Washington State Workers Comp medial branch and RFA rules

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Ligament

Interventional Pain Management
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No oral analgesics for 4 hours pre-op
No IV Sedation
Patient must have at least 4/10 pain pre-op

Cervical:
Patient MUST have 100% time concordant anesthetic phase pain relief from MBB x 2 for 6 hours.
--99% mbb pain relief? No RFA for you!
Only on joint per side may be treated total.
--more than one joint painful? to freaking bad!
C2/3 TON is not allowed!

Lumbar:
Patient MUST have 80% time concordant anesthetic phase pain relief

See attached guidelines

This state is a real shame.

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Attachments

  • Facet Neurotomy Guideline-2.pdf
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Last edited:
No oral analgesics for 4 hours pre-op
No IV Sedation
Patient must have at least 4/10 pain pre-op

Cervical:
Patient MUST have 100% time concordant anesthetic phase pain relief from MBB x 2 for 6 hours.
--99% mbb pain relief? No RFA for you!
Only on joint per side may be treated total.
--more than one joint painful? to freaking bad!
C2/3 TON is not allowed!

Lumbar:
Patient MUST have 80% time concordant anesthetic phase pain relief

See attached guidelines

This state is a real shame.

What will this do to payments?
 
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What will this do to payments?

In the sense that nobody will tolerate MBBs cause they may be in opioid withdrawal and can't have IV sedation, and won't qualify for RFA because they only had 95% relief during the anesthetic phase, it will decrease payments.

Fortunately I do not have a large L&I population, but its still a loss.
 
It will never be covered. Every 15 min for 6 hours

Complete shame and a slap in the face to the profession



Documentation of pain relief should
be a patient-generated report in real
time, every 15 minutes for the first
six hours following the block. The
documentation tool is included in
this guideline (Pain Relief Diary)
x Duration of pain relief should be
consistent with the expected duration
of the local anesthetic injected
 
The only way to take down these insurance companies is when no doctor sees their patients. Opt out if you can. There's no point in working for free.

That's our only shot. Narrow down their networks so thin, that their insurance has no value, and it hurts their pocket book, and eventually go out of business.
 
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