4th Qtr 2016 Physician MSK (IP) Case Study#4
39yof-Cervical Facet blocks (64490), (64491), (64492)
Coventry Healthcare (Aetna) FL
Medicare LCD 33930
Request for a left C 4 -5, C 5 – 6 and C 6 – 7 facet injection.
C/O left neck pain radiating to the shoulder blade, elbow, wrist and fingers.
TX: She has been on NSAIDS, muscle relaxants, narcotics, Medrol Dosepak, physical therapy over 3 months.
PE: Patient reports pain on limited range of motion with positive facet loading, Spurling’s positive, left shoulder impingement, motor decreased throughout left upper extremity, reflexes intact except positive bilateral Hoffman’s. Cervical spine MRI reveals right C 4 – 5 bulge, disc desiccation at C 5 – 6 with C 5 – 6 disc osteophyte complexes impinging exiting roots. X-ray of cervical spine shows C 5 – 6 degeneration with near collapse with reversal of cervical lordosis
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