

DIPLOPIA

DYSPHAGIA

DYSARTHRIA

IMPAIRED BALANCE

IMPAIRED COORDINATION

LANGUAGE DISORDER

MOTOR WEAKNESS

MUSCLE SPASMS

MULTIPLE SCLEROSIS

NEUROLOGIC DECLINE

NUMBNESS

SENSORY LOSS

SPASTICITY

SPEECH DISORDER

TREMOR

WEAKNESS

OSTEOARTHRITIS, HIP:

REHABILITATION

ANTALGIC GAIT

ARTHRITIS

ARTHROPLASTY

HIP

HIP PAIN

JOINT

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Subset Criteria/Diagnosis

OSTEOARTHRITIS, HIP:

REHABILITATION (cont’d)

OSTEOARTHRITIS

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

OSTEOARTHRITITS, KNEE:

REHABILITATION

ARTICULAR CARTILAGE DEFECTS

ARTHRITIS

ARTHROPLASTY

AUTOLOGOUS CHONDROCYTE IMPLANTATION (ACI)

CREPITUS

DEBRIDEMENT

KNEE

KNEE PAIN

JOINT

JOINT EFFUSION

JOINT STIFFNESS

MICROFRACTURE ABRASION

OSTEOARTHRITIS

SUBCHONDRAL DRILLING

TOTAL KNEE REPLACEMENT

OSTEOARTHRITIS, SHOULDER:

REHABILITATION

ARTHRITIS

ARTHROPLASTY

GLENOHUMERAL

JOINT

OSTEOARTHRITIS

SHOULDER

SHOULDER PAIN

SHOULDER REPLACEMENT

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 13

Subset Criteria/Diagnosis

PAIN SYNDROMES:

REHABILITATION

ACHING

CAUSALGIA

COMPLEX REGIONAL PAIN SYNDROME

FATIGUE

FIBROMYALGIA

FLEXION CONTRACTURES

NERVE BLOCK

PAIN

PAIN SYNDROME

REFLEX SYMPATHETIC DYSTROPHY (RSD)

RHEUMATIC DISORDER

STIFFNESS

SWELLING

TENDERNESS

TENDER POINT

PEDIATRIC:

REHABILITATION

APRAXIA

AUTISM SPECTRUM DISORDER

CONGENTIAL DEFECTS

CONTRACTURE RELEASE

DEVELOPMENTAL DELAY

DYSPRAXIA

JOINT REPLACEMENT

MUSCULOSKELETAL IMPAIRMENT

NONPROGRESSIVE CNS DISORDERS

PEDIATRIC

PEDIATRIC REHABILITATION

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Subset Criteria/Diagnosis

PEDIATRIC:

REHABILITATION (cont’d)

PLAGIOCEPHALY

SCOLIOSIS

SPASTICITY MANAGEMENT

TORTICOLLIS

PELVIC FLOOR:

REHABILITATION

ANAL SPHINCTER

BLADDER

BLADDER TRAINING

BOWEL

BOWEL TRAINING

CONSTIPATION

DYSPAREUNIA

ERECTILE DYSFUNCTION

FECAL INCONTINENCE

IMPAIRED MUSCLE PERFORMANCE

IMPAIRED POSTURE

LOWER ABDOMEN

OVERACTIVE BLADDER

PELVIC FLOOR

PELVIC FLOOR DYSFUNCTION

PELVIC FLOOR MUSCLE TRAINING (PFMT)

PELVIC ORGAN PROLAPSE

PELVIC PAIN

PERINEUM

POSTERIOR TIBIAL NERVE STIMULATION

PROSTATE

RECTUM

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Subset Criteria/Diagnosis

PELVIC FLOOR:

REHABILITATION (cont’d)

THERAPEUTIC ELECTRICAL STIMULATION (TENS)

TRANSCUTANEOUS NEUROSTIMULATION

URINARY INCONTIENCE

UTERUS

VAGINA

PULMONARY:

