Lumber and cervical ESI - same visit

[epidural man]

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Would any of you ever entertain (or have you done) doing a lumbar and cervical ESI on the same visit?

 

[lobelsteve]

Only if patient was able to come off blood thinners 1x or drove over 3 hours to see me.

 

[Ducttape]

are you going to use 160 mg depomedrol for this injection?

only if the patient were a significant risk for coming off anticoagulation - but generally speaking these patients have far greater other health concerns.

 

[buddababa]

i dont think insurance will pay for it

 

[bedrock]

i dont think insurance will pay for it

Yep. Patient would have to pay cash for the second epidural.

However I have never done two ESI the same day. Insanely rare to have a patient that desperately needs two ESI at once.

One area is worse than the other, and should be addressed first.

 

[callmeanesthesia]

One patient. Work comp set aside so functionally cash pay, and on blood thinners. I use 40 mg depo routinely for ESIs so I did 40 per site.

 

[DrSpine]

I don’t do this much but sometimes. For Personal Injury: yes. I only do it if the patient is going under MAC for any weird reason (not common) or on blood thinners. Insurance World is unlikely to okay it. That being said, I’ve done this I think once in my life or twice?

 

[MitchLevi]

Extenuating circumstances and use 40 at both sites. Also, I'd do this expecting not to be paid for one of them.

 

[Asclepius186]

Just do a caudal with catheter run all the way up to cervical spine. One injection. Hit both areas. Easy

/s

 

[buddababa]

Yep. Patient would have to pay cash for the second epidural.

However I have never done two ESI the same day. Insanely rare to have a patient that desperately needs two ESI at once.

One area is worse than the other, and should be addressed first.

same

 

[clubdeac]

Used to do it occasionally when I worked at the VA and patients had severe neck and lbp and responded well to previous ILESIs