reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-510 - Lower digestive tract impairments

Current through Register Vol. 24-14, July 15, 2024
(1) Rule for evaluation of permanent lower
				digestive tract impairments.
(a) Categories
				2, 3 and 4 include the presence of complaints of whatever degree.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-520 - Categories of permanent lower digestive tract impairments

Current through Register Vol. 24-14, July 15, 2024
(1) No objective
				findings of impairment of lower digestive tract. Subjective complaints may be
				present or absent.
(2) The
				objective findings of lower digestive tract impairment are infrequent and of
				brief duration, and there is limitation of activities, but special diet or
				medication is not required, and there are neither systemic manifestations nor
				impairment of nutrition.
(3) There
				are objective findings of lower digestive tract impairment or anatomic loss or
				alteration and mild gastrointestinal symptoms with occasional disturbance of
				bowel function, accompanied by moderate pain and minimal restriction of diet;
				mild symptomatic therapy may be necessary; no impairment of
				nutrition.
(4) There are moderate
				to marked intermittent bowel disturbances with continual or periodic pain;
				there is restriction of activities and diet during exacerbations, there are
				constitutional manifestations such as fever, anemia or weight loss. Includes
				but is not limited to any permanent ileostomy or colostomy.
Order 74-32, § 296-20-520, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-530 - Impairment of anal function

Current through Register Vol. 24-14, July 15, 2024
(1) Rule
				for evaluation of permanent impairment of anal function.
(a) Categories 2, 3 and 4 include the
				presence of complaints of whatever degree.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-540 - Categories of permanent impairments of anal function

Current through Register Vol. 24-14, July 15, 2024
(1) No objective findings of impairment of
				anal function. Subjective complaints may be present or absent.
(2) There are objective findings of mild
				organic disease, anatomic loss or alteration with loss of anal function and
				mild incontinence involving gas and/or liquid stool.
(3) There are objective findings of moderate
				anal disease, anatomic loss or alteration with loss of anal function and
				moderate incontinence requiring continual care.
(4) There are objective findings of marked
				anal disease, anatomic loss, alteration and/or complete fecal
				incontinence.
Order 74-32, § 296-20-540, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-550 - Liver and biliary tract impairments

Current through Register Vol. 24-14, July 15, 2024
(1) Rule for evaluation of permanent liver
				and biliary tract impairments.
(a) Categories
				2, 3, 4 and 5 include complaints of whatever degree.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-560 - Categories of permanent liver and biliary tract impairments

Current through Register Vol. 24-14, July 15, 2024
(1) There are no
				objective findings of impairment of the liver or biliary tract. Subjective
				complaints may be present or absent.
(2) There are objective findings on
				biochemical studies of minimal impairment of liver function with or without
				symptoms, or there are occasional episodes of loss of function of the biliary
				tract, but nutrition and strength are good.
(3) There are objective findings on
				biochemical studies of mild impairment of liver function without symptoms, or
				there is recurrent biliary tract impairment, but no ascites, jaundice or
				bleeding esophageal varices and nutrition and strength are good.
(4) There are objective findings on
				biochemical studies of moderate impairment of liver function with jaundice,
				ascites, bleeding esophageal varices or gastric varices and nutrition and
				strength may be affected; or there is irreparable obstruction of the common
				bile duct with recurrent cholangitis.
(5) There are objective findings on
				biochemical studies of marked impairment of liver function and nutritional
				state is poor; or persistent jaundice, bleeding esophageal varices or gastric
				varices.
Order 74-32, § 296-20-560, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-570 - Impairments of the spleen, loss of one kidney, and surgical removal of the bladder with urinary diversion

Current through Register Vol. 24-14, July 15, 2024
(1) Rule
				for evaluation of permanent impairments of the spleen, loss of one kidney, and
				surgical removal of bladder with urinary diversion.
(a) Categories 1, 2 and 3 include complaints
				of whatever degree.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-580 - Categories of permanent impairment of the spleen, loss of one kidney, and surgical removal of bladder with urinary diversion

Current through Register Vol. 24-14, July 15, 2024
(1) Loss of spleen by splenectomy after age
				eight.
(2) Loss of one kidney by
				surgery or complete loss of function of one kidney.
(3) Surgical removal of bladder with urinary
				diversion.
Order 74-32, § 296-20-580, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-590 - Impairment of upper urinary tract

Current through Register Vol. 24-14, July 15, 2024
(1)
				Rule for evaluation of permanent impairment of upper urinary tract.
(a) Categories 2, 3, 4 and 5 include the
				presence of complaints of whatever nature.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-600 - Categories of permanent impairments of upper urinary tract