REHABILITATION

CHRONIC LUNG DISEASE

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

DYSPNEA

HYPOXEMIA

INSPIRATORY MUSCLE TRAINING

LUNG TRANSPLANT

LUNG VOLUME REDUCTION

NONINVASIVE POSITIVE PRESSURE SUPPORT (NIPPV)

OXYGEN THERAPY

PULMONARY

PULMONARY REHABILITATION

RESPIRATORY

ROTATOR CUFF DISORDERS:

REHABILITATION

ARTHROSCOPIC

IMPINGEMENT SYNDROME

INFRASPINATUS

ROTATOR CUFF DISORDER

ROTATOR CUFF SURGERY

ROTATOR CUFF SYNDROME

SHOULDER

SHOULDER PAIN

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Copyright 2018 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Produced in Cork, Ireland. 16

Subset Criteria/Diagnosis

ROTATOR CUFF DISORDERS:

REHABILITATION (cont’d)

SUBACROMIAL BURSITIS

SUBSCAPULARIS

TENDONITIS

TERES MINOR

SOFT TISSUE DISORDERS, ELBOW: REHABILITATION

BICEPS MUSCLE

BICEPS TENDON RUPTURE

ELBOW

ELBOW PAIN

EPICONDYLAGIA

EPICONDYLITIS

EPICONDYLOPLASTY

HUMERUS

LATERAL EPICONDYLE

MEDIAL EPICONDYLE

RUPTURE

SOFT TISSUE DISORDER

TEAR

SOFT TISSUE DISORDERS, FOOT & ANKLE:

REHABILITATION

ACHILLES TENDINOPATHY

ACHILLES TENDON

ANKLE

ARCH

CALCANEUS

FOOT

FOOT PAIN

GASTROCNEMIUS-SOLEUS COMPLEX

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Subset Criteria/Diagnosis

SOFT TISSUE DISORDERS, FOOT & ANKLE:

REHABILITATION (cont’d)

HEEL

HEEL PAIN

PLANTAR FASCIAL RELEASE

PLANTAR FASCIITIS

SOFT TISSUE DISORDER

TENDONITIS

SOFT TISSUE DISORDERS, KNEE:

REHABILITATION

BAKER’S CYST

HAMSTRING INJURY

ILLIOTIBIAL BAND

KNEE

KNEE PAIN

MENISCAL CYSTS

PATELLAR

PATELLA DISLOCATION

PATELLAR INSTABILITY

PATELLA SUBLUXATION

PATELLAR TENDINOPATHY

PATELLAR TENDON TEAR

PATELLOFEMORAL PAIN SYNDROME

PLICA SYNDROME

QUADRICEPS TEAR

RETROPATELLAR PAIN

SOFT TISSUE DISORDER

SPINAL DISORDERS, CERVICAL:

CHIROPRACTIC

CERVICAL NERVE ROOT IMPINGEMENT

CERVICAL RADICULOPATHY

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Subset Criteria/Diagnosis

SPINAL DISORDERS, CERVICAL:

CHIROPRACTIC (cont’d)

CERVICAL SPINAL DISORDER

CERVICAL SPINAL STENOSIS

CERVICAL SPINE

CERVICAL SPONDYLOSIS

NECK

NECK PAIN

SPINAL CORD COMPRESSION

STENOSIS

SPINAL DISORDERS, CERVICAL:

REHABILITATION

CERVICAL NERVE ROOT IMPINGEMENT

CERVICAL RADICULOPATHY

CERVICAL SPINAL DISORDER

CERVICAL SPINAL STENOSIS

CERVICAL SPINE

CERVICAL SPONDYLOSIS

NECK

NECK PAIN

SPINAL CORD COMPRESSION

SPINAL DISORDERS, LUMBAR:

CHIROPRACTIC

ARTHRITIS

BACK

BACK PAIN

DISC SPACE COLLAPSE

FORAMINAL STENOSIS

INTERVERTEBRAL FORAMINA

LUMBAR DISC HERNIATION

LUMBAR RADICULOPATHY

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Subset Criteria/Diagnosis

SPINAL DISORDERS, LUMBAR:

CHIROPRACTIC (cont’d)

