Medical Treatment Guidelines

Medical Treatment Guidelines
The Medical Treatment Guidelines (also called Medical Practice Guidelines or Review Criteria) are evidence based and were developed by the Office of the Medical Director in collaboration with practicing physicians and advisors.

Some guidelines are intended to be educational tools for medical providers. Some guidelines and the review criteria are used by L&I in the Utilization Review program and claim management process to promote best practices and improve the health of injured workers. They are published by L&I, which is solely responsible for coverage decisions that may result from their use.

How to use the guidelines
Although doctors are expected to be familiar with the guidelines and follow the recommendations, L&I also understands that guidelines are not hard-and-fast rules. Good medical judgment is important in deciding how to use and interpret this information.

Guideline history and development process
See the Guideline Process (33 KB PDF) for background information and a description of how guidelines are prioritized, developed, and implemented. The book of Medical Treatment Guidelines (F252-010-000) (673 KB PDF / 4 min) is outdated and is available for archival reference only. For the most current versions of the various sections please check the individual listings and effective dates below.

Medical Treatment Guidelines [NEW GUIDELINES ONLY]

1. Acute Cauda Equina Syndrome (CES) (112 KB PDF). (Effective August 1, 2009)
http://www.lni.wa.gov/ClaimsIns/Files/OMD/CESGuidelineFinal.pdf

2. Ankle/Foot Surgery (31 KB PDF).
3. Antiepileptic drugs guideline for chronic pain (22 KB PDF).
4. Carpal Tunnel Syndrome (CTS) Guideline (267 KB PDF).
5. Cervical Nerve Root, Single (28 KB PDF).
6. Cervical or Lumbar Facet Neurontomy, Criteria for (73 KB PDF).
7. Chronic Pain Clinic Treatment, Review Criteria for Inpatient (19 KB PDF).
8. Complex Regional Pain Syndrome (CRPS) (57 KB PDF).
9. Controlled Substances (61 KB PDF).
10. Facet Neurotomy (73 KB PDF).
11. Fibromyalgia (41 KB PDF).
12. Knee Surgery (73 KB PDF).
13. Low Back Pain, Guideline for Hospitalization for (40 KB PDF).
14. Lumbar Fusion, Guidelines for (Arthrodesis) (36 KB PDF). (Effective November 1, 2009)
http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/LumbarFusion.pdf

15. Lumbar Nerve Root , Single (Lumbar Laminectomy) (20 KB PDF).
16. Lumbar Spine, MRI of the (14 KB PDF).
17. Outpatient Prescription of Oral Opioids for Chronic, Noncancer Pain (193 KB PDF).
18. Porphyria (30 KB PDF).
19. Proximal Median Nerve Entrapment (PMNE) (150 KB PDF).(Effective August 1, 2009)
http://www.lni.wa.gov/ClaimsIns/Files/OMD/PMNEFinalGuideline.pdf

20. Psychiatric Conditions (53 KB PDF).
21. Shoulder Surgery, Criteria for (49 KB PDF).
22. Thoracic Outlet Surgery (26 KB PDF).
23. Work-Related Radial Nerve Entrapment: Diagnosis and Treatment (152 KB PDF). (Effective April 1, 2010)
http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/RNEGuideline.pdf

24. Work-Related Ulnar Neuropathy at the Elbow (UNE) Diagnosis and Treatment (167 KB PDF). (Effective January 1, 2010)
http://www.lni.wa.gov/ClaimsIns/Files/OMD/UNEFinalGuideline102609.pdf

For questions about these guidelines or the guideline development process, please contact:

Simone P. Javaher, ONC
E-mail: stil235@LNI.wa.gov
Phone: 360-902-5762.

to see or download full-text of all guidelines, please click below:
http://www.lni.wa.gov/ClaimsIns/Providers/Treatment/TreatGuide/