Current through Register Vol. 24-14, July 15, 2024
(1) No objective
				findings of impairment of upper urinary tract. Subjective complaints may be
				present or absent.
(2) Loss of
				upper urinary function as evidenced by creatinine clearance of 75 to 90
				liters/24 hr. (52 to 62.5 ml/min) and PSP excretion of 15 percent to 20 percent
				in 15 minutes; or if there are intermittent objective findings of upper urinary
				tract disease or dysfunction not requiring continuous treatment or
				surveillance.
(3) Loss of upper
				urinary tract function as evidenced by creatinine clearance of 60 to 75
				liters/24 hr. (42 to 52 ml/min) and PSP excretion of 10 percent to 15 percent
				in 15 minutes; or although function is greater than these levels, there are
				objective findings of upper urinary tract disease or dysfunction requiring
				continuous surveillance and frequent symptomatic treatment.
(4) Loss of upper urinary tract function as
				evidenced by creatinine clearance of 40 to 60 liters/24 hr. (28 to 42 ml/min)
				and PSP excretion of 5 percent to 10 percent in 15 minutes; or although
				function is greater than these levels, there are objective findings of mild or
				moderate upper urinary tract disease or dysfunction which can be only partially
				controlled.
(5) Loss of upper
				urinary tract function as evidenced by creatinine clearance below 40 liters/24
				hr. (28 ml/min) and PSP excretion below 5 percent in 15 minutes; or although
				function is greater than these levels there are objective findings of severe
				upper urinary tract disease or dysfunction which persists despite continuous
				treatment.
Order 74-32, § 296-20-600, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-610 - Additional permanent impairments of upper urinary tract due to surgical diversion

Current through Register Vol. 24-14, July 15, 2024
(1) Rule for
				evaluation of additional permanent impairments of upper urinary tract due to
				surgical diversion.
(a) These categories
				include the presence of complaints of whatever degree.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-620 - Categories of additional permanent impairments of upper urinary tract due to surgical diversion

Current through Register Vol. 24-14, July 15, 2024
(1)
				Uretero-intestinal diversion or cutaneous ureterostomy without
				intubation.
(2) Nephrostomy or
				intubated ureterostomy.
Order 74-32, § 296-20-620, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-630 - Impairment of bladder function

Current through Register Vol. 24-14, July 15, 2024
(1)
				Rules for evaluation of permanent impairment of bladder function.
(a) In making examinations for evaluation of
				impairments of bladder function, physicians shall use objective techniques
				including, but not limited to, cystoscopy, cystography, voiding
				cystourethrography, cystometry, uroflometry, urinalysis and urine
				culture.
(b) Categories 2, 3, 4 and
				5 include the presence of complaints of whatever degree.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-640 - Categories of permanent impairments of bladder function

Current through Register Vol. 24-14, July 15, 2024
(1) No objective findings are present.
				Subjective complaints may be present or absent.
(2) Objective findings of bladder
				dysfunction, intermittent treatment required, but there is no dysfunction
				between such intermittent attacks.
(3) Objective findings of bladder
				dysfunction, continuous treatment required or there is good bladder reflex
				activity but no voluntary control.
(4) Objective findings of bladder
				dysfunction, there is poor reflex activity with intermittent dribbling and no
				voluntary control.
(5) Objective
				findings of bladder dysfunction, there is no reflex or voluntary control and
				there is continuous dribbling.
Order 74-32, § 296-20-640, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-650 - Anatomical or functional loss of testes

Current through Register Vol. 24-14, July 15, 2024
(1) Rule for evaluation of permanent
				anatomical or functional loss of testes.
(a)
				Categories 2, 3, 4 and 5 include the presence of whatever complaints.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-660 - Categories of permanent anatomical or functional loss of testes

Current through Register Vol. 24-14, July 15, 2024
(1) No objective
				findings. Subjective complaints may be present or absent.
(2) Anatomical or functional loss of one
				testicle.
(3) Anatomical or
				functional loss of both testes after the age of 65.
(4) Anatomical or functional loss of both
				testes between the ages of 40 and 65.
(5) Anatomical or functional loss of both
				testes before the age of 40.
Order 74-32, § 296-20-660, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-670 - Disability

