Diagnosis: Neck pain.
Treatment: Trigger point injections.
The insurer denied trigger point injections.
The health plan's determination is upheld.

The patient is a female with complaints of neck pain. She underwent trigger point injections of the left cervical paraspinals. The following office visit reported pain 0 out of 10. Previous interventions have helped greatly, and pain improved by 100%. The patient presented for follow-up indicating she fell, broke her nose, and there has been a severe flareup of neck pain going into the cervical paraspinals. Pain is rated 9 out of 10.

The requested trigger point injections are not medically necessary. Although efficacy was noted with previous injections, there is no documentation of the duration of the efficacy being at least 6 weeks. Furthermore, there is no documentation of noninvasive modalities, such as physical therapy being used in conjunction with injections. Therefore, the requested Trigger Point Injections are not medically necessary for this patient.