Injections for other tendon origin/insertions. 10. Palmar cutaneous branch of median nerve. The wrecking ball that was the SYMPLICITY HTN-3 trial has nearly destroyed the entire concept of renal denervation (RDN). It looks like CPT code 62263 is the correct code for the percutaneous epidural adhesion. Neurectomy of the anterior interosseus nerve. CPT code 46505; HCPCS codes J0585, J0586, J0587, J0588 Group 1 Codes: Group 2 Paragraph: CPT Code 52287; HCPCS code J0585 Group 2 Codes: Group 3 Paragraph: Printed on 10/4/2017. Author Joan Arenas-Prat 1 Affiliation 1 *Serveis Mèdics Penedès, Department. Username Forgot my Username. We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. 61 ± 2. To apply the principles of therapeutic joint denervation to treat thumb CMC arthritis, a basic understanding of the innervation patterns to the CMC joint is needed. Denervation of the thumb CMC joint has emerged as a viable treatment option. Basilar Thumb Arthritis is a form of arthritis that causes pain at the base of the thumb and difficulty with pinching and grasping due to carpal-metacarpal (CMC) joint arthritis. 2003 Mar;7 (1):26-31. 12) Carpometacarpal dislocation, closed (833. 20612 Aspiration and/or injection of ganglion cyst(s) any location 20615 Aspiration and injection for treatment of. Pain in joint, forearm (719. Prior to surgery, all patients reported poor function and significant levels of pain, with an average VAS of 7. Patient satisfaction was higher in the denervation group. Metacarpophalangeal dislocation, closed (834. I am having trouble finding what code would be most appropriate. Osteoarthritis of the carpometacarpal (CMC)-1 joint is a common condition that can cause significant pain and functional problems. This article was converted to the new Billing and Coding Article type. Enrollment will occur at the time. #2. 26 $767 26842 Arthrodesis, carpometacarpal joint, thumb, with or without internal Best answers. #5. A needle orBest answers. 01) Metacarpal base fracture, closed (815. 9% Renal denervation, bilateral 5192 0339T $4,679 $4,953 5. 08/01/2019 R4 The title of the article has been revised to add Billing and Coding. Although orthopedists may refer to the surgery differently 25447 ( Arthroplasty interposition intercarpal or carpometacarpal. Chemodenervation is the blockade of neuronal signaling at the neuromuscular junction using botulinum neurotoxin (BoNT). cgallimore said: Hi, There isn't a CPT code for this procedure. 9% Coronary PCI Drug Eluting Stents (including FFR/OCT) DES, with. 2). The number of VT episodes was decreased from 11. In preparation for the transition from ICD-9 to ICD-10 medical coding on . DOI: 10. 6 cm to 20. 84). hansur. Report 64646 for chemodenervation of one to five muscle (s) of the trunk. Nine studies were identified with 184 denervation procedures undertaken in 175 patients. Lateral femoral cutaneous sensory nerve B. e8. Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through the same fascial incision (20150) Excision or curettage of bone cyst or benign tumor; humerus; with autograft includes graft harvest (24115) Excision or curettage of bone cyst or benign tumor; humerus; with allograft (24116) Excision. 03) Thumb base metacarpal fracture, open (815. Remember Me. I agree with 20600 for the CMC injection code. Between June 1995 and June 2013, a total of 648 patients underwent SPD for ST. The first carpometacarpal (CMC) joint is a frequent location of osteoarthritis (OA) in the hand. Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes. Conclusions: Carpometacarpal denervation appears to provide similar short-term outcomes as suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. Note: Report CPT code 64999 when facet cyst aspiration/rupture. May 22, 2017. 2018. Layer closure of wounds of neck, hands, feet and/or external genitalia; 7. 28 (P<0. Note: Report CPT code 64999 when facet cyst aspiration/rupture. 16. 10 $761 CMC Joint Fusion CPT® Code Description 2020 Total RVUs 2020 Medicare National Average Payment 26841 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; 21. Fusion in opposition, thumb, with autogenous graft (includes obtaining graft) (26820) Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation (26841) Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft) (26842) All patients who underwent first CMC joint denervation surgery from January 2015 through September 2017 were retrospectively identified. 