Current through all regulations passed and filed through September 16, 2024
Reimbursement for a spinal cord
stimulator for treatment of allowed conditions in a claim resulting from an
allowed work related injury or occupational disease is limited to claims in
which current best medical practices as implemented by this rule are
followed.
This rule governs the bureau's
reimbursement of a spinal cord stimulator to treat a work related injury or
occupational disease. It is not meant to preclude, or substitute for, the
treating physician's responsibility to exercise sound clinical judgment in
light of current best medical practices when treating injured
workers.
A provider's failure to comply with
this rule may constitute endangerment to the health and safety of injured
workers, and claims involving a spinal cord stimulator not in compliance with
this rule may be subject to peer review by the bureau of workers' compensation
stakeholders' health care quality assurance advisory committee (HCQAAC)
pursuant to rule
4123-6-22 of the Administrative
Code or other peer review committee established by the bureau.
Medical treatment reimbursement
requests (on form C-9 or equivalent) for a spinal cord stimulator are not
subject to dismissal by the MCO pursuant to paragraph (F)(7) of rule
4123-6-16.2 of the
Administrative Code.
(A)
Authorization for a spinal cord stimulator will be
considered only in cases in which the following criteria are met:
(1)
Allowed
conditions. The injured worker has one or more of the following conditions
allowed in their claim:
(a)
Failed thoracic or lumbar spinal
surgery.
(b)
Complex regional pain syndrome.
(c)
Non-operable
peripheral vascular disease/limb ischemia.
(d)
Neuropathic pain
post-thoracic or post-lumbar surgery.
(e)
Chronic thoracic
or lumbar radiculopathy.
(f)
Spinal cord injury dysesthesias.
(2)
Conservative care. The injured worker has undergone at least
sixty days of conservative care, which may include but is not limited to:
(a)
Anti-inflammatory
medication(s) treatment;
(b)
Chiropractic or osteopathic treatment;
(c)
Epidural steroid
injection therapy;
(d)
Pain management program participation;
(e)
Physical medicine
rehabilitation program participation; or
(f)
Physical
therapy.
(3)
Surgeon evaluation. The injured worker has been
personally evaluated by the operating surgeon and undergone a comprehensive
evaluation, in which all of the following have been documented:
(a)
Date of
injury;
(b)
Mechanism of injury;
(c)
Past medical
history, including:
(i)
Prior surgeries;
(ii)
List of current
medical and psychological conditions;
(iii)
List of current
medications;
(iv)
List of drug allergies.
(d)
Physical
examination;
(e)
Pertinent neurological and vascular
testing;
(f)
Completion of a health behavioral assessment and, when
appropriate, identified intervention services;
(g)
Consideration of
vocational rehabilitation services.
(4)
Education. The
injured worker and physician of record, treating physician, or operating
surgeon have reviewed and signed the educational document, "What BWC Wants You
to Know About Spinal Cord Stimulators," attached as an appendix to this
rule.
(5)
Spinal cord stimulator trial. Having met the criteria
outlined in paragraphs (A) (1) to (A)(4) of this rule, and prior to
implantation of a spinal cord stimulator, the injured worker has completed an
approved seven-day spinal cord stimulator trial, with documented improvement in
a majority of the following areas:
(a)
Activities of daily living, documented through use of
an evidence-based tool (e.g., "OSWESTRY Disability Index Questionnaire or
Roland Morris Disability Questionnaire");
(b)
Gait;
(c)
Mood and affect;
(d)
Pain level,
documented through use of an evidence-based pain scale (e.g., visual analog
scale) and a decrease of use of the morphine equivalent dosage of any
pre-procedure opioid analgesic; and
(e)
Sleep.
(B)
BWC will not
reimburse for a spinal cord stimulator:
(1)
For the treatment
of failed cervical spine surgery, neuropathic pain post-cervical surgery, or
cervical radiculopathy;
(2)
When the injured worker has an implanted pacemaker or
defibrillator, metabolic or alcoholic neuropathy, or somatization disorder;
or
(3)
When any of the following documented conditions are
uncontrolled or untreated:
(a)
Substance use disorder;
(b)
Psychois;
or
(c)
Bipolar disorder.
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