Diagnosis: Lumbar Radiculopathy
Treatment: Pain Management (injection 62323 x 1)
The insurer denied the pain management (injection 62323 x 1).
The denial is overturned.

The patient is a female with lumbar radiculopathy. She has previously had ESIs (epidural steroid injections) with greater than 85% relief for 4.5 months with each injection. Her last injection was over six months ago. She has had six weeks of return of pain. She has failed conservative treatment. She had PE (physical examination) findings consistent with radiculopathy. This correlates to her MRI (magnetic resonance imaging) findings.

Yes, the requested injection (62323 times [x] 1) is medically necessary.

This approach is consistent with the guidelines set forth by the American Society of Interventional Pain Physicians (ASIPP). [1] They recommend in the therapeutic phase (after the diagnostic phase is completed, which is the case here), the suggested frequency of interventional techniques should be two months or longer between each injection, provided that greater than (>) 50% relief is obtained for two months. Again this is demonstrated in the attached notes. Given that the options, such as surgery or spinal cord stimulation, are more invasive, and do not offer any guarantees, and given that the patient has failed conservative treatment, and has had 85% relief for over 4.5 months each time, the requested ESI (epidural steroid injection) is medically necessary.