6 to 8 weeks: The splint can now be worn at night. 21) Late effect of sprain/strain (nonspecific) (905. 10. The procedure is well tolerated, with faster recovery as compared with trapeziectomy. Vanden Berge DJ, Kusnezov NA, Rubin S, et al. g. Some authors have described the. Denervation of the first CMC joint is a relatively new procedure for managing stable thumb CMC. 21) Late effect of sprain/strain (nonspecific) (905. Neurectomy of the anterior interosseus nerve. CPT code 20551 should be used when the origin or insertion of a tendon is injected, in contrast to an injection of the tendon sheath, CPT code 20550. Straightforward – 10 minutes: 99212. 2 The most commonly involved joints are the fourth and fifth CMC joints. In younger patients, a CMC denervation procedure of the first carpometacarpal joint tends to provide reliable improvement in. 2 branch at the ulnocarpal joint (range, 0–2) and 1. (2012) Sympathetic innervation of the anterior left ventricular wall by the right and left stellate ganglia. " D. The DBUN gave an average of 1. Thread starter cclarson; Start date Aug 11, 2020; Create Wiki Sort by date. The complications of primary surgery, although relatively rare, can present in various clinical ways. Low complexity – 15 minutes: 99213. 21) Late effect of sprain/strain (nonspecific) (905. Coding Table 3 lists ICD-10-CM. 1 Carpometacarpal arthritis has a predilection for older women, and this progressive disease can be debilitating and can worsen patients’ quality of life. 2. MCP Ligament Injury Codes. It runs from the scaphoid and trapezium carpal bones, and from the flexor retinaculum to the proximal phalanx of thumb. 008 Corpus ID: 253927867; Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients. Sacroiliac (SI) Joint Nerve Denervation (CPT Code 64625) Medicare does not have a National Coverage Determination (NCD) for SI nerve denervation. Wrist denervation is one of the several treatment modalities for chronic wrist pain. Browse sample topics. Neurolysis is performed with. There were no articular branches to the ulnocarpal joint in one specimen (6%) and to the fifth CMC joint in two specimens (12%). Ankeny, IA. Wrist denervation is a safe and effective procedure for the treatment of chronic wrist pain that can delay or eliminate the need for salvage or anatomically distorting procedure, such as proximal row carpectomy. Other Injections/Aspirations . 052. The preferred surgical option when. And how do you code the the following combo case and urodynamic with modifiers? Case 1: Vag hyst (58260), ant & post repair (57265), colpopexy (57283) and sling (87288). 4 to 6 weeks: Physical therapy begins. 48 The characteristic feature of a saddle joint is that each articular surface is concave in one dimension and convex in the other. Renal Hemodynamics and Renal Function After Catheter-Based Renal Sympathetic Denervation in Patients With Resistant Hypertension. Renal denervation did not result in any significant long-term increase in renal artery stenosis or worsening of renal function. wneu. Foucher was convinced that. Facet Joint Denervation or Radiofrequency Ablation. Patient with right thumb metacarpophalangeal (MCP) joint instability, carpometacarpal (CMC) osteoarthritis, and wrist scaphotrapeziotrapezoidal (STT) arthritis presents for treatment of the thumb and wrist. 5 months). MCP Joint Dislocation / Ligament Injury CPT Codes. 