Per the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC):
On November 20, 2017, The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) solicited and received constructive input from workers’ compensation system participants on the proposed Lumbar Spine Magnetic Resonance Imaging (MRI) Plan-Based Audit (Plan-Based Audit). TDI-DWC appreciates the input provided by system participants. All comments were carefully considered and discussed. The Commissioner of Workers’ Compensation W. Ryan Brannan, approved the Plan-Based Audit on January 23, 2018.
All medical quality reviews initiated on or after January 1, 2018, will follow the approved Medical Quality Review Process (Process) in effect. The Process and Plan-Based Audit are posted on the TDI website here.
Joseph Mathews, who serves as the practice administrator representative on TOA’s board of directors, provided the following summary:
ODG (Official Disability Guidelines) does not recommend MRI for uncomplicated low back pain, with radiculopathy, until after at least one month of conservative therapy unless symptoms of a severe or progressive neurologic deficit were present.
- Select 10 health care practitioners who ordered the highest number of lumbar spine MRIs prior to 30 days from the date of injury from July 1, 2015 through June 30, 2017.
- In the event of a tie, select the health care practitioner with the highest billed amount.
Purpose for Plan-Based Audit
Evaluate the appropriateness of a doctor’s decision and recordkeeping that supports the ordering of lumbar spine magnetic resonance image (MRI) prior to one month of conservative therapy.
Click here to read complete details from TDI-DWC.