Thomas Gugerli, DC FASBE

T1, T2, and STIR sequencing of the cervical, thoracic, and lumbar spinal regions to diagnose herniated, bulged, protruded, and fragmented discs. The clinical necessity and timing of ordering MRI spinal studies.

The morphology of ligaments from the neonate to maturity and the wound repairing process explaining permanency. The functionality and lack thereof with collagen, elastin, and fibroblast in trauma care.

The diagnosis and management of anatomical and biomechanical spine pain using x-ray, MRI, digitizing, and electrodiagnostics to conclude a prognosis and treatment plan. Collaborating with other spinal specialists from the acute stage of care through rehabilitation.

The mechanisms of facet and meniscoid failure with repetitive micro and macro traumas. The central nervous system responses with facet nociceptors and ligamentous mechanoreceptors. The central nervous system’s response as compensation to biomechanical failure.

ICD -10, and CPT cross-coding requirements form the acute stage through rehabilitation, including home care. The documentation of passive vs. active care in chronic and trauma case management.

The Safe Use of X-Ray in a Clinical Setting, Utilizing the guidelines created by the American College of Radiology and the evidence in the scientific literature for case management involving x-ray. Understanding the standards for safe radiation exposure when creating a demonstrative spinal biomechanical diagnosis and ruling out anatomical pathology

The documentation of short and long-term care, including demonstrative validation or spinal pathology in the clinical setting. Connective tissue pathological mechanisms in chronic and traumatic etiology.

The requirements for diagnosing based upon in an initial evaluation and management encounter ranging from a 99202 – 99205 that includes comorbidities, non-musculoskeletal, and sequalae to injury diagnosis.

Diagnosing and Case Management, The requirements for diagnosing imaging inclusive of static x-rays, biomechanical x-rays, and MRI. Documenting the clinical findings of disc bulge, herniation, protrusion, extrusion, and fragmentation. Coding, diagnosing, and documenting individual treatment encounters in the clinical setting.

Elements of Evaluation and Management codes 99202-99203-99204-99205, inclusive of complexity of management and time components. Demonstrative documentation of spinal-related pain generators; spinal cord, thecal sac, myelomalacia, spinal nerve root insult, connective tissue, recurrent meningeal nerves.

Elements of Evaluation and Management codes 99202-99203-99204-99205, inclusive of complexity of management and time components. Demonstrative documentation of spinal-related pain generators; spinal cord, thecal sac, myelomalacia, spinal nerve root insult, connective tissue, recurrent meningeal nerves.

Elements of Evaluation and Management codes 99202-99203-99204-99205, inclusive of complexity of management and time components. Demonstrative documentation of spinal-related pain generators; spinal cord, thecal sac, myelomalacia, spinal nerve root insult, connective tissue, recurrent meningeal nerves.

Protocols and Disc Pathology, Normal anatomy of axial and sagittal views utilizing T1, T2, gradient and STIR sequences of imaging. Degeneration and annular fissures of discs in both trauma and non-trauma patients and the biochemical properties of joints in age dating pathology. Disc bulges from degenerative and sequela to osseous issues, herniation pathology and protrusion, extrusion, migrated and sequestered variations. Clinical scenarios as sequela to disc and pre-existing pathologies. ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences.

Herniated, bulged, extruded, protruded, sequestered and degenerative discs. The morphology of a pathological disc vs. normal morphology and the sequences required including T1, T2 and STIR for all spinal regions. Modic 1-2-3 changes detailed and the traumatic relationship. ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences.

Epidemiology of IVD in asymptomatic cohort, annular tears, HIZs, pathogenesis of IVD healing, IVD nutrition, Modic changes. Research and physiologic rationales related to the effect of trauma and mechanisms of healing affecting the intervertebral disc.