WSI has developed the below policies, which serve to guide care and outline documentation requirements. A medical provider should be familiar with these policies and follow the recommendations.
The below treatment guidelines are primarily based on ODG by MCG. WSI may incorporate other resources into the development of a policy as appropriate.
WSI adopted ODG by MCG, formerly Work Loss Data Institute’s Official Disability Guidelines (ODG), in July 2005, to use in the utilization review and claim management process. ODG by MCG provides independent, evidence-based medical treatment guidelines for conditions commonly associated with the workplace.
ODG by MCG copyrights the information and consents to WSI publishing the material. No part of the below publications may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. The complete guidelines and referenced materials are available through subscription to ODG by MCG. A provider can subscribe by visiting www.odgbymcg.com or calling 800-488-5548. WSI has negotiated a substantial discount on the annual subscription rate; please reference WSI to learn more and receive the discounted rate.
- Cervical Epidural Steroid Injection
- Chronic Opioid Therapy
- Definitive Drug Testing
- Lumbar Fusion Surgery
- Ongoing Management of Opioids
- Opioid and Benzodiazepine Therapies
- Prior Authorization for Brand Necessary Medications
- Sacroiliac Injections (Diagnostic and Therapeutic)
- Spinal Cord Stimulators for Pain
The below guidelines are primarily based on Centers for Medicare and Medicaid Services (CMS). WSI may incorporate other resources in the development of a policy as appropriate.
- Billing Therapeutic Activities
- Documentation Requirements for Prior Authorization of Therapeutic Injections
- Evaluation and Management Services
- Falsified Medical Records
- Physical and Occupational Therapy Documentation
- Physical Medicine and Rehabilitation Time-Based Services
- Vasopneumatic Device Modality
For additional information on reimbursement, refer to the procedures found in the Billing & Payment section.