Title: Epidural Steroid and Facet Injections for Spinal Pain
Policy Effective Date: June 1, 2015
Epidural steroid injections in this policy apply to the lumbar spine only. This section does not address cervical injections.
The facet joint injections section of this policy addresses multiple sites, and is not limited to the lumbar spine.
The use of ultrasound guidance for epidural steroid injection(s) and facet joint injection(s) is unproven and not medically necessary. There is insufficient clinical evidence regarding its safety and/or efficacy in published peer-reviewed medical literature. The available published evidence for ultrasound guidance for epidural and facet injections is limited to a small feasibility study and a cadaver study.
Epidural Steroid Injections
Epidural steroid injection is proven and medically necessary for the treatment of acute and sub-acute sciatica or radicular pain of the low back caused by spinal stenosis, disc herniation or degenerative changes in the vertebrae. Epidural steroid injections have a clinically established role in the short-term management of low back pain when the following two criteria are met:
- The pain is associated with symptoms of nerve root irritation and/or low back pain due to disc extrusions and/or contained herniations; and
- The pain is unresponsive to conservative treatment, including but not limited to pharmacotherapy, exercise or physical therapy
Epidural steroid injection is unproven and not medically necessary for all other indications of the lumbar spine.
There is a lack of evidence from randomized controlled trials indicating that epidural steroid injections effectively treat patients with lumbar pain not associated with sciatica or radicular pain.
Note: This policy does not apply to obstetrical epidural anesthesia utilized during labor and delivery.
Facet Joint Injections
Diagnostic facet joint injection and/or facet nerve block (e.g., medial branch block) is proven and medically necessary to localize the source of pain to the facet joint in persons with spinal pain.
Therapeutic facet joint injection is unproven and not medically necessary for the treatment of chronic spinal pain. Clinical evidence about the very existence of facet joint syndrome is conflicting, and evidence from studies is inadequate regarding the superiority of periodic facet joint injections compared to placebo in relieving chronic spinal pain. (pain lasting more than 3 months).
Additional Information
Facet joint injection, as a diagnostic procedure prior to radiofrequency ablation, is not recommended in patients with:
- neurologic abnormalities
- more than one pain syndrome
- definitive clinical and/or imaging findings pointing to a specific diagnosis other than facet joint syndrome
- previous spinal surgery at the clinically suspected levels
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Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
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