Document exactly this:
Proceed with An initial diagnostic facet joint injection/medial branch block to determine facet joint origin as the patient has met all of the following criteria:
o Pain is exacerbated by facet loading maneuvers on physical examination (e.g., hyperextension, rotation).
o Clinically significant improvement has not occurred (the pain remains at a 3 or more on a 1-10 pain scale) after a
minimum of four weeks of conservative care (including, but not limited to pharmacotherapy, 6 week home exercise program as directed by me for more than the last 6 weeks, or physical therapy)
o Clinical findings and imaging studies suggest no other cause of the pain (e.g., spinal stenosis with neurogenic
claudication, disc herniation with radicular pain, infection, tumor, fracture, pain related to prior surgery).
o The spinal motion segment is not fused.
o A radiofrequency joint denervation/ablation procedure is being considered.
Recommend proceeding to a second facet joint injection/medial branch block performed to confirm the validity of the clinical response to the initial facet joint injection, as the patient has met all of the following criteria:
o Administered at the same level and side as the initial block
o The initial diagnostic facet join injection produced a positive response as demonstrated due to the patient meeting all of the following criteria:
-For at least the expected minimum duration of the effect of the local anesthetic and,
-Functional improvement that is specific to the individual with demonstrable improvement in the physical functions
previously limited by the facetogenic pain; Patient reports an 87% improved ability to stand and wash dishes, stand and bath, walk in the grocery store.
Just make it a dot phrase. It will apply to all insurances.This is taken directly from UHC with some tweaks.
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