Current through Register Vol. 24-14, July 15, 2024
(1) The rules for
				determining disability are as follows:
(a)
				The determination of the percentage of disability in terms of total bodily
				impairment for any category is solely an administrative function and shall be
				done only in accordance with the tables of disability listed in WAC
				296-20-680 and
				296-20-690, or as otherwise
				provided in this chapter.
(b) When
				the industrial injury or occupational disease has caused further impairment to
				a bodily area where permanent bodily impairment existed prior to the industrial
				injury or occupational disease, the department shall award the percentage
				difference between the disability for the category of impairment which
				preexisted the industrial injury or occupational disease and the disability for
				the category of permanent impairment existing after the industrial injury or
				occupational disease.
(c) Neither
				the combined values chart provided in the guides to the evaluation of permanent
				impairment nor any other formula for the combination of the disabilities to
				different body areas or organ systems used in any other nationally recognized
				guide for determining bodily impairments shall be applied in computing the
				amount of disabilities to be awarded under these rules.
(d) Except as otherwise specifically
				provided, a percentage of total bodily impairment in one body area or system
				shall not be added to or combined with a percentage of total bodily impairment
				from another body area or system; the percentages for each body area or system
				shall be stated separately.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-680 - Classification of disabilities in proportion to total bodily impairment

Current through Register Vol. 24-14, July 15, 2024
(1)
Permanent Cervical and Cervico-Dorsal
								Impairments
Category
1
2
3
4
5
0%
10%
20%
25%
35%
(2)
Permanent Dorsal Region Impairments
Category
1
2
3
0%
10%
20%
(3)
Permanent Dorso-Lumbar and Lumbosacral
								Impairments
Category
1
2
3
4
5
6
7
8
0%
5%
10%
15%
25%
40%
60%
75%
(4)
Permanent Impairments of the Pelvis
Category
1
2
3
4
5
6
7
8
9
0%
2%
5%
5%
5%
5%
10%
10%
15%
(5)
Permanent Convulsive Neurologic Impairments
Category
1
2
3
4
0%
10%
35%
60%
(6)
Permanent Mental Health Impairments
Category
1
2
3
4
5
0%
10%
25%
45%
70%
(7)
Permanent Cardiac Impairments
Category
1
2
3
4
5
6
0%
10%
20%
35%
50%
65%
(8)
Permanent Respiratory Impairments
Category
1
2
3
4
5
6
0%
15%
25%
40%
65%
75%
(9)
Permanent Variable Respiratory Impairment with
								Normal Baseline Spirometry
Category
1
2
3
4
0%
5%
10%
15%
(10)
Permanent Air Passage Impairments
Category
1
2
3
4
5
6
0%
5%
15%
25%
35%
60%
(11)
Permanent Air Passage Impairments Due to Nasal
								Septum Perforations
Category
1
2
0%
2%
(12)
Permanent Loss of Taste and Smell
Category
1
2
3%
3%
(13)
Permanent Speech Impairments
Category
1
2
3
4
5
6
0%
5%
10%
20%
30%
35%
(14)
Permanent Skin Impairments
Category
1
2
3
4
5
6
0%
5%
10%
25%
40%
60%
(15)
Permanent Impairments of Upper Digestive Tract,
								Stomach, Esophagus or Pancreas
Category
1
2
3
4
5
0%
5%
10%
35%
60%
(16)
Permanent Impairments of Lower Digestive
								Tract
Category
1
2
3
4
0%
5%
15%
30%
(17)
Permanent Impairments of Anal Function
Category
1
2
3
4
0%
5%
15%
25%
(18)
Permanent Impairments of Liver and Biliary
								Tract
Category
1
2
3
4
5
0%
5%
20%
40%
60%
(19)
Permanent Impairments of the Spleen, Loss of One
								Kidney, and Surgical Removal of Bladder with Urinary Diversion
Category
1
2
3
15%
10%
20%
(20)
Permanent Impairments of Upper Urinary Tract
Category
1
2
3
4
5
0%
10%
25%
45%
65%
(21)
Additional Permanent Impairments of Upper Urinary
								Tract Due to Surgical Diversion
Category
1
2
10%
15%
(22)
Permanent Impairments of Bladder Function
Category
1
2
3
4
5
0%
10%
20%
30%
50%
(23)
Permanent Anatomical or Functional Loss of
								Testes
Category
1
2
3
4
5
0%
5%
10%
25%
35%
Statutory Authority:
					 RCW
					 51.04.020(4),
					 51.04.030 and
					 51.32.080(2).
					 94-03-073, § 296-20-680, filed 1/17/94, effective 3/1/94. Statutory
					 Authority: Chapters 51.04,
					 51.32 and 51.36 RCW. 90-04-007,
					 § 296-20-680, filed 1/26/90, effective 2/26/90. Statutory Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-680, filed 12/23/80, effective 3/1/81;
					 Order 74-32, § 296-20-680, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-690 - Permanent impairments of the cervico-dorsal (WAC 296-20-240) and lumbosacral regions (WAC 296-20-280) jointly

