DOCSLIB.ORG

Presents the Evaluation, Treatment and Management Of

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Presents the Evaluation, Treatment and Management Of Presents The Evaluation, Treatment and Management of Temporomandibular Disorders, Craniofacial Pain And Orofacial Pain April 20, 2017 By Michael Karegeannes PT/MHSc/LAT/MTC/CFC/CCTT/CMTPT Jeff Verhagen PT/MBA/CMTPT Mike Verplancke DPT/CSCS/CMTPT Freedompt.com Treatingtmj.com Michael Karegeannes, PT, MHSc, LAT, MTC, CFC, CCTT, CMTPT, is the owner of Freedom Physical Therapy Services , 4 clinics in WI, since 1997 and a practicing physical therapist since 1989. His specialties in the field of physical therapy include: TMD, spine and pelvic dysfunctions, myofascial pain, and orthopedic therapies. Michael graduated from the University of Wisconsin-Madison in 1989 with a Bachelor’s of Science Degree in Physical Therapy. After he graduated, he received his athletic training license from the University of Wisconsin-Milwaukee, and later, Michael completed his manual therapy certification and Masters of Health Science from the University of St. Augustine in Florida. In 2005, Michael had the honor of being trained by Dr. Mariano Rocabado, (in conjunction with the University of St. Augustine) who is the leading national expert in the field of craniofacial therapies. Michael holds a Craniofacial Certification with the University of St. Augustine. In addition, Michael has attended an orofacial pain and TMD residency with the University of Minnesota Dental School. He is a member of the American Academy of Orofacial Pain (AAOP), a board member with the Physical Therapy Board of Craniofacial and Cervical Therapeutics (PTBCCT) and is one of the few physical therapists in the United States recognized as a certified cervical and temporomandibular therapist with the AAOP. In 2011, Michael received thorough and extensive training in the technique of intramuscular dry needling and is certified through Myopain Seminars, the premier post-graduate medical and physical therapy continuing education company in the United States with a focus on myofascial trigger points. Michael is also on faculty with Myopain Seminars. Michael is also one of the few PTs in the USA trained in the CRAFTA approach to TMD. His diverse experience, knowledge, and manual skills allow Michael to be highly effective in the evaluation and treatment of his clientele. Michael is a member of the APTA, WPTA, NATA, AAOP, PTBCCT, AES, PAMA and IMS. Jeffrey Verhagen started his career as a Physical Therapist in 1990 after graduating from the University of Wisconsin -Madison. He furthered his breadth of knowledge by attending several post-graduate continuing education opportunities with a focus on manual therapy for orthopedic, spine and sports injuries. He soon learned that he enjoyed treating spine problems and patients with headaches. In order to properly assess the etiology of headaches, he expanded his studies to include the evaluation and treatment of TMD/craniofacial pain and in 2013 completed a certification in Intramuscular Dry Needling through Myopain Seminars. Dry Needling treats myofascial trigger points and their affect on localized and referred pain. He soon learned that he could successfully treat TMD and craniofacial pain for patients that had tried other treatment approaches and still were left with pain and loss of function. Jeff has attended several courses and has reviewed the literature to expand his ability to successfully treat this challenging population. Freedom Physical Therapy Services, commissioned Steve Kraus PT, a well known TMJ therapist and educator, to come to the Milwaukee area and teach the latest treatment techniques and research on TMD/craniofacial pain to our therapy staff. Jeff looks forward to continuing to expand his knowledge to better serve this patient population. Jeff has been with Freedom Physical Therapy Service since July of 2000 and currently serves as the Clinical Operations Administrator for the practice. He earned his Master of Business Administration from Cardinal Stritch University in 1999. He also served 21 years in the Army Reserves and is a Desert Storm veteran. Jeff resides in Brookfield with his wife and two children and enjoys many hobbies to include golf, fishing and reading. Michael Verplancke left his roots of St. Louis, Missouri, to both attend and play ice hockey at St. Mary’s University of Minnesota, where Mike graduated in 1998 with a Bachelor of Arts degree in Biology. He then attended Finch University of Health Sciences/The Chicago Medical School in North Chicago, Illinois, to obtain his physical therapy degree. He graduated in 2001 with a Doctorate of Physical Therapy. Mike has participated in numerous continuing education seminars with a focus on manual therapy techniques, evaluation and treatment of the spine and