WSR 11-04-060

INTERPRETIVE AND POLICY STATEMENT

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed January 27, 2011, 10:15 a.m. ]

Pursuant to RCW 34.05.230, following are policy and interpretive statements issued by the department regarding the insurance services division policies.

If you have any questions or need additional information, please call Tamara Jones at (360) 902-6805.


Insurance Services Division: Office of the Medical Director.

New Provider Bulletin 09-07: Comprehensive Treatment for Chronic Noncancer Pain.

To explain the revisions the department is making to its policies concerning the treatment of injured workers with chronic pain management issues, this provider bulletin:


Explains that injured workers may be evaluated for and enrolled in a comprehensive treatment program for chronic noncancer pain if it meets the definition of a structured intensive, multidisciplinary program (SIMP).

Explains special conditions and requirements applying to workers considering having lumbar fusion or lumbar intervertebral artificial disc replacement due to uncomplicated degenerative disc disease.

Explains that prior authorization is required to participate in a structured intensive, multidisciplinary program.

Explains billing rules for structured intensive, multidisciplinary program.


Contact Bob Mayer, P.O. Box 44322, Olympia, WA 98504, (360) 902-6500, mayr235@lni.wa.gov.


Insurance Services Division: Office of the Medical Director, Claims Administration, and Self-Insurance.

New Provider Bulletin 09-08: Influenza Claims.

This provider bulletin explains when a claim for exposure to and/or contraction of influenza is considered to be an allowable workers' compensation claim. It also describes what treatment and testing may be authorized by the insurer for high-risk patients in accordance with the Centers for Disease Control and Prevention (CDC) recommendations.

Contact Jami Lifka, P.O. Box 44321, Olympia, WA 98504, (360) 902-4941, Jami.Lifka@lni.wa.gov.


Insurance Services Division: Office of the Medical Director, Claims Administration, Self-Insurance, and Crime Victims Compensation.

New Provider Bulletin 09-09: Work-Related Ulnar Neuropathy at the Elbow (UNE) Diagnosis and Treatment.

This provider bulletin explains review criteria for the diagnosis and treatment of ulnar neuropathy at the elbow. It also explains that request for surgery due to ulnar neuropathy at the elbow requires prior authorization.

Contact Simone P. Javaher, BSN, MPA, P.O. Box 44321, Olympia, WA 98504, (360) 902-5762, Simone.Javaher@lni.wa.gov.


Insurance Services Division: Office of the Medical Director, Claims Administration, Self-Insurance, and Crime Victims Compensation.

New Provider Bulletin 09-10: Quantitative Sensory Testing (QST).

This provider bulletin implements noncoverage of certain medical tests described or defined as quantitative sensory tests. It expands and further defines noncoverage of these tests. Prior policy of some quantitative sensory tests was published in Provider Bulletin 04-06, Electrodiagnostic Sensory Nerve Conduction Threshold Testing.

Contact Josh Morse, P.O. Box 44321, Olympia, WA 98504, (360) 902-5026, mojo235@lni.wa.gov.


Insurance Services Division: Office of the Medical Director, Claims Administration, Self-Insurance, and Crime Victims Compensation.

New Provider Bulletin 09-11: Bone Growth Stimulators.

Effective January 15, 2010, bone growth stimulation is a covered service for state fund, self-insured, and crime victims claims consistent with the health technology clinical committee's determination dated October 30, 2009. This policy explains covered and noncovered conditions. It also explains that all requests for bone growth stimulators require prior authorization.

Contact Josh Morse, P.O. Box 44321, Olympia, WA 98504, (360) 902-5026, mojo235@lni.wa.gov.


Insurance Services Division: Office of the Medical Director.

New Provider Bulletin 10-02: Work-Related Radial Nerve Entrapment (RNE) Diagnosis and Treatment.

This provider bulletin provides notice of a new medical treatment guideline for work-related radial nerve entrapment. The guideline is an educational resource for providers who treat injured workers in the Washington workers' compensation system under Title 51 RCW. The complete guideline is posted at http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/RNEGuideline.pdf.

This guideline was developed in 2010 by the Washington state industrial insurance medical advisory committee (IIMAC) and its subcommittee on upper extremity entrapment neuropathies. The subcommittee presented its work to the full IIMAC, and the IIMAC made an advisory recommendation to the Washington state department of labor and industries to adopt the guideline.

The guideline highlights the following information:


The most recent available scientific literature was reviewed.

A provisional diagnosis can be made based on the worker's history and physical.

A confirmed diagnosis requires an abnormal electrodiagnostic test result.

Surgery will not be authorized without a confirmed diagnosis.

A summary table with review criteria is included.


Contact Simone P. Javaher, BSN, MPA, P.O. Box 44321, Olympia, WA 98504, (360) 902-5762, Simone.Javaher@lni.wa.gov.


Insurance Services Division: Office of the Medical Director.

New Provider Bulletin 10-04: Medical and Surgical Supply Coverage and Payment Policy.

This provider bulletin describes the department's new medical and surgical supply program. The new medical and surgical supply program changes the way the department pays for purchased medical and surgical supplies. This bulletin pertains to claims made against both the state fund and self-insured employers (insurers) and to the crime victims compensation program. The authority for payment of medical and surgical supplies is found in RCW 51.04.030 and WAC 296-23-165.

Effective July 1, 2010, medical and surgical supplies will be paid at maximum fee schedule.

This bulletin states:


Policies for the purchase of all HCPCS 'A' codes between A4206-A9999.

Which medical surgical supplies require prior authorization.

Which HCPCS 'A' codes are noncovered.

The billing rules.


Contact Aaron Huff, BS, CHES, P.O. Box 44322, Olympia, WA 98504, (360) 902-4259, hufa235@lni.wa.gov.


Insurance Services Division: Office of the Medical Director.

New Provider Bulletin 10-05: Work-Related Neurogenic Thoracic Outlet Syndrome Diagnosis and Treatment.

This provider bulletin provides notice of a new medical treatment guideline for neurogenic thoracic outlet syndrome. The guideline is an educational resource for providers who treat injured workers in the Washington workers' compensation system under Title 51 RCW. The complete guideline is posted at http://www.lni.wa.gov/ClaimsIns/Providers/Treatment/TreatGuide/default.asp.

This guideline was developed in 2010 by the Washington state industrial insurance medical advisory committee (IIMAC) and its subcommittee on upper extremity entrapment neuropathies. The subcommittee presented its work to the full IIMAC, and the IIMAC voted with full consensus to advise that the Washington state department of labor and industries adopt the guideline. This guideline is based on the best available clinical and scientific evidence from a systematic review of the literature and a consensus of expert opinion.

The guideline highlights the following information:


References for the most recent available scientific literature are included.

A provisional diagnosis can be made based on the worker's history and physical.

A confirmed diagnosis requires abnormal electrodiagnostic test results.

Surgery will not be authorized without a confirmed diagnosis.

A summary table with review criteria is included.


Contact Simone P. Javaher, BSN, MPA, P.O. Box 44321, Olympia, WA 98504, (360) 902-5762, Simone.Javaher@lni.wa.gov.


Insurance Services Division: Employer Services Program.

New Policy 63.06: Entity Conversions for Foreign Corporations.

This policy applies when a corporation registered in another state is allowed to convert to a different entity in that state. Conversion acts allow a registered corporation to convert directly to another entity without changing their obligations to third parties.

Contact Sandra Craypo, P.O. Box 44162, Olympia, WA 98504, (360) 902-4741, rivt235@lni.wa.gov.

Washington State Code Reviser's Office