Current through Register Vol. 24-14, July 15, 2024
(1)
Permanent Cervical and Cervicodorsal Impairment
								Category 1 Plus Permanent Dorsolumbar and Lumbosacral Impairment
Category
1
0%
2
5%
3
10%
4
15%
5
25%
6
40%
7
60%
8
75%
(2)
Cervical-Cervicodorsal Category 2 Plus
								Dorsolumbar-Lumbosacral
Category
1
10%
2
15%
3
20%
4
25%
5
35%
6
50%
7
70%
8
75%
(3)
Cervical Cervicodorsal Category 3 Plus
								Dorsolumbar-Lumbosacral
Category
1
20%
2
25%
3
30%
4
35%
5
45%
6
55%
7
70%
8
75%
(4)
Cervical-Cervicodorsal Category 4 Plus
								Dorsolumbar-Lumbosacral
Category
1
25%
2
30%
3
35%
4
40%
5
45%
6
55%
7
70%
8
80%
(5)
Cervical-Cervicodorsal Category 5 Plus
								Dorsolumbar-Lumbosacral
Category
1
35%
2
40%
3
45%
4
50%
5
55%
6
65%
7
70%
8
80%
Order 74-32, § 296-20-690, filed 6/21/74, effective
					 10/1/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-21 - Reimbursement policies: Psychiatric services, biofeedback, physical medicine › SPECIFIC THERAPEUTIC PROCEDURES › Section 296-21-270 - Mental health services

Current through Register Vol. 24-14, July 15, 2024
(1) The following
				rule supplements information contained in the fee schedules regarding coverage
				and reimbursement for mental health services.
(2) Treatment of mental conditions to workers
				is to be goal directed, time limited, intensive, targeted on specific symptoms
				and functional status and limited to conditions caused or aggravated by the
				industrial condition. Specific functional goals of treatment must be identified
				and treatment must have an emphasis on functional, measurable improvement
				towards the specific goals.
(3)
				Mental health services to workers are limited to those provided by
				psychiatrists, doctoral level psychologists, psychiatric advanced registered
				nurse practitioners, licensed independent clinical social workers, licensed
				marriage and family therapists, licensed mental health counselors, and
				according to department policy. Psychiatrists and psychiatric advanced
				registered nurse practitioners may prescribe medications while providing
				concurrent care. For purposes of this rule, the term "mental health services"
				refers to treatment by psychologists, psychiatric advanced registered nurse
				practitioners, psychiatrists, licensed independent clinical social workers,
				licensed marriage and family therapists, and licensed mental health
				counselors.
(4) Initial evaluation,
				and subsequent treatment must be authorized by department staff or the
				self-insurer, as outlined by department policy. The report of initial
				evaluation, including test results, and treatment plan is to be sent to the
				worker's attending provider, as well as to the department or self-insurer. A
				copy of the 60-day narrative reports are to be sent to the department or
				self-insurer and to the attending provider.
(5)
(a) All
				providers are bound by the medical aid rules in chapter 296-20 WAC. Reporting
				requirements are defined in chapter 296-20 WAC. In addition, the following are
				required: Testing results with scores, scales, and profiles; report of raw data
				sufficient to allow reassessment by a panel or independent medical examiner.
				Explanation of the numerical scales is required.
(b) Providers must use the edition of the
Diagnostic and Statistical Manual of Mental Disorders
of the
				American Psychiatric Association designated by the department in the initial
				evaluation, follow-up evaluations and 60-day narrative reports.
(c) A report to the department or
				self-insurer will contain, at least, the following elements:
(i) Subjective complaints;
(ii) Objective observations;
(iii) Identification and measurement of
				target symptoms and functional status;
(iv) Assessment of the worker's condition and
				goals accomplished in relation to the target symptoms and functional status;
				and
(v) Plan of care.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-21 - Reimbursement policies: Psychiatric services, biofeedback, physical medicine › SPECIFIC THERAPEUTIC PROCEDURES › Section 296-21-280 - Biofeedback rules

