OCCIPITAL NEURALGIA AND HEADACHE - Health Plan of Nevada

• Prognostic - to predict the outcome of long-lasting interventions (e.g., infusions, neurolyis,
rhizotomy).
• Preemptive - to prevent pain following procedures.
Nerve blocks may be used intraoperatively to prevent pain of the procedure, diagnostically to ascertain
cause of pain, or therapeutically to relieve chronic pain. Blocks are useful in a variety of circulatory
and neuropathic syndromes.
It is considered to be prudent and good medical practice to evaluate the patient thoroughly and to
provide the modality most likely to establish or treat the presumptive diagnosis. If the first procedure
fails to produce the desired effect and rules out certain possibilities, then the next logical procedure is
performed. For example, providing epidural blocks, facet joint blocks, sacroiliac joint injections and
lumbar sympathetic blocks on the same day is considered reasonable and necessary only in rare cases.
It would be expected that the least invasive modality should be tried first, advancing to more invasive
modalities, if needed.
Surgeon administered nerve blocks provided as anesthesia services are considered part of the global
surgical procedure and are not reimbursed separately.
Nerve blocks are indicated in patients who are not adequately controlled by appropriate doses of
medications or who are refractory to medical therapy.
Usually, up to three injections or three sets of injections in any given 60-day period are sufficient for a
course of treatment. If additional nerve blocks are given, then documentation supporting the necessity
must be in the clinical record.
Steroids are often included and injected for anti-inflammatory effects. Consideration should be given
to the cumulative dose injected and limitations made to avoid steroid complications.
Nerve Destruction:
Surgically induced lesions of nerve tracts, which involve the destruction of nerve tissue, are primarily
indicated for controlling the chronic or acute pain arising from conditions such as terminal cancer or
lumbar degenerative arthritis. Induced lesions of nerve tracts may be produced by surgically cutting the
nerve (rhizolysis), chemical destruction of the nerve, or by the creation of a radiofrequency lesion.
This A/B MAC has determined that program payment will be made for chemical, surgical, and radio
frequency destruction of a nerve.
The medical record must contain documentation indicating the reason for the procedure, a description
of the procedure performed, and the method of destruction used. Medical review will determine if the
procedure performed is medically reasonable and necessary. The payment or denial will coincide with
the current standard of medical practice.
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