Physician 2nd Quarter 2016 IRR – Interventional Pain Case Study #4
Coventry Healthcare (MO) Commercial - Use Aetna CPB 0016 as criteria.
Lumbar Facet/Medial branch nerve block and Sacroiliac joint injection – 64493, 64494, 27096
54yoM with request for bilateral L4–5 and L5–S1 facet injection and bilateral sacroiliac joint injection. He has constant 5–10/10 low back pain radiating to the knees for 4 years, which is increased with activity. He has tried PT, chiropractic, massage, and TENS.
Physical examination causes pain with extension and rotation of the spine as well as compression loading of the sacroiliac joints.
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