Provider Newsletter - June 2013

Provider News

This is a periodic roundup of L&I news for medical providers. To subscribe by email, join our Medical Provider News email list.

You can also read previous Provider News editions.

In the Provider News for June 2013:

Ready, set: L&I's new opioid guideline is effective July 1, 2013

Here’s a summary of the changes to coverage and authorization processes. You can find the guideline, forms, and tools at

Image of bottle of opioid pills

Coverage limits after July 1, 2013

  • Opioids will be covered for up to 6 weeks after an injury or surgery.
  • Prescribing opioids longer than 6 weeks requires prior authorization, which will be given only when:
    • The worker has had clinically meaningful improvements in function and pain during acute phase, AND
    • The provider has performed recommended screening and assessments, AND
    • The screenings show that the worker has low risk for complications from opioid therapy, AND
    • All of the above is documented on the opioid request form.
  • Prescriptions for opioids will have a 28-day supply limit. Prescribing in multiples of 7-day supplies reduces the incidence of supply ending on a weekend.
  • In general, opioids will not be covered beyond the acute phase for workers who were on chronic opioid therapy at the time of the injury.
  • Long-acting opioids will not be covered for acute pain from injury or surgery and the department will no longer participate in the state’s preferred drug list (PDL) for this drug class.
  • Concurrent use of opioids with benzodiazepines is generally not recommended.  Benzodiazepine coverage beyond 30 days will require prior authorization.
  • Any opioid dose increase will need to result in clinically meaningful improvement in function.

How providers can prepare

  • Review the guideline.
  • If you plan to continue prescribing opioids for a worker, request authorization at least 2 weeks before the authorization period ends.
  • Assess pain and function at each visit.
  • Familiarize yourself with the screening tools recommended in the guideline, or, if you prefer other tools, make sure they are validated and meet the requirements for assessing risk.
  • Discuss the guidelines and rules with your patients, emphasizing the ongoing monitoring required for chronic opioid therapy.

Billing codes

As before, we will pay you for your time completing the requirements for authorization. We encourage you to submit copies of all required screenings along with the Subacute Opioid Request Form for increased reimbursement. You will be using billing codes 1076M, 1077M and 1078M; see the authorization forms for instructions.


About authorization
Contact the claim manager or, for self-insured claims, the employer. Get contact information at

About policy
Contact L&I's pharmacy manager at

L&I's FindADoc application receives award

Screenshot of the Find-a-Doc application in use

Your injured worker patients now have an easier time finding their way to your office, thanks to an improved mapping feature in L&I’s Find a Doctor website that was debuted in Oct 2012.  The L&I project that improved the FindADoc application is receiving an award for outstanding work with Geographic Information Systems (GIS) technology.

Prior to the improvement, FindADoc calculated trip miles from point to point, often described as "as the crow flies." The system sometimes gave confusing information to injured workers based on incorrect travel distances.  The application now shows realistic distances and travel routes from an injured worker's address to a provider's office.

The FindADoc project shares the award with another L&I project which improved efficiency for construction compliance inspectors. The award comes from Esri, an international company with 40% of the world's market share for GIS products. Esri reviewed 100,000 projects and will present 175 awards in San Diego in July.

This award is an example of Washington State's leadership in using technology to improve the way we do business. L&I’s mapping innovation is already moving to other Washington agencies.

Update on L&I's Stay at Work program

We value your help in getting injured workers back on the job. As you know, employers sometimes need help understanding how to create light-duty jobs and why they are worth the effort.

Here’s an educational video that we’ve created to let employers know that Stay at Work is a great program that will help them get injured workers back on the job. Watch how a Tacoma roofing company helps a valued employee recover:

Can't see the video? Watch it on YouTube.

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