QUESTION: I would appreciate guidance on using the AMA Guides, Sixth Edition, to rate a multilevel cervical fusion (C4-C7). Reported indications for the fusion were chronic cervical spine pain, severe degenerative disk disease, and transient improvement with a variety of spinal injections. The patient had no radicular complaints or findings. There was no pre-operative psychological assessment, but the patient has chronic depression. In addition to continued neck pain, she complains of headaches, the etiology of which is ill defined. While the cervical fusion meets the definition of alteration of motion segment integrity (AOMSI) per Table 17-2 (6th ed, 564), it appears that there is no ratable impairment since there are no radicular symptoms or signs. Should I rate the three-level fusion and resultant AOMSI as class 1, despite the lack of past radiculopathy or even nonverifiable radicular...
