3rd Quarter 2016 Pain Nav MSK Nursing IRR- Case Study #2

Health Plan: BSC

Request is for 64493 x 1 64494 x 1 64495 x1 (Left L3-S1)

Pt c/o left side LBP. Denies any radiation, numbness, tingling. Pain present x 2 months.

PE: + facet loading.

Pt has failed > 4 weeks conservative treatment with Norco, Lyrica, and HEP. No prior injections.

MRI shows facet arthropathy from L3-S1

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