TMJ/craniofacial pain, mobilization techniques, and intramuscular dry needling. In 2002, Mike obtained his credentials as a Certified Strength and Conditioning Specialist (CSCS), which has assisted him with exercise prescription, as well as progression of overall health and wellness for patients. In 2014, Mike completed his certification in Intramuscular Dry Needling through Myopain Seminars. This treatment approach has provided a technique that improves treatment of Myofascial Trigger Points and their affect on localized and referred pain, as well as muscle activation patterns throughout the body. In addition, Michael has attended an Orofacial Pain and TMD residency with the University of Minnesota Dental School. Mike has been trained in Temporal Mandibular Disorders (TMD) and Craniofacial Pain (CFP) by Dr. Mariano Rocabado, a world renowned leader in the field of TMD and CFP. Mike is currently working towards his Craniofacial Certification in conjunction with Dr. Rocabado and the University of St. Augustine. Mike has been an employee at Freedom Physical Therapy since July of 2005, and is currently the Lead Physical Therapist and clinic director of the Grafton location. Mike has a wide range of hobbies and interests, which include playing ice hockey, softball, golf, and basketball. He also enjoys spending quality time with his wife, Marion, their three daughters, Sophia, Liliana, and Emilia, and their Golden Retriever, Stan. Green Bay, WI April 20, 2017 Michael Karegeannes PT www.treatingtmj.com 1 Time Ordered Agenda 4-20-2017 9:00 – 9:45am Introduction and TMJ Anatomy and TMJ Biomechanics 9:45 – 10:30am Pathomechanics, abnormal mechanics and parafunction, etiology, imaging 10:30 – 11:00pm Break 11:00 – 12:00pm Epidemiology, Lab Evaluation of ROM of TMJ, Lab Muscle Palpation, Hypermobility Screen, muscle treatment 12:00 – 2:00pm Lunch 2:00 - 2:45 pm TMJ Arthralgia and various Disc related TMJ Dysfunction 2:45pm – 3:30pm Lab Mobilization Techniques for the TMJ 3:00 - 3:45pm Break 3:45 – 4:15pm TMJ Exercise, Rocabado 6 x 6, self help 4:15 – 5:00pm Cervical spine as it relates to TMJ, Ergonomics, Lab C spine assessment/treatment, dry needling Demo to facial and selected neck muscles 5:00pm Adjourn, Thank you! Green Bay, WI April 20, 2017 Michael Karegeannes PT www.treatingtmj.com 2 The Evaluation, Treatment and Management of Temporomandibular Disorders, Craniofacial Pain and Orofacial Pain By Michael Karegeannes PT/MHSc/LAT/MTC/CFC/CCTT/CMTPT CRANIO-CERVICO-MANDIBULAR RELATIONSHIP Cranio-Vertebral Cranio-Mandibular ASSIMILATION Green Bay, WI April 20, 2017 Michael Karegeannes PT www.treatingtmj.com 3 Tragus of the ear Anatomical Video Clip The condyle (anterior view). The medial pole (MP) is more prominent that the lateral pole (LP). Copyright ©2013 by Mosby, an imprint of Elsevier Inc. Medial and Lateral Discal Collateral Ligament (A) Lateral view and (B) diagram showing the anatomic components. RT, retrodiscal tissue, SRL, superior retrodiscal lamina (elastic); IRL, inferior retrodiscal lamina (collagenous); ACL, anterior capsular ligament (collagenous); SLP and ILP, superior and inferior lateral pterygoid muscles. AS, articular surface; SC and IC, superior and inferior joint cavity; the discal (collateral) ligament has not been drawn. TMJ ( anterior or coronal view). AD, articular disc; CL, capsular ligament; LDL, lateral discal ligament; MDL, medial discal ligament; DC, superior joint cavity; IC, inferior joint cavity. Courtesy of Per-Lennart Westeson, M.D., Rochester, NY. Green Bay, WI April 20, 2017 Michael Karegeannes PT www.treatingtmj.com 4 TMJ Mechanics/Disc TMJ pain primarily originates from tissues in the posterior and lateral aspect of the TMJ, ie capsule, TMJ ligament, Lateral collateral ligament , synovium and retrodiscal tissue. Mandibular Biomechanics Osteokinematics • Depression (opening) – 40 to 50mm normal- 36 mm for most dental procedures • Elevation (closing) • Protrusion- 5 to 7 mm from incisor to incisor • Retrusion to protrusion 10mm, be specific and consistent • Lateral excursion – 10 mm 4:1 Ratio For every 1mm of lateral excursion, 4mm of opening. TMJ AUTOPSY SPECIMEN TMJ AUTOPSY SPECIMEN (Normal Joint) (Reducing Disc) Green Bay, WI April 20, 2017 Michael Karegeannes PT www.treatingtmj.com 5 TMJ AUTOPSY SPECIMEN Mandibular Opening Patterns (Non-Reducing Disc) • Deflection: Movement away from midline but it does NOT return to midline Mandibular Opening Patterns (cont) Mandibular Opening Patterns (cont) Deviation: “S” Movement away from midline but returns to midline as it gets to end range. • Midline: Could be normal, or could be bilateral Disc dislocation without reduction, depends on?? A man with reducing disc displacement of the right joint. (a) On mouth opening, there is an early transient locking and a slight deflection of the mandibular midline to the right affected side.
