I. POLICY PURPOSE

The purpose of this policy is to ensure that managed care organization (MCO) staff and BWC staff approve appropriate pre-operative cardiac evaluations for non-cardiac surgery for an allowed condition in an injured worker’s (IW) claim. 

II. APPLICABILITY

This policy applies to BWC staff and MCO staff.

III. DEFINITIONS

None

IV. POLICY

A.    It is the policy of BWC that reasonably necessary, pre-operative cardiac evaluations for an IW requiring non-cardiac surgery for an allowed condition(s) be provided when:

1.    The IW has an underlying and/or pre-existing cardiac condition; or,

2.    There is a concern that the IW may have an undiagnosed underlying cardiac disease.

B.    MCOs shall work with providers if the cardiac evaluation changes the medical management of the IW and leads to specific interventions.

C.   The MCO’s evaluation of whether and to what extent pre-operative cardiac evaluation is reasonably necessary must comply with the Miller policy.

D.   As part of the pre-operative evaluation for a cardiac condition prior to non-cardiac surgery, MCOs may authorize:

1.    A medical history review;

2.    A physical examination;

3.    An electrocardiogram;

4.    An echocardiogram and/or an exercise stress test; or.

5.    In place of an exercise stress test, a chemical stress test when the IW is deemed physically unable to participate in an exercise stress test.

E.    If an equivocal or positive diagnostic test is returned (e.g., “positive” cardiac stress test), the IW and/or another third-party payer shall be responsible for the cost of further diagnostic testing and treatment that is deemed necessary for the purpose of cardiac clearance for surgery.