W. Va. Code R. § 85-20-39

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 85-20-39 - Treatment Guidelines: Lumbar Fusion

39.1. Indications of compensable lumbar fusion:

a. Injuries to bone or soft tissue that cause instability;

b. For a second or third time disc surgery, the injured worker must have a second medical opinion and prior approval from the Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable.

39.2. Lumbar fusion may also be appropriate treatment for other noncompensable conditions for which treatment will not be authorized:

a. Cancer;

b. Symptomatic spondylolisthesis; and

c. Documented instability for other cause.

d. Degenerative disc disease with pre-operative documentation of instability.

e. Pseudoarthrosis.

39.3. Contraindications for lumbar fusion.

a. Primary surgery for a new, acute disc herniation with unilateral radiation leg pain.

39.4. Surgical procedures.

a. Bony fusion with or without instrumentation. A second concurring surgical opinion must be obtained before surgery unless clear evidence of a medical emergency exist.

W. Va. Code R. § 85-20-39