Neurology and Neurosurgery - Clinical Review Criteria Guidelines
Table of Contents
Neurology/Neurosurgery
– Clinical/Review Criteria Guidelines
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
Ø
Deep brain/thalamic electrical stimulation for intractable tremors
(Parkinson’s, dystonias, other tremors) refer to the Parkinson’s section that follows
Ø
Facial nerve paralysis (Bell’s palsy)
Ø
Cerebral palsy
Ø
Spinal cord injury
Ø
Stroke and other CNS Disorders
Ø
Cranial electrical stimulation/electrosleep therapy
Neurology/Neurosurgery
Studies – refer
to guidelines throughout this and Radiology chapters for additional tests and
diagnostic procedures
Ø
Autonomic Nervous System Function Testing
Ø
Brain death – diagnosis
Ø
Electroencephalogram (EEG) – std., ambulatory, sleep-deprived,
surgical,
Ø
Brain mapping (quantitative EEG)
Ø
Electrocorticography (EcoG)
Ø
EMG studies – also refer to the following Neurofeedback guideline
o
Electromyelogram (EMG)/Nerve Conduction Velocity (NCV)
o
Surface EMG, Spinoscopy
o
Electromyography, Anal or Urethral External Sphincter
Ø
Epiduroscopy
Ø
Neuromuscular junction testing by repetitive
stimulation
Ø
Neuropsychological testing
Ø
Sensory Nerve Testing
v
Perception Threshold/Sensory Nerve Conduction Threshold (SNCT)
v
Sensory/Somatosensory Evoked Potentials
(
Ø
Visual and Auditory Evoked Response Tests
Guillain-Barre syndrome (GBS):
Therapy
Headaches, migraine, tension, other
Ø
Cervico-occipital and cluster headaches – related procedures
Ø
Cranial Electrical Stimulation
Ø
Dihydroergotamine (DHE); Histamine desensitization
therapies
Ø
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)
Ø
Conservative therapy
Ø
Low Level Laser Therapy for the Treatment of Carpal Tunnel
Syndrome (CTS)
Ø
Carpal Tunnel Release
Transient
Ischemic Attack (TIA) – Hospitalization indications
Trigeminal
Neuralgia – Radiofrequency Ablation, Other therapies
Parkinson’s
disease
Ø
Deep brain/thalamic electrical stimulation for intractable tremors
(Parkinson’s, dystonias, other tremors)
Ø
Pallidotomy for the treatment of Parkinson’s disease
Ø
Fetal tissue Cell (mesencephalic, adrenal-brain and fetal
xenograft) transplantation for the treatment of Parkinson’s disease
Ø
Thalamotomy for movement
disorders
Seizures/Epilepsy – diagnosis and management
Ø
Electroencephalographic biofeedback for intractable seizures
Ø
Surgical evaluation for intractable seizure disorders – Grid
Monitoring
Ø
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
Ø
Low back pain – evaluation and management introduction
(‘acute’, ‘slow to recover’)
Ø
Algorithm for ‘slow to Recover’ back pain evaluation
Ø
Anterior Spinal Surgery, Endoscopic/Minimally Invasive
Ø
Artificial/Prosthetic Intervertebral Discs/Disc replacement
Ø
Cervical Spine – refer to related guidelines throughout this
section
à
Cervical pain, acute, without preceding trauma – guideline
à
Cervical nerve root entrapment – surgical indications
à
Cervical Laminoplasty
à
Spinal Instability, cervical – lateral screw fixation
Ø
Chymopapain Chemonucleolysis
Ø
Endoscopic/Minimally Invasive Anterior Spinal Surgery- refer to Anterior Spinal Surgery
Ø
Epidural injections – steroids, nerve blocks –
refer to spinal stenosis and the Anesthesiology section: Nerve blocks
Ø
Epidural adhesions – neurolysis
Ø
Facet Denervation: Neurotomy, Rhizotomy, or Articular Rhizolysis
o
Facet Denervation: Percutaneous Radiofrequency
Ø
Implantable Infusion Pumps for Chronic Severe Back Pain
Ø
Intervertebral Discs/Disc replacement – refer to
‘Artifical/prosthetic intervertebral discs’
Ø
Intradiscal Electrothermal Therapy (IDET)
Ø
Laminectomy
Ø
Laser assisted spinal endoscopy
Ø
Machines to treat low back pain
Ø
Magnets for the treatment of chronic low back pain
Ø
Microdiscectomy, Percutaneous Lumbar Discectomy, automated
Ø
Neuroreflexotherapy (NRT)
Ø
NucleoplastyTM
Ø
Percutaneous vertebroplasty/kyphoplasty
Ø
Postural Reconstruction Physiotherapy
Ø
Prolotherapy
Ø
Scoliosis – Therapies
Ø
Spinal fusion/arthrodesis
Ø
Spinal Instability, lumbo-sacral – Pedicle screw fixation
Ø
Spinal stenosis
v
Interspinous distraction or dynamic stabilization for spinal
stenosis (X-stop or Dynesys)
Ø
Surface electrical muscle stimulation for juvenile scoliosis- refer to guideline in DME chapter
Ø
Trigger Point Injections
Ø
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
Ø
Low back pain imaging studies
Ø
Myelography and Cisternography
Ø
Discography
Ø
Scoliosis in children – indications for radiography
Ø
Videofluoroscopy of the spine (Motion X-rays,
Dynamic Spinal Visualization)
Ø
Epidurogram/Epiduroscopy
Ø
Cervical spine; Diagnostic radiology; post-trauma
Skull x-rays- post-trauma
Diagnostic Arteriography/Angiography/Venography – Indications
Ø
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
Neurology and Neurosurgical web site resources