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Facet Joint block diagnostic.

Maggie Posted Thu 01st of May, 2014 16:50:19 PM

UHC denied repeat Facet joint block based on the assumption that studies were inadequate for chronic pain and should not be treated after pain lasting more than 3 months.
Exacerbations and remissions of pain needs the treatment more than what a standard dose of one medication or one procedure. Each procedure has a limited time to relieve pain except arthroplasties (Major joints) which is not available for Facet joints.
Is there any advice or we should just treat with opioids meds for rest of the life??

SuperCoder Answered Fri 02nd of May, 2014 06:17:00 AM

I agree and checked UHC and its written also there.

If the physician feels the need within 3 months, you have the patient sign an ABN that they will be responsible for charges and explain that UHC will not pay as it is considered experimental and investigational. Appealing can be done but there are futile chances as this is made clear in their back pain- clinical policy .

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Epidural_Steroid_and_Facet_Injections_for_Spinal_Pain.pdf

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