Current through Register Vol. 24-14, July 15, 2024
Procedures listed in the fee schedules are for use by medical
				  doctors, osteopathic physicians, licensed psychologists and other qualified
				  providers as determined by department policy. All providers of biofeedback are
				  bound by the medical aid rules and fee schedule for biofeedback
				  services.
Administration of biofeedback treatment is limited to those
				  practitioners who are certified by the Biofeedback Certification Institute of
				  America or who meet the minimum education, experience, and training
				  qualifications to be so certified. Those practitioners wishing to administer
				  biofeedback treatment to workers, must submit a copy of their biofeedback
				  certification or supply evidence of their qualifications to the department or
				  self-insurer.
(1) The department will
				authorize biofeedback treatment for the following conditions when accepted
				under the industrial insurance claim:
(a)
				Idiopathic Raynaud's disease;
(b)
				Temporomandibular joint dysfunction;
(c) Myofascial pain dysfunction syndrome
				(MPD);
(d) Tension
				headaches;
(e) Migraine
				headaches;
(f) Tinnitus;
(g) Torticollis;
(h) Neuromuscular reeducation as result of
				neurological damage in CVA or spinal cord injury;
(i) Inflammatory and/or musculoskeletal
				disorders causally related to the accepted condition.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-21 - Reimbursement policies: Psychiatric services, biofeedback, physical medicine › SPECIFIC THERAPEUTIC PROCEDURES › Section 296-21-290 - Physical medicine

Current through Register Vol. 24-14, July 15, 2024
(1)
Whom
				does the department authorize and pay for physical medicine or physical therapy
				services?
The department or self-insurer may authorize and pay for
				  physical medicine services from the following providers:
* A medical or osteopathic physician who is "board certified
				  or board qualified" in the field of physical medicine and rehabilitation;
				  or
* A licensed physical therapist; or
* The injured worker's attending doctor, within the
				  limitations listed below.
The physical medicine services must be personally performed
				  by the:
* Physical medicine and rehabilitation physician; or
* Attending doctor; or
* Licensed physical therapist; or
* Physical therapist assistant employed by and serving under
				  the direction of a licensed physical therapist, physical medicine and
				  rehabilitation physician, or attending doctor as required in
				  RCW
				   18.74.180(3)(a); or
* Licensed athletic trainer employed by and serving under the
				  direction of a licensed physical therapist, physical medicine and
				  rehabilitation physician, or attending doctor as required in
				  RCW
				   18.250.010(4)(a)(v).
Note: Licensed physical therapy provider rules are contained
				  in chapter 296-23 WAC.
(2)
When may the department or self-insurer pay the attending doctor for
				physical medicine services?
The department or self-insurer may pay the
				attending doctor to provide physical medicine modalities and/or procedures in
				the following situations:
(a) The attending
				doctor's scope of practice includes physical medicine modalities and
				procedures.
(b) Only the physical
				medicine modalities and procedures allowed under the department's fee schedules
				and payment policies will be authorized or paid.
(c) No more than six physical medicine visits
				may be authorized and paid to the attending doctor. If the worker requires
				treatment beyond six visits, the worker must be referred to a licensed physical
				therapist or a board certified or qualified physical medicine and
				rehabilitation physician for such treatment. Payments will be made in
				accordance with the department's fee schedules and payment policies.
(d) In remote areas, where no physical
				medicine and rehabilitation specialist, licensed physical therapist or physical
				therapist assistant is available, physical medicine visits required by the
				patient's accepted condition(s) may be authorized and paid to the attending
				doctor. Payments will be made in accordance with the department's fee schedules
				and payment policies.
(e) The
				attending doctor may bill for office visits in addition to the physical
				medicine services only when a separately identifiable office visit service is
				provided in addition to the physical medicine service.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › RADIOLOGY › Section 296-23-135 - General information - Radiology

Current through Register Vol. 24-14, July 15, 2024
(1)
				Rules and billing procedures pertaining to all practitioners rendering services
				to workers are presented in the general instruction section beginning with WAC
				296-20-010.
(2) Billing codes, reimbursement levels, and
				supporting policies are listed in the fee schedules.
(3) Refer to WAC
				296-20-132 and
				296-20-135 for information
				regarding use of the conversion factors.
(4) Refer to the fee schedules for
				information on use of coding modifiers.
(5) The values listed in the fee schedules
				only apply when these services are performed by or under the responsible
				supervision of a doctor.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 94-14-044, § 296-23-135, filed 6/29/94, effective 7/30/94; 93-16-072,
					 § 296-23-135, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › RADIOLOGY › Section 296-23-140 - Custody of X rays