Load more

Recommended publications
  • Temporomandibular Joint Dysfunction Corporate Medical Policy Policy
    Temporomandibular Joint Dysfunction Corporate Medical Policy File Name: Temporomandibular Joint Dysfunction File Code: UM.SURG.07 Origination: 06/2011 Last Review: 07/2019 Next Review: 07/2020 Effective Date: 10/01/2019 Description/Summary Temporomandibular joint (TMJ) dysfunction refers to a group of disorders characterized by pain in the TMJ and surrounding tissues. Initial conservative therapy is generally recommended; there are also a variety of nonsurgical and surgical treatment possibilities for patients whose symptoms persist. Policy Coding Information Click the links below for attachments, coding tables & instructions. Attachment I - CPT® Code Table & Instructions Attachment II - ICD-10-CM Diagnosis of TMJ When a service may be considered medically necessary • The following diagnostic procedures may be considered medically necessary in the diagnosis of temporomandibular joint (TMJ) dysfunction: - Diagnostic x-ray, tomograms, and arthrograms; - Computed tomography (CT) scan or magnetic resonance imaging (MRI) (in general, CT scans and MRIs are reserved for presurgical evaluations); - Cephalograms (x-rays of jaws and skull); - Pantograms (x-rays of maxilla and mandible). When a service is considered investigational • The following diagnostic procedures are considered investigational in the diagnosis of TMJ dysfunction: - Electromyography (EMG), including surface EMG; Page 1 of 17 Medical Policy Number: UM.SURG.07 - Kinesiography; - Thermography; - Neuromuscular junction testing; - Somatosensory testing; - Transcranial or lateral
    [Show full text]
  • CIHI - Canadian Institute for Health Information CEDIS - the Canadian Emergency Department Information System Committee
    CIHI - Canadian Institute for Health Information CEDIS - The Canadian Emergency Department Information System Committee ICIS - Institut canadien d'information sur la santé SIGDUC - le comité des systèmes d'informations de gestion des départements d'urgence canadiens Bernard Unger1, Marc Afilalo1, Jean François Boivin2, Michael Bullard3, Eric Grafstein4, Michael Schull5, Eddy Lang1, Antoinette Colacone1, Nathalie Soucy1, Xiaoqing Xue1, Eli Segal3 1 Emergency Multidisciplinary Research Unit, SMBD-Jewish General Hospital, McGill University, Montreal 2 Centre for Clinical Epidemiology and Community Studies, SMBD-Jewish General Hospital, McGill University, Montreal 3 University of Alberta Hospital, University of Alberta, Edmonton, Alberta 4 St. Paul's Hospital, Vancouver, University of British Columbia, Vancouver, British Columbia 5 Sunnybrook Health Sciences Centre and Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario with/avec Canadian Institute for Health Information - Classifications & Terminologies and Clinical Administrative Databases (CAD) teams Institut canadien d'information sur la santé - les équipes de classifications & terminologies & des bases de données clinico-administratives (BDCA) Alberta Children's Hospital: Belanger F, Millar K BC Children's Hospital: Clarke M, Colbourne M, Haughton D, Hung G, Whitehouse S Canadian Pediatric Society Cape Breton Regional Hospital: Currie T Children's Hospital of Eastern Ontario: Farion K CH de l'Université de Montréal: Desaulniers P, Boulet M, Charbonneau L, Laurens JP, Jourdenais E CH de l'Université de Québec-Pavillon CHUL: Bernier D, Germain V, Guimont C, Nazair P, Turgeon R Colchester Regional Hospital: Howlett M Credit Valley Hospital, Mississauga: Humniski AM, Letovsky E, Scampoli N CSSS Gatineau: Folot MH, Forest G, Michaud MN, Pham Dinh M, Sibille P Foothills Medical Centre, Calgary: Wertzler B Greater Niagara General Hospital: Turineck D Grey Nuns Comm.
