Diagnosis: foot pain/diabetic neuropathy
Treatment: spinal cord stimulator
The insurer denied Outpatient Procedure: Neurostimulator Insertion.
The health plan's determination is overturned.

This is a male with a history of diabetic neuropathy who has bilateral foot pain. His pain is constant, burning, with a pain level 9/10. He had tried Lyrica, Gabapentin, Effexor, Oxycodone and Cymbalta without adequate pain relief. An electromyography (EMG) revealed evidence of prediabetic neuropathy. Spinal cord stimulation (SCS) was recommended to manage his persistent severe pain.

Outpatient Procedure: Neurostimulator Insertion is medically necessary for this patient.
This patient has painful diabetic neuropathy. There are strong clinical evidence to show SCS is effective for painful diabetic neuropathy. This patient has failed conservative treatments. It is medically necessary to consider SCS in this case. This patient has severe pain from diabetic neuropathy. He had failed extensive treatments including Lyrica, Gabapentin, Effexor, Oxycodone and Cymbalta. His pain level is 9/10. Further interventions such as SCS are required to relieve his severe pain.