LUMBAR SPINAL CANAL

LUMBAR SPINAL STENOSIS

OSTEOARTHRITIS

OSTEOPHYTE FORMATION

SCOLIOSIS

SPINAL STENOSIS

SPINAL DISORDERS, LUMBAR:

REHABILITATION

ARTHRITIS

BACK

BACK PAIN

DISC SPACE COLLAPSE

FORAMINAL STENOSIS

INTERVERTEBRAL FORAMINA

LUMBAR DISC HERNIATION

LUMBAR RADICULOPATHY

LUMBAR SPINAL CANAL

LUMBAR SPINAL DISORDER

LUMBAR SPINAL STENOSIS

OSTEOARTHRITIS

OSTEOPHYTE FORMATION

SCOLIOSIS

SPINAL STENOSIS

SPONDYLOLISTHESIS

SPRAIN, WRIST:

REHABILITATION

ARTHROSCOPIC REPAIR

DISLOCATION

LIGAMENT REPAIR

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Subset Criteria/Diagnosis

SPRAIN, WRIST:

REHABILITATION (cont’d)

SPRAIN

SUBLUXATION

TORN LIGAMENT

WRIST

WRIST PAIN

WRIST SPRAIN

STRAIN, LOW BACK:

CHIROPRACTIC

BACK

BACK PAIN

BACK SPASM

LOW BACK PAIN

LOW BACK STRAIN

LUMBAR SPINE

STRAIN, LOW BACK:

REHABILITATION

BACK

BACK PAIN

BACK SPASM

LOW BACK PAIN

LOW BACK STIFFNESS

LOW BACK STRAIN

STRAIN, NECK:

CHIROPRACTIC

NECK

NECK PAIN

NECK SPASM

NECK STRAIN

WHIPLASH

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STRAIN NECK:

REHABILITATION

NECK

NECK PAIN

NECK SPASM

NECK STRAIN

WHIPLASH

TENDON INJURY, HAND:

REHABILITATION

BOUTONNIERE DEFORMITY

DIP JOINT

EXTENSOR TENDON INJURY

FINGER

FLEXOR TENDON INJURY

HAND

MALLET FINGER TENDON INJURY

PIP JOINT

TERMINAL TENDON

TENDON RUPTURE, ACHILLES:

REHABILITATION

ACHILLES TENDON TEAR

CALCANEUS BONE

GASTROCNEMIUS

SOLEUS

THORACIC OUTLET SYNDROME:

REHABILITATION

AXILLARY SUBCLAVIAN VEIN

BRACHIAL PLEXUS

CERVICAL RIB RESECTION

COSTOCLAVICULAR SPACE

EMBOLECTOMY

INTERSCALENE TRIANGLE

RETROPECTORALIS MINOR SPACE

SHOULDER PAIN

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THORACIC OUTLET SYNDROME:

REHABILITATION (cont’d)

SUBCLAVIAN ARTERY

THORACIC OUTLET SYNDROME (TOS)

THROMBECTOMY

TRAUMATIC BRAIN INJURY (TBI): REHABILITATION

BRAIN

BRAIN INJURY

COGNITIVE IMPAIRMENT

HEAD

HEADACHE

HEAD INJURY

IMPAIRED ATTENTION

IMPAIRED CONCENTRATION

LANGUAGE IMPAIRMENT

MEMORY LOSS

POST CRANIOTOMY

SPEECH IMPAIRMENT

SWALLOWING IMPAIRMENT

TRAUMATIC BRAIN INJURY (TBI)

VOICE IMPAIRMENT

TRIGGER FINGER:

REHABILITATION

DIGITAL FLEXOR TENDON

FINGER

STENOSING TENOSYNOVITIS

TENDON SHEATH

THUMB

TRIGGER FINGER

TRIGGER THUMB

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ULNAR NEUROPATHY:

REHABILITATION

CUBITAL TUNNEL

EPICONDYLECTOMY

HAND

ELBOW

ELBOW PAIN

FOREARM

ULNAR NERVE

ULNAR NEUROPATHY

WRIST