    [Show full text]
  • Workcover NSW 2012 Claims Estimation
    Minimum Weekly Compensation Estimate for Certain Injuries Extract from Workcover NSW Claims Estimation Manual - Dec 2012 Minimum Bodily Location And Injury Type Estimate GROUP 1: HEAD (includes cranium, eye, ear, mouth, nose and face) Fracture of skull (without brain injury) 6 weeks Fracture of jaw (without dislocation) 6 weeks Fracture-dislocation of jaw 12 weeks Concussion 1 week Serious head injuries (including closed/open head and brain injuries, severe facial Refer to Chapter J injuries involving face, nose and/or ear) Eye Major burn/thermal injury 26 weeks Moderate thermal or chemical burn 6 weeks Foreign body (corneal) and abrasions 2 weeks Foreign body (intraocular) 6 weeks Conjunctivitis/chemical irritation 1 week Contusions/bruising 1 week Retinal detachment 6 weeks Ear Perforated ear drum 2 weeks GROUP 2: NECK Whiplash associated disorder (WAD) without radicular pain 4 weeks Whiplash associated disorder (WAD) with radicular pain 12 weeks Contusion/bruising/sprains 4 weeks Fracture: to vertebral body 12 weeks to spinous or transverse process 6 weeks Fracture – dislocation 26 weeks Fracture with spinal cord injury Refer to Chapter J/Q GROUP 3: TRUNK (includes upper/lower back, chest, abdomen and pelvic region) Acute or recurrent back pain (non-radicular) 4 weeks Radicular back pain 12 weeks Fracture: of vertebral body 12 weeks of transverse or spinous process 6 weeks of sacrum 4 weeks of coccyx 4 weeks Contusion/bruising (upper/lower back) 4 weeks Chest/thorax: Closed rib fracture 4 weeks Fracture with complications (eg: pneumothorax)
    [Show full text]
  • Diagnostic Treatment Protocols Regulation Interpretative Guide
    Alberta Office of the Superintendent of Insurance Diagnostic Treatment Protocols Regulation Interpretative Guide Last updated: August 23, 2018 Alberta Treasury Board and Finance Superintendent of Insurance Financial Sector Regulation and Policy (FSRP) Room 402, Terrace Building 9515 - 107 Street Edmonton, Alberta, T5K 2C3 Phone 780-427-8322 • Fax 780-420-0752 For toll-free service in Alberta, call 310-0000, then enter the number. For more information, visit insurance.alberta.ca T able of Contents Table of Contents ........................................................................ 1 General Information .................................................................... 3 Introduction ..................................................................................................... 3 Scope of the Diagnosis and Treatment Protocols ......................................... 4 Definitions .................................................................................... 5 For the purposes of this Guide ....................................................................... 5 Claims and Billing ....................................................................... 6 Privacy Statement ....................................................................... 9 For Health Care Practitioners ......................................................................... 9 For More Information ..................................................................................... 9 Sprains and Strains ..................................................................