Current through Register Vol. 24-14, July 15, 2024
(1) Radiographs
				should not be sent to the department or self-insurer unless they are requested
				for comparison and interpretation in determining a permanent disability,
				administrative or legal decisions, and for cases in litigation. X rays must be
				retained for a period of ten years by the radiologist or the attending
				doctor.
(2) X rays must be made
				available upon request to consultants, to medical examiners, to the department,
				to self-insurers, and/or the board of industrial insurance appeals.
(3) In cases where the worker transfers from
				one doctor to another, the former attending doctor will immediately forward all
				films in his possession to the new attending doctor.
(4) When a doctor's office is closed because
				of death, retirement, or upon leaving the state, department approved custodial
				arrangements must be made to insure availability on request. If a radiological
				office is closed for any of the previously listed reasons or because the
				partnership or corporation is being dissolved, disposition of X rays for
				industrial injuries will be handled in the same manner. In the event custodial
				arrangements are to be made, the department must approve the arrangements prior
				to transfer of X rays to the custodian so as to assure their availability to
				the department or self-insurer upon request.
(5) Refer to chapter 296-20 WAC (including
				WAC 296-20-125)  and to chapter
				296-21 WAC for additional information.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-140, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › RADIOLOGY › Section 296-23-145 - Duplication of X rays and extra views

Current through Register Vol. 24-14, July 15, 2024
Every attempt should be made to minimize the number of X rays
				  taken for workers. The attending doctor or any other person or institution
				  having possession of X rays which pertain to the injury and are deemed to be
				  needed for diagnostic or treatment purposes should make these X rays available
				  upon request.
The department or self-insurer will not authorize or pay for
				  additional X rays when recent X rays are available except when presented with
				  adequate information regarding the need to re-X ray.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-145, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › PATHOLOGY › Section 296-23-155 - Pathology general information and instructions

Current through Register Vol. 24-14, July 15, 2024
(1) Rules and billing procedures pertaining
				to all practitioners rendering service to workers are presented in general
				information section beginning with WAC
				296-20-010.
(2) Refer to WAC
				296-20-132 and
				296-20-135 for information
				regarding use of the conversion factors.
(3) Refer to the fee schedules for
				information on use of coding modifiers.
(4) Billing codes, reimbursement levels, and
				supporting policies are listed in the fee schedules.
(5) The reimbursement levels listed in the
				fee schedules apply only when the services are performed by or under the
				responsible supervision of a physician. Unless otherwise specified, the listed
				values include the collection and handling of the specimens by the laboratory
				performing the procedure. SERVICES IN PATHOLOGY AND LABORATORY are provided by
				the pathologist or by technologists under responsible supervision of a
				physician.
(6) Laboratory
				procedures performed by other than the billing physician shall be billed at the
				value charged that physician by the reference (outside) laboratory under the
				individual procedure number or the panel procedure number listed under "PANEL
				OR PROFILE TESTS" (see modifier -90).
(7) The department or self-insurer may deny
				payment for lab procedures which are determined to be excessive or unnecessary
				for management of the injury or conditions.
(8) Separate or multiple procedures: It is
				appropriate to designate multiple procedures that are rendered on the same date
				by separate entries.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 94-14-044, § 296-23-155, filed 6/29/94, effective 7/30/94; 93-16-072,
					 § 296-23-155, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › DENTAL › Section 296-23-160 - General information and instructions

Current through Register Vol. 24-14, July 15, 2024
(1) The department or self-insurer is
				responsible only for repair or replacement of teeth injured or prosthodontics
				broken as a result of an industrial injury.
(2) Information pertaining to industrial
				claims is explained in WAC
				296-20-010.
(3) Information pertaining to reports of
				accident is outlined in WAC
				296-20-025.
(4) Information pertaining to the care of
				workers is explained in WAC
				296-20-110.
(5) An estimate of cost is not needed prior
				to authorization of dental work unless indicated due to the extensive nature of
				the dental work. The department or self-insurer reserves the right to review
				all charges billed.
(6) Billing
				instructions are listed in WAC
				296-20-125. Bills for services
				must be itemized, specifying tooth numbers and materials used. No services will
				be paid on rejected or closed claims except those rendered in conjunction with
				a reopening application.
(7)
				Billing codes, billing modifiers, reimbursement levels, and supporting policies
				are listed in the fee schedules.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-160, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › MISCELLANEOUS SERVICES AND APPLIANCES › Section 296-23-165 - Miscellaneous services and appliances