011. These investigators reported on the outcome of patients treated with this procedure for ST in their department. CMC Denervation. Neurectomy of the dorsal ulnar sensory nerve articular branches. Since the resulting chemical denervation of muscle produces local paresis or paralysis, selected muscles can be treated. (2014) Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up. Denervation of the proximal interphalangeal joint: a realistic and simple procedure. on denervation in thumb carpometacarpal joint osteoarthritis 1. Fusion in opposition, thumb, with autogenous graft (includes obtaining graft) (26820) Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation (26841) Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft) (26842)All patients who underwent first CMC joint denervation surgery from January 2015 through September 2017 were retrospectively identified. Late effect, arm fracture (nonspecific) (905. A graft jacket was rolled. Innervation of thumb carpometacarpal joint: implications for diagnostic block and denervation proceduresJoint denervation, a technique yielding good reproducible results in wrist and first carpometacarpal joint osteoarthritis, is, at the proximal interphalangeal joint level, a good alternative to implant arthroplasty or arthrodesis. It is concluded that volar CMC joint denervation is a useful procedure, preserving joint function and relieving pain long-term. Late effect, arm fracture (nonspecific) (905. If denervation is performed bilaterally, Modifier 50 should be appended to the procedure code with number of services of one. Selective denervation of the thumb carpometacarpal (CMC) joint is a viable approach to treat pain and disability associated with CMC arthritis, with less morbidity and faster. 04. LAPAROSCOPIC LIVER BIOPSY CPT code(s) to report Descriptor Global period Work RVU Total RVU 47562 Laparoscopy, surgical;. It is part of the wrist "The carpometacarpal (CMC) joints are five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones". Article Guidance. Google Scholar Kloppenburg M, Kwok WY. 0 cm (12045) Layer closure of wounds of neck, hands, feet and/or external genitalia; 20. Prospective studies with validated patient-reported and objective outcome measures between distinct treatment arms, such as denervation versus ligament. Mission & Cause Our Mission. 10 $761 CMC Joint Fusion CPT® Code Description 2020 Total RVUs 2020 Medicare National Average Payment 26841 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; 21. 1 No prior spinal fusion surgery in. #3. These investigators reported on the outcome of patients treated with this procedure for ST in their department. 61 ± 2. Medicare does not have a National Coverage Determination (NCD) for decompression;. It is a sensory nerve. Medical conditions that can affect the thenar eminence include carpal tunnel syndrome, arthritis, and amyotrophic lateral sclerosis (ALS), among others. It pierces the deep fascia of the forearm approximately 7 cm proximal to the radiocarpal joint (9 cm proximal to radial styloid) runs over snuff box to supply dorsal radial surface of hand. We present the innervation of the thumb CMC joint (thenar - recurrent - branch of median nerve, palmar branch of median nerve, superficial branch of. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. 7-fold increase in the incidence of denervation since 2010 compared to a 2. 2022. High complexity – 40 minutes: 99215. Some authors have described the nerve branches of. The chart below identifies which trade name. 1016/j. The Tenodesis Screw with a convenient disposables kit the CMC Ligament Reconstruction Kit will enable a faster, more convenient repair providing strong and immediate fixation of the tendon graft. e. Introduction. 0. Quick reference tables. CPT Code 52287; HCPCS code J0585 Group 2 Codes: Group 3 Paragraph: Printed on 10/4/2017. 5. 6 months, pain was reduced from mean of 8. Primary repair of collateral ligament, metacarpophalangeal joint (26540) Primary repair of collateral ligament, metacarpophalangeal joint; with tendon or fascial graft (includes obtaining graft) (26541) Primary repair of collateral ligament, metacarpophalangeal joint; with local tissue eg, adductor advancement) (26542)A Prospective Comparison Study of Denervation Versus Suspension Arthroplasty for Carpometacarpal Arthritis of the Thumb Sorka T Deeyor, BS 1; Arjun Vohra, MD 1; Haroon (Aaron) Kisana, MD, MS 1; Aaron Llanes, MS 1; Christina M Regan, BS 1; Clayton Hui, BSE 1; Joshua W. Common examples of unbundling and miscoding errors include: Reporting a ganglion cyst excision (25111 Excision of ganglion, wrist (dorsal or volar); primary) in addition to a synovectomy of the wrist (25118 Synovectomy, extensor tendon sheath, wrist, single compartment ): 25111 is bundled into the 25118. Medical Coding. Methods A systematic literature search was performed up to September 2022. Average follow up at 31. A list of the most common CPT codes for a PM&R and interventional pain management clinic. 