    [Show full text]
  • National Health Statistics Reports, Number 150, December 28, 2020
    National Health Statistics Reports Number 150 December 28, 2020 The 2020 International Classification of Diseases, 10th Revision, Clinical Modification Injury Diagnosis Framework for Categorizing Injuries by Body Region and Nature of Injury by Holly Hedegaard, M.D., M.S.P.H., National Center for Health Statistics; Renee L. Johnson, M.S.P.H., R.P.T., National Center for Injury Prevention and Control; Matthew F. Garnett, M.P.H., National Center for Health Statistics; and Karen E. Thomas, M.P.H., National Center for Injury Prevention and Control Abstract Introduction Background—Injury diagnosis frameworks, or matrices, based on the Injury diagnosis frameworks, such International Classification of Diseases (ICD) provide standardized categories for as the Barell matrix (1) and the Injury reporting injuries by body region and nature of injury. In 2016, the National Center for Mortality Diagnosis (IMD) matrix (2), Health Statistics (NCHS) and the National Center for Injury Prevention and Control provide standardized categories for (NCIPC) published a proposed injury diagnosis matrix for use with data coded using reporting injuries by body region and the ICD, 10th Revision, Clinical Modification (ICD–10–CM). At the time the proposed nature of injury. Nature of injury refers matrix was developed, ICD–10–CM coded data were not available to evaluate the to the type of anatomic or physiologic performance of the proposed matrix. As data became available, NCHS and NCIPC disruption (e.g., fractures, dislocations, received recommendations from clinicians and researchers to improve the consistency sprains, open wounds, burns, injuries and clinical applicability of categorization of codes within the matrix. This report to internal organs, or poisoning) that describes the modifications made to the 2016 proposed ICD–10–CM injury diagnosis occurred as a result of an injury event matrix and presents the final 2020 ICD–10–CM injury diagnosis matrix.
    [Show full text]
  • Temporomandibular Joint Disorder Treatment Product Applicability
    bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Temporomandibular Joint Disorder Treatment Policy Number: OCA 3.968 Version Number: 13 Version Effective Date: 01/01/17 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan New Hampshire Medicaid MassHealth NH Health Protection Program Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options ◊ Notes: + Disclaimer and audit information is located at the end of this document. ◊ The guidelines included in this Plan policy are applicable to members enrolled in Senior Care Options only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of the prior authorization request. Review the member’s product-specific benefit documents at www.SeniorsGetMore.org to determine coverage guidelines for Senior Care Options. Policy Summary The Plan considers medical and/or surgical (non-dental) treatment of a temporomandibular joint (TMJ) disorder to be medically necessary ONLY when the disorder is caused by or results in a specific medical condition. Examples of specific medical conditions include jaw fractures and/or dislocations and degenerative arthritis. Prior authorization is required. It will be determined during the Plan’s prior authorization process if the treatment of a TMJ disorder is considered medically necessary for the requested indication (and must be related to a specific medical condition). See the Plan’s policy, Medically Necessary (policy number OCA 3.14), for the product- specific definitions of medically necessary treatment. Review the member’s applicable benefit Temporomandibular Joint Disorder Treatment + Plan refers to Boston Medical Center Health Plan, Inc.
    [Show full text]
  • Temporomandibular Joint Disorders Policy Number: MP-016 Last Review Date: 02/21/2019 Effective Date: 04/01/2019 Policy
    Temporomandibular Joint Disorders Policy Number: MP-016 Last Review Date: 02/21/2019 Effective Date: 04/01/2019 Policy Evolent Health considers Temporomandibular Joint (TMJ) Disorders medically necessary for the following indications: Moderate to severe pain presented as TMJ pain, preauricular pain, referred ear pain, or masticatory muscle pain a) Disabling joint function characterized by: o Restricted range of jaw motion o Excessive range of jaw motion o Joint noises (clicking, popping, and crepitation) associated with pain o Abnormal masticatory function (e.g. painful chewing) b) Imaging evidence of joint derangement or disease Therapeutic Management: 1. Coverage for Nonsurgical Management: a) Medical visits b) Diagnostic x-rays/imaging studies (radiographs, panoramic radiographic imaging, cephalometic radiographic images, arthrogram, MRI and/or CT) c) Pharmacological treatment for pain – usually pain is relieved with over-the- counter non-steroidal anti-inflammatory drugs (NSAIDs) or other pain medications d) Arthrocentesis e) TMJ joint injections – intracapsular diagnostic and therapeutic injections or injections of anesthetic agents into the trigeminal nerve are limited to once per course of treatment Note: Documentation must indicate patient education related to stress reduction, dietary recommendations, jaw rest and modification of jaw habits. 2. Surgical treatment is indicated with at least two of the following: a) Earaches, headaches, masticatory or cervical myalgias refractory to medical treatment b) Difficulty chewing c) Restricted range of motion, manifested by any one of the following: i. Interincisal opening of less than 35 mm, or ii. Lateral excursive movement of less than 4 mm (side-to-side movement), or iii. Protrusive excursive movement of less than 4 mm (front-to-back motion), or iv.