Current through Register Vol. 24-14, July 15, 2024
(1)
				The department or self-insurer will reimburse for certain proper and necessary
				miscellaneous services and items needed as a result of an industrial accident.
				Nursing care, attendant services, transportation, hearing aids, eyeglasses,
				orthotics and prosthetics, braces, medical supplies, oxygen systems, walking
				aids, and durable medical equipment are included in this classification.
(a) When a fee maximum has been established,
				the rate of reimbursement for miscellaneous services and items will be the
				supplier's usual and customary charge or the department's current fee maximum,
				whichever is less. In no case may a supplier or provider charge a worker the
				difference between the fee maximum and their usual and customary
				charge.
(b) When the department or
				self-insurer has established a purchasing contract with a qualified supplier
				through an open competitive request for proposal process, the department or
				self-insurer will require that workers obtain specific groups of items from the
				contractor. When items are obtained from a contractor, the contractor will be
				paid at the rates established in the contract. When a purchasing contract for a
				selected group of items exists, suppliers who are not named in the contract
				will be denied reimbursement if they provide a contracted item to a worker. The
				noncontracting supplier, not the worker, will be financially responsible for
				providing an item to a worker when it should have been supplied by a
				contractor. This rule may be waived by an authorized representative of the
				department or self-insurer in special cases where a worker's attending doctor
				recommends that an item be obtained from another source for medical reasons or
				reasons of availability. In such cases, the department may authorize
				reimbursement to a supplier who is not named in a contract. Items or services
				may be provided on an emergency basis without prior authorization, but will be
				reviewed for appropriateness to the accepted industrial condition and medical
				necessity on a retrospective basis.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › MISCELLANEOUS SERVICES AND APPLIANCES › Section 296-23-180 - Vehicle and home modification

Current through Register Vol. 24-14, July 15, 2024
Requires prior approval from the assistant director for
				  industrial insurance.
Statutory Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 96-10-086, §
					 296-23-180, filed 5/1/96, effective 7/1/96. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-180, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › CHIROPRACTIC › Section 296-23-195 - Chiropractic consultations

Current through Register Vol. 24-14, July 15, 2024
See WAC
				  296-20-035,
				  296-20-045, and
				  296-20-051 for rules pertaining
				  to consultation.
Chiropractic consultation requires prior notification to the
				  department or self-insurer. Consultants must be from an approved list of
				  chiropractic consultants.
The codes and reimbursement levels for chiropractic
				  consultations services are listed in the fee schedules.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-195, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › NATUROPATHIC PHYSICIANS › Section 296-23-205 - General instructions-Naturopathic physicians

Current through Register Vol. 24-14, July 15, 2024
General instructions for naturopathic physicians:
(1) Refer to WAC
				296-20-010 through
				296-20-125 for general rules and
				billing procedures including, but not limited to:
(a) WAC
				296-20-06101 for reporting
				requirements.
(b) WAC 296-20-01002
				for the definition of "proper and necessary" health care services.
(c) WAC
				296-20-03002 for treatment not
				authorized by the department.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › NATUROPATHIC PHYSICIANS › Section 296-23-215

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-215, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › OCCUPATIONAL THERAPY › Section 296-23-235 - Work hardening

Current through Register Vol. 24-14, July 15, 2024
The department will publish billing instructions,
				  reimbursement limits, quality assurance standards, utilization review
				  guidelines, admission criteria, outcome criteria, measures of effectiveness,
				  minimum staffing levels, certification requirements, special reporting
				  requirements, and other criteria that will ensure workers receive good quality
				  services at cost-effective payment levels. Providers will be required to meet
				  the department's requirements in order to qualify as a work hardening provider.
				  The department may also establish a competitive or other appropriate selection
				  process for work hardening providers. Providers should refer to WAC
				  296-20-12050 regarding special
				  programs.
Billing codes, reimbursement levels, and supporting policies
				  for work hardening services are listed in the fee schedules.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-235, filed 8/1/93, effective
					 9/1/93.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › OCCUPATIONAL THERAPY › Section 296-23-238 - Acupuncture rules

