Pain interferes minimally on an intermittent basis with usual daily activities. Mild Not related to rest or sleep. Pain controlled by one or more of the following: NSAIDs with no or tolerable side effects, aspirin at regular doses, paracetamol. Pain occurs with movement and interferes with usual daily activities. Vigorous activities cannot be performed. Moderate Not related to rest or sleep. Pain controlled by one or more of the following: NSAIDs with no or tolerable side effects, aspirin at regular paracetamol. Pain is constant and interferes with most activities of daily living. Severe Pain at rest or interferes with Pain not controlled, even by narcotic analgesics. Previous non-surgical treatments NSAIDs, paracetamol, aspirin or narcotic analgesics at regular Correctly Done during 6 months with no pain relief; weight control treatment if overweight, physical therapies done. NSAIDs, paracetamol, aspirin or narcotic analgesics at inadequate Incorrectly doses or less than 6 months with no pain relief; or no weight control Done treatment if overweight or no physical therapies done. Functional Limitations Functional capacity adequate to conduct normal activities and Minor Walking capacity of more than one hour. No aids needed. Functional capacity adequate to perform only a few or none of the normal activities and self-care. Moderate Walking capacity of about one half hour. Aids such as a cane are needed. Largely or wholly incapacitated. Walking capacity of less than half hour or unable to walk or Severe bedridden. Aids such as a cane, a walker or a wheelchair are required. Policy statement: Hip Resurfacing Status: Prior Approval
Mild Pain interferes minimally on an intermittent basis with usual daily activities. Not related to rest or sleep. Pain controlled by one or more of the following: NSAIDs with no or tolerable side effects, aspirin at regular doses, paracetamol. Moderate Pain occurs with movement and interferes with usual daily activities. Vigorous activities cannot be performed. Not related to rest or sleep. Pain controlled by one or more of the following: NSAIDs with no or tolerable side effects, aspirin at regular paracetamol. Severe Pain is constant and interferes with most activities of daily living. Pain at rest or interferes with Pain not controlled, even by narcotic analgesics. Previous non-surgical treatments Correctly Done NSAIDs, paracetamol, aspirin or narcotic analgesics at regular during 6 months with no pain relief; weight control treatment if overweight, physical therapies done. Incorrectly Done NSAIDs, paracetamol, aspirin or narcotic analgesics at inadequate doses or less than 6 months with no pain relief; or no weight control treatment if overweight or no physical therapies done. Functional Limitations Minor Functional capacity adequate to conduct normal activities and Walking capacity of more than one hour. No aids needed. Moderate Functional capacity adequate to perform only a few or none of the normal activities and self-care. Walking capacity of about one half hour. Aids such as a cane are needed. Severe Largely or wholly incapacitated. Walking capacity of less than half hour or unable to walk or bedridden. Aids such as a cane, a walker or a wheelchair are required. Policy statement: Hip Resurfacing Status: Prior Approval
Clinical%20Priorities%20Policy%20Version%202%209%20FINAL%20Jan%202018.docx