    [Show full text]
  • Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for Independent Work of Students D
    Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for independent work of students during the training for the practical studies Academic discipline Surgical stomatology Module № 6 The topic of the stadies Arthritis, arthrosis, pain dysfunction syndrome of №6 temporomandibular joint. Ankylosis of TMJ. Plastic surgery of TMJ. Contractures and dislocations of the lower jaw. Diagnosis, surgical treatment and physiotherapy. Course V Faculty Foreign Students Training, Stomatological Poltava -2020 1. Relevance of the topic: Inflammatory and degenerative diseases of the TMJ belong to a rather common diseases are very difficult in its clinical course and difficult to treat, the frequency of which increases with age. Therefore, knowledge of the clinic, treatments and prevention of inflammatory and degenerative diseases of the TMJ is currently relevant in the study of this subject. 2. THE SPECIFIC AIMS: 2.1. To define what is arthritis, arthrosis, arthrito-arthrosis of the TMJ. 2.2. To analyze the etiology and pathogenesis arthritis, arthrosis, arthrito-arthrosis of the TMJ. 2.3. To suggest a plan of examination for patient with arthritis, arthrosis, arthrito- arthrosis of the TMJ. 2.4. To classify arthritis, arthrosis, arthrito-arthrosis of TMJ. 2.5. To list the main clinical features of acute TMJ arthritis. 2.6. To list the main clinical features of chronic TMJ arthritis. 2.7. To list the major clinical signs of osteoarthritis and TMJ arthritis. 2.8. To list the major clinical signs of TMJ osteoarthritis. 2.9. To appoint the treatment for patients with arthritis, arthrosis, arthrito-arthrosis of TMJ. 2.10. To analyze the data further diagnostic testing of patients with arthritis, arthrosis , arthritis, arthrosis of the TMJ.
    [Show full text]
  • Temporomandibular Joint Disorders Policy
    Manual: IU Health Plans Department: Utilization Management Policy # UMDET088.1 Effective Date: 12/19/2019 Supersedes Policy # UMDET088.0/or Last update or issue date: 05/01/2018 Page(s) Including attachments: 5 Medicare Advantage X Commercial Temporomandibular Joint Disorders Policy I. Purpose Indiana University Health Plans (IU Health Plans) considers clinical indications when making a medical necessity determination for Temporomandibular Joint Disorders. II. Scope All Utilization Management (UM) staff conducting physical and behavioral health UM review. III. Exceptions 1. The following services for TMJ disorders are ineligible or not covered for payment under this policy: A. Dental prostheses (stabilization splints) including the Therabite Jaw Motion Rehabilitation system or orthodontic treatment including irreversible occlusal therapy B. Physical Therapy C. Continuous Passive Motion (CPM) therapy D. Range of motion measurements E. Biofeedback F. Botulinum toxin (type A or Type B) G. Alloplastic joint implants H. Acupuncture I. Cognitive behavioral therapy J. Pulsed radiofrequency energy - Energex K. Electromyography L. Kinesiography M. Lateral skull X-rays N. Neuromuscular junction testing O. Nuclear medicine studies P. Somatosensory testing Q. Sonogram R. Transcranial X-rays S. Ultrasonic Doppler auscultation IV. Definitions None V. Policy Statements 1. IU Health Plans considers Temporomandibular Joint Disorders medically necessary for all of the following indications: A. Moderate to severe pain presented as TMJ pain, preauricular pain, referred ear pain, or masticatory muscle pain 1. Disabling joint function characterized by one or more of the following: a. Restricted range of jaw motion b. Excessive range of jaw motion c. Joint noises (clicking, popping, and crepitation) associated with pain d. Abnormal masticatory function (e.g.