11) Metacarpal base fracture, open (815. Undoubtedly, denervation of the first carpometacarpal (CMC-1) joint represents a promising treatment alternative for patients suffering from CMC-1-joint osteoarthritis, resistant to conservative. 7) Late effect, arm fracture (nonspecific) (905. 11 - Unilateral primary osteoarthritis of first carpometacarpal joint, right hand was found in ICD-10. 0 ± 4. The Current Procedural Terminology (CPT ®) code 64721 as maintained by American Medical Association, is a medical procedural code under the range - Neuroplasty (Exploration, Neurolysis or Nerve Decompression) Procedures on the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System. J Am Acad Orthop Surg. 1 (0. Results Of 169 references, 17 articles reporting on 384 denervations in 351 patients were selected. 53 - other international versions of ICD-10 M26. Microsurgical denervation of the spermatic cord is one surgical treatment Dr. 01) Metacarpal base fracture, closed (815. It can be of particular benefit in. Occipital Nerve (CPT Code 64744) for Treatment of Headaches . Renal denervation in high-risk patients with. g. 7 Disturbances of salivary secretion R68. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. 2 to 0. American Society for Surgery of the Hand assh. Chemical neurolysis is the application of a chemical agent directly to a nerve or motor point to intentionally interfere with nerve conduction through destruction of a portion of the nerve. Purpose To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective joint denervation for the treatment of pain and impairment associated with thumb CMC arthritis. Medical notes documenting the following, when applicable: Upon request we may require. Carpometacarpal (CMC) joint/trapeziometacarpal (TMC) joint implants: HCPCS codes not covered for indications listed in the CPB: C1776: Joint device (implantable). Please refer to the Local Coverage Article: Billing and Coding: Facet Joint Interventions for Pain Management (A58405). Authors. It is. The BP-lowering effect of renal denervation was sustained for up to 3 years. Prospective Clinical Trial Comparing Trapezial Denervation With Trapeziectomy for the Surgical Treatment of Arthritis at the Base of the Thumb J Surg Res. Before undergoing surgical CMC denervation, patients received a joint block at the first CMC joint with 0. 6, and 55. 0. 04 closed or 833. Neurectomy of the dorsal ulnar sensory nerve articular branches. 1097/BTH. It lies at first slightly lateral to the radial artery, concealed beneath the Brachioradialis. We read with great interest the recent systematic review by Teo I. I agree with 20600 for the CMC injection code. and therapeutic facet joint injections, facet joint denervation, and facet cyst aspiration/rupture as described by CPT® codes: 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or. American. interosseous nerve. Intradiscal biacuplasty (IDB) (Baylis Medical Inc. 001) reduction in pain scores from baseline (M = 6. Event marketing. 2014 Dec;18(4):158-9. For the study cohort, the conversion rate to T + LRTI at 2 years was 9%. Pooled analysis of 3 studies on the first carpometacarpal joint showed a statistically significant (P < . When a physician performs a right first carpometacarpal joint injection without ultrasound guidance, is it appropriate to report code 20605 for an intermediate joint injection (eg, wrist), or is it appropriate to report code 20600 for a small joint injection?. Coding Index: CPT Hand Codes: ICD Hand Codes: AMA:. Each of three patients, two of whom were musicians, returned to full professional ability. Arthrotomy, elbow, for infection, with exploration, drainage or removal of foreign body (24000) Arthrotomy of the elbow, with capsular excision for capsular release separate procedure (24006) Arthrotomy, elbow; with synovial biopsy only (24100) Arthrotomy, elbow; with joint exploration, with or without biopsy. 2022. 