The Treatment Guidelines are written from a clinical perspective and are intended to guide clinical care.
The Treatment Guidelines (also called Medical Treatment Guidelines, Medical Practice Guidelines or Review Criteria) are evidence based and 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. Other guidelines and 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.
See Conditions and Treatments (Coverage Decisions) for additional information. Providers should consult the Medical Aid Rules and Fee Schedule (MARFS) for documentation and coding requirements.
How to use the guidelines
Health care providers are expected to be familiar with the guidelines and follow the recommendations. Good medical judgment is important in deciding how to use and interpret this information.
Guideline history and development process
See the Guideline Process for background information and a description of how guidelines are prioritized, developed, and implemented. All currently available guidelines are listed individually below.
Conservative Care Resources
Practice resources provide additional clinical perspective and guidance. Their purpose is to provide concise summaries of published clinical and scientific literature regarding the utility and effectiveness of commonly used care approaches for work related conditions. They are intended to inform care options and promote shared decision-making.
High-level information on invasive treatments is included for informational purposes for conservative care providers, but the Treatment Guidelines should be consulted for surgical interventions. Conservative care and practice resources do not change L&I coverage or payment policy.
Treatment Guidelines and Resources
Ankle and Foot
- Ankle and Foot Surgical Guideline
- Conservative Care Options for Work-Related Foot and Ankle Conditions – CME/CE Available
Beryllium
Carpal Tunnel
- Carpal Tunnel Syndrome (CTS) Guideline
- Conservative Care Options for Occupational Carpal Tunnel Syndrome
Cervical Spine
- Cervical Radiculopathy and Myelopathy
- Single Cervical Nerve Root
- see also, Spine for Spinal Injections
Complex Regional Pain Syndrome
Elbow
- Conservative Care Options for Work-Related Epicondylitis / Epicondylosis
- Proximal Median Nerve Entrapment (PMNE)
- Ulnar Neuropathy at the Elbow (UNE) Diagnosis and Treatment
Facet Neurotomy
Knee
- Conservative Care of Occupational Knee Conditions – CME/CE Available
- Knee Surgery – CME/CE Available
Lumbar Spine
- Low Back Pain, Guideline for Hospitalization for
- Lumbar Spine Surgery Guideline – CME/CE Available
- Active Rehabilitation for Work-Related Low Back Conditions – CME/CE Available
- see also, Spine for Spinal Injections
Opioids
Options for Documenting Functional Improvement
- Options for Documenting Functional Improvement in Conservative Care plus Functional Scales – CME/CE Available
Nerve Entrapment
Shoulder
- Shoulder Conditions Diagnosis and Treatment Guideline
- Conservative Care Options for Work-Related Mechanical Shoulder Conditions – CME/CE Available
Spine
- Cervical Radiculopathy and Myelopathy
- Facet Neurotomy
- Low Back Pain, Guideline for Hospitalization for
- Lumbar Spine Surgery Guideline – CME/CE Available
- Single Cervical Nerve Root
- Spinal Injections
Thoracic Outlet Syndrome
Rehabilitation and Recovery
Advanced Imaging Guidance
The Washington Legislature passed a new law in 2009 (ESHB 2105/ Chapter 258, Laws of 2009) that directed the State to convene an Advanced Imaging Management Work Group. The Work Group was directed to identify evidence-based best practice guidelines for advanced imaging; State agencies were directed to implement the Work Group recommendations. Work Group recommendations include:
- Evidence-based checklists for certain high-cost, high-use imaging studies.
- Web-based utilization review.
For information about how to request authorization please see L&I's utilization review information pages.
Advanced Imaging Studies Guidelines
Additional Resources
Optimizing your practice
These resources can decrease the administrative burden and enhance your clinic’s ability to work within the Workers’ Compensation system. They include:
Provider Best Practice Resources
- Documentation Best Practices for Washington State Workers’ Compensation - (3 CE)
- Readiness Assessment Index for Occupational Health Best Practices
Forms for referral and collaboration
- Attending Providers' Referral Practices Quick Reference Card - (3 CE)
- Attending Providers Referral Form (F252-098-000)
- PT/OT Referral Checklist (F245-495-000)
- PT/OT Referral Form (F252-099-000)
Working with employers of injured workers
- Notice to Employer of Injured Worker Assessment & Treatment
This template can be used to notify employers that you are the attending provider for one of their employees for an industrial injury. It lets you document important information and request the employer's assistance with return to work. It also includes useful information for the employer on what to do when they have a claim. - Employer Contact Resource for AP's Office
This workflow table identifies what your office staff and you need to do and document when you have a patient with a new work injury. - Return To Work Assistance For Employers