    [Show full text]
  • Temporomandibular Joint Disorder
    Medical Policy MP 2.01.21 Temporomandibular Joint Disorder BCBSA Ref. Policy: 2.01.21 Related Policies Last Review: 02/21/2019 2.01.30 Biofeedback for Chronic Pain Effective Date: 02/21/2019 7.01.29 Percutaneous Electrical Nerve Stimulation and Section: Medicine Percutaneous Neuromodulation Therapy DISCLAIMER Our medical policies are designed for informational purposes only and are not an authorization, explanation of benefits or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically. POLICY DIAGNOSTIC PROCEDURES The following diagnostic procedures may be considered medically necessary in the diagnosis of temporomandibular joint disorder (TMJD): Diagnostic x-ray, tomograms, and arthrograms; Computed tomography (CT) scan or magnetic resonance imaging (MRI) (in general, CT scans and MRIs are reserved for presurgical evaluations); Cephalograms (x-rays of jaws and skull); Pantograms (x-rays of maxilla and mandible). (Cephalograms and pantograms should be reviewed on an individual basis.) The following diagnostic procedures are considered investigational in the diagnosis of TMJD: Electromyography (EMG), including surface EMG; Kinesiography; Thermography; Neuromuscular junction testing; Somatosensory testing; Transcranial or lateral skull x-rays; intraoral tracing or gnathic arch tracing (intended to demonstrate deviations in the positioning of the jaw that are associated with TMJD); Muscle testing; Standard dental radiographic procedures; MP 2.01.21 Temporomandibular Joint Disorder Range-of-motion measurements; Computerized mandibular scan (measures and records muscle activity related to movement and positioning of the mandible and is intended to detect deviations in occlusion and muscle spasms related to TMJD); Ultrasound imaging/sonogram; Arthroscopy of the temporomandibular joint (TMJ) for purely diagnostic purposes; Joint vibration analysis.
    [Show full text]
  • Temporomandibular Joint Disorder Treatment Product Applicability
    bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Temporomandibular Joint Disorder Treatment Policy Number: OCA 3.968 Version Number: 14 Version Effective Date: 12/01/17 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan New Hampshire Medicaid MassHealth NH Health Protection Program Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options ◊ Notes: + Disclaimer and audit information is located at the end of this document. ◊ The guidelines included in this Plan policy are applicable to members enrolled in Senior Care Options only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of the prior authorization request. Review the member’s product-specific benefit documents at www.SeniorsGetMore.org to determine coverage guidelines for Senior Care Options. Policy Summary The Plan considers medical and/or surgical (non-dental) treatment of a temporomandibular joint (TMJ) disorder to be medically necessary ONLY when the disorder is caused by or results in a specific medical condition. Examples of specific medical conditions include jaw fractures and/or dislocations and degenerative arthritis. Prior authorization is required. It will be determined during the Plan’s prior authorization process if the treatment of a TMJ disorder is considered medically necessary for the requested indication (and must be related to a specific medical condition). See the Plan’s Medically Necessary medical policy (policy number OCA 3.14) for the Temporomandibular Joint Disorder Treatment + Plan refers to Boston Medical Center Health Plan, Inc.
    [Show full text]
  • MEET the PRESENTER ICD-10-CM Diagnosis Coding for Orthopedics
    WELCOME TO PMI’s WEBINAR PRESENTATION Brought to you by: Practice Management Institute® www.pmiMD.com MEET THE PRESENTER Nancy Maguire On the topic: ICD-10-CM Diagnosis Coding for Orthopedics Welcome to Practice Management Institute’s Webinar and Audio Conference Training. We hope that the information contained herein will give you valuable tips that you can use to improve your skills and performance on the job. Each year, more than 40,000 physicians and office staff are trained by Practice Management Institute. For 30 years, physicians have relied on PMI to provide up-to-date coding, reimbursement, compliance and office management training. Instructor-led classes are presented in 400 of the nation’s leading hospitals, healthcare systems, colleges and medical societies. PMI provides a number of other training resources for your practice, including national conferences for medical office professionals, self-paced certification preparatory courses, online training, educational audio downloads, and practice reference materials. For more information, visit PMI’s web site at www.pmiMD.com Please be advised that all information in this program is provided for informational purposes only. While PMI makes all reasonable efforts to verify the credentials of instructors and the information provided, it is not intended to serve as legal advice. The opinions expressed are those of the individual presenter and do not necessarily reflect the viewpoint of Practice Management Institute. The information provided is general in nature. Depending on the particular facts at issue, it may or may not apply to your situation. Participants requiring specific guidance should contact their legal counsel. CPT® is a registered trademark of the American Medical Association.
    [Show full text]