99: Rheumatoid arthritis: M12. Coverage is subject to the specific terms of the member's benefit plan. 16 Salibi et al16 also chose a prospectivePROCEDURE PERFORMED: Decompression median nerve, forearm. The present. Selective denervation has been successfully employed to treat arthritis pain in a number of joints throughout the body. cclarson Guru. Before undergoing surgical CMC denervation, patients received a joint block at the first CMC joint with 0. 2) Late effect of contusion (nonspecific) (906. jhsa. Video marketing. 6 cm to 12. We present the innervation of the thumb CMC joint (thenar - recurrent - branch of median nerve, palmar branch of. This study reviewed literature on CMC denervation for first CMC arthritis. 26215. 0001). I ran these two codes through Optum360 EncoderPro and 3M Coding and Reimbursement System and both have CCI conflicts. Messages 2 Location Haverhill, MA Best. 4 Idiopathic orofacial. The denervation of the first CMC joint has gained traction as a viable treatment for CMC arthritis. }, author={Raymond Rath and Max Haerle. 13) Malunion of fracture (733. 2018; pii: S0363-5023(17)30905-X. N/A. 2022. old 115Kg 1m74, Diabetes Architect Bilateral. CPT code 64625 has been added to CPT/HCPC Codes Group 2 effective for dates of service on or after 01/01/2020. Papatheodorou et al. CODING FOR LAPAROSCOPIC APPENDECTOMY CPT code(s) to report Descriptor Global period Work RVU Total RVU 44970 Laparoscopy, surgical, appendectomy 090 9. 1 cm to 30. Branches arising from the lateral antebrachial cutaneous nerve, palmar cutaneous branch of the median nerve, and radial. 25447 Includes Trapezium Excision. Across the medical community, LightForce ® Therapy Lasers are used to treat chronic and acute musculoskeletal conditions as well as post-activity recovery. Thumb carpometacarpal joint (CMCJ) osteoarthritis (OA) is a common problem affecting 7% of men and 15% of women. Remember Me. Arthroplasty of the basal joint of the thumb. Joint denervation, a technique yielding good reproducible results in wrist and. J Am Coll Cardiol 2011; 58(11):1176-82. 2) Late effect of. Common conditions of the wrist and distal radius from chapters 13 and 19 (M and S codes) are: Wrist drop (M21. 1 Denervation of first CMC joint. Based on the documentation/abstract (below) he had gone in intending to do a LRTI procedure. You may develop scar tenderness. Password Forgot my Password. This is the American ICD-10-CM version of M26. A recent systematic review showed 83% patient satisfaction for proximal interphalangeal finger joint denervation and 90% satisfaction for the thumb carpometacarpal joint denervation (13). Carpometacarpal CMCjoints American Academy of Professional Coders – – TMC (Thumb) Session 1A, 10-11:30 AM Friday, October 26th, 2012 Hand Dissection Skin Palmar. 6 months, pain was reduced from mean of 8. 0 “primary arthrosis of first carpometacarpal joint, bilateral “ M18. 65 preop to 0. on denervation in thumb carpometacarpal joint osteoarthritis. interosseous nerve. Purpose The first carpometacarpal (CMC) joint is a frequent location of osteoarthritis in the hand. Case 2 (urodynamic): 51729, 51741, 51784, 51797, 52000. An instruction was discovered in the Medicare MAC NGS Coding Article 52863 Pain Management related to the new sacroiliac RFA code. . The design of the study is a prospective non-blinded, non-randomized control study. ICD-10 Codes Description K11. 12) Carpometacarpal dislocation, closed (833. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code M62. 5, 52, and 66. Early-stage arthritis is often amenable to nonsurgical treatment with an orthosis and steroid injections. Deep Debridement or excision of recipient site. Hand surgeons who document thumb carpometa-carpal stabilization" " "Eaton procedure" or "LRTI" in their notes often stump orthopedic coders who cannot locate any such descriptors in CPT. CPT code 46505; HCPCS codes J0585, J0586, J0587, J0588 Group 1 Codes: Group 2 Paragraph: CPT Code 52287; HCPCS code J0585 Group 2 Codes: Printed on 8/8/2018. It is concluded that volar CMC joint denervation is a useful procedure, preserving joint function and relieving pain long-term. #1. High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis. Username Forgot my Username. 