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				or self-insurer may pay for acupuncture treatment when ordered by the worker's
				attending provider or physician assistant and only for specific conditions
				related to the accepted condition on a claim and per department
				policy.
(2) For the purposes of
				this section, "acupuncture" is the insertion of needles or lancets, with or
				without electrical stimulation, to directly or indirectly stimulate acupuncture
				points and meridians.
(3) The
				department may amend the list of covered conditions for acupuncture treatment
				as documented in the medical coverage decision on acupuncture.
(4) Acupuncture services may be administered
				by a provider acting within the scope of their licensure.
(5) The department or self-insurer will pay
				for a maximum of one acupuncture treatment per day for not more than ten visits
				per worker's compensation claim.
(6) The acupuncture provider must submit
				documentation of functional status to the attending provider and the department
				or the self-insurer at baseline, at the middle visit and following the end of
				treatment or ten visits, whichever comes first. Providers must use validated
				instruments per department policy to track and document the worker's pain and
				functional status during the course of acupuncture treatment.
(7) The department or self-insurer may review
				the quality of acupuncture services provided to workers.
(8) Providers should refer to WAC
				296-20-01002 for the
				definition of "proper and necessary treatment." See WAC
				296-20-010
				for general information and WAC
				296-20-125 for
				billing procedures.
(9) Billing
				codes, reimbursement levels and payment policies for acupuncture are listed in
				the department's
Medical Aid Rules and Fee
				Schedules
.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › NURSING › Section 296-23-240 - Licensed nursing rules

Current through Register Vol. 24-14, July 15, 2024
(1) Registered
				nurses and licensed practical nurses may perform private duty nursing care in
				industrial injury cases when the attending physician deems this care necessary.
				Registered nurses may be reimbursed for services as outlined by department
				policy. (See chapter 296-20 WAC for home nursing rules.)
(2) Advanced registered nurse practitioners
				(ARNPs) may perform advanced and specialized levels of nursing care on a fee
				for service basis in industrial injury cases within the limitations of this
				section. ARNPs may be reimbursed for services as outlined by department
				policy.
(3) In order to treat
				workers under the Industrial Insurance Act, the advanced registered nurse
				practitioner must be:
(a) Recognized by the
				Washington state board of nursing or other government agency as an advanced
				registered nurse practitioner (ARNP). For out-of-state nurses an equivalent
				title and training may be approved at the department's discretion.
(b) Capable of providing the department with
				evidence and documentation of a reliable and rapid system of obtaining
				physician consultations.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › NURSING › Section 296-23-241 - Advanced registered nurse practitioners

Current through Register Vol. 24-14, July 15, 2024
(1) Advanced registered nurse practitioners
				(ARNPs) may independently perform the functions of an attending provider under
				the Industrial Insurance Act, with the exception of rating permanent
				impairment. These functions are referenced in the medical aid rules as those of
				an attending or treating provider, and include, but are not limited to:
Completing and signing the report of accident or provider's
				  initial report, where applicable;
Certifying time-loss compensation;
Completing and submitting all required or requested
				  reports;
Referring workers for consultations;
Performing consultations;
Facilitating early return to work offered by and performed
				  for the employer(s) of record;
Doing all that is possible to expedite the vocational
				  process, including making an estimate of the worker's physical or mental
				  capacities that affect the worker's employability.
(2) Psychiatric advanced registered nurse
				practitioners can provide psychiatric services as defined in WAC
				296-21-270.
(3) ARNPs can state whether a worker has
				permanent impairment, such as on the department's activity prescription form
				(APF). ARNPs cannot rate permanent impairment or perform independent medical
				examinations (IMEs).
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030. 09-14-104, §
					 296-23-241, filed 6/30/09, effective 7/31/09. Statutory Authority: 2007 c 275,
					 RCW
					  51.04.020 and
					 51.04.030. 08-04-094, §
					 296-23-241, filed 2/5/08, effective 2/22/08. Statutory Authority: 2004 c 65 and
					 2004 c 163. 04-22-085, § 296-23-241, filed 11/2/04, effective
					 12/15/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › NURSING › Section 296-23-245 - Licensed nursing billing instructions

Current through Register Vol. 24-14, July 15, 2024
(1) Registered nurses may be required to
				obtain provider account numbers from the department as outlined by department
				policy.
(2) Advanced registered
				nurse practitioners must obtain provider account numbers from the
				department.
(3) Refer to WAC
				296-20-132 and
				296-20-135 for information
				regarding the conversion factors.
(4) Refer to the department's billing
				instructions for additional information.
(5) Services performed by advanced registered
				nurse practitioners must be billed using the appropriate procedure code number
				listed in the fee schedules preceded by a Type of Service Code "N."
(6) Refer to WAC 296-20-303 for rules
				regarding home attendant services.
Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.32.060,
					 51.32.072, and
					 7.68.070. 01-18-041, §
					 296-23-245, filed 8/29/01, effective 10/1/01. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-23-245, filed 8/1/93, effective
					 9/1/93.