Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) listed the “health care provider performing spinal hardware removal” as one of the review categories for the Calendar Year (CY) 2013 Medical Quality Review Annual Audit Plan (Audit Plan). After much consideration and further research into the available data, the Office of the Medical Advisor has recommended that this category be deleted from the CY 2013 Audit Plan. The Commissioner of Workers’ Compensation Rod Bordelon has approved the Medical Advisor’s recommendation.
While there remains a concern as to the medical necessity of many of these procedures, the data available to select workers’ compensation system participants indicates that a relatively small number of these spinal hardware removal procedures have been performed. Coupled with the challenge of obtaining multiple serial quality imaging studies from numerous sources, together with matching contemporary clinical records, it has been determined that resources would be better used in other ongoing and future plan-based audits to have a more meaningful overall impact in monitoring the workers’ compensation system.