Ohio BWC's new rule for low back fusion surgery

Date: January 03, 2018

Guest Column from our Partner Bricker & Eckler LLP

Authors Sue Roudebush, 614.227.7744, [email protected] and Nick Lanphear, 614.227.2306, [email protected]

Effective January 1, 2018, the Ohio Bureau of Workers’ Compensation (BWC) has a new rule for when injured workers can request lumbar fusion surgery, as well as requirements that must be met prior to seeking authorization for such a procedure – Ohio Administrative Code § 4123-6-32 Payment for Lumbar Fusion Surgery.

This rule was created, in part, as a response to the current opiate crisis that exists in Ohio. According to the BWC, 68 percent of lumbar fusion surgeries are unsuccessful. This leaves the majority of injured workers who utilize this type of treatment unhappy and dependent on pain killers, such as opioids. In an effort to reduce this risk, the BWC is requiring injured workers to engage in conservative care management for at least 60 days, except in specific cases. It is hoped that this approach will enable workers with low back pain to benefit from non-surgical interventions and return to work more quickly, reserving lumbar fusion surgery for only the few that require it.

The new rule, which deals only with lumbar fusion surgeries, sets forth best practices which must be met by medical providers if reimbursement for the procedure will be sought through the BWC. This includes conservative care prior to a request for the surgery, as well as documented, continued follow-up care.

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