Diagnosis: Back pain.
Treatment: Pain management, injection (62323).

The insurer is denied coverage for pain management, injection (62323).

The denial is upheld.

This male patient has a history of back pain.

An Epidural steroid injection (ESI) is indicated for the management of back/radicular pain syndromes. The injection is recommended if a course of conservative treatment had been completed. There should be functional limitations. The injection is provided to one site.

The records show the patient has back pain for several years. There is no documented functional loss. He has not completed a course of conservative treatment of 6 weeks. His pain pattern is subjective. There is no evidence of objective radiculopathy. The practitioner has prescribed 2 injections.

It is also important to note the patient has instability patterns on his flexion extension views. He has abnormal motion of a specific segment. This would more than likely be the source of his pain generator. An injection will have little effect on the listhesis.

There are no indications for the ESI at this time.

The health plan did act reasonably with sound medical judgment, and in the best interest of the patient.

The carrier's denial of coverage for pain management, injection (62323) is upheld. The medical necessity is not substantiated.