9% $2,003 $2,142 6. Results are listed in Table 1. Both procedures demonstrated durable improvement in bMHQ compared with the preoperative state with similar long-term outcomes over 2 years of. PHYSICAL THERAPY. 3. 6 ± 1. All patients demonstrated improved grip strength at diagnostic injection. 3)Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Undoubtedly, denervation of the first carpometacarpal (CMC-1) joint does represent a promising surgical treatment alternative for patients suffering from persistent CMC-1-joint osteoarthritis. Wang and colleagues (2015) noted that selective peripheral denervation (SPD) is currently the primary surgical treatment for ST. The Coding Information section has been revised to add a guideline for CPT code 72275. Hardware CPT Codes. 2. 30465956. 12) Carpometacarpal dislocation, closed (833. Berger RA. Arthrotomy, for infection, with exploration, drainage or removal of foreign body; carpometacarpal joint (26070) Arthrotomy, for infection, with exploration, drainage or removal of foreign body; metacarpophalangeal joint (26075) Arthrotomy, for infection, with exploration, drainage or removal of foreign body; interphalangeal joint, each (26080)Forearm deep fascia. 26230. 2. The traditionally more extensive wrist denervation has evolved to procedures requiring fewer incisions. 1016/j. The new evidence has come in recent years, assuring the antihypertensive effect of RDN. 03) to postoperatively (M = 1. 25% bupivacaine. 01) Metacarpal base fracture, closed (815. In5 to 10 days: You will have a follow-up appointment with your surgeon. Listing of a service code in this policy does not imply that the service described by this code is a covered or non-covered health service. The same would apply if ultrasound guided. Injections for other tendon origin/insertions. Both codes 62263 and 62264 should be reported only one time for the entire series of injections, infusions, or mechanical lysis procedures performed, not per adhesiolysis treatment. The procedure is well tolerated, with faster. My surgeons are starting to perform AIN to Ulnar nerve transfer more often and we are trying to determine the most appropriate coding. 11) Metacarpal base fracture, open (815. Between June 1995 and June 2013, a total of 648 patients underwent SPD for ST. Epub 2017 Apr 25. Conclusions: Selective denervation of the CMC joint is an effective approach to treat pain and alleviate impairment associated with CMC arthritis. CPT code. Results. Fenig performs to treat this pain. Local Coverage Determinations. Terminal branches. 4 million people in the UK have osteoarthritis of the hand, requiring two million primary care consultations per annum. . CPT code 52287 - Cystourethroscopy, with injection(s) for chemodenervation of the bladder 2018 Non-Facility (Office), Medicare Nat’l Average . Abstract and Figures. CPT ‡ Code 2019 Payment3 2020 Payment1 % Change 2019 Payment4 2020 Payment2 % Change Hypertension Renal Denervation Renal denervation, unilateral 5192 0338T $4,679 $4,953 5. 2. Page 443 CPT AMA 2020 edition - definition of neuroplasty is spelled out so it's no wonder they won't pay the 24359 no matter what modifier you slap on it. C. Lower extremity sensory and mixed nerves A. 008. Description of Procedure or Service Facet joint denervation is performed under local anesthetic and with fluoroscopic guidance. October 1, 2015 *, a sample listing of the ICD-10 CM and/or ICD-10. 3. Selective denervation of the CMC joint is an effective approach to treat pain and alleviate impairment associated with CMC arthritis. Results: A total of 9 patients and 11 first CMC joints underwent this operation. ICD and CPT Codes for Hand Surgery. 1 _, if it is Primary (Degenerative) Osteoarthritis, and unilateral. 030 To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective. Arthrodesis was also performed on the MCP joint using K-wires. Resection of the trapezium, often combined with soft tissue stabilization, is still considered the gold standard. Hypertension 2012; 60(2):419-24. Code 25442. 1 (0. 9, 10, 11. My physician performed an Epidural Lysis and performed three injections over the course of three days.