With a transforaminal epidural steroid injection (ESI), often referred to as a 'nerve block', the needle is placed alongside the nerve as it exits the spine, and medication is placed into the 'nerve sleeve'. The medication then travels up the sleeve and into the epidural space from the side. This allows for a more concentrated delivery of steroid into one affected area (usually one segment and one side). Transforaminal ESIs can also be modified slightly to allow for more specific coverage of a single nerve and can provide diagnostic benefit, in addition to improved pain and function.
To establish medical necessity for spinal injections, the claim form must cite, and documentation must support, an appropriate diagnosis. Allowable diagnoses may vary by payer (Check with your particular payers for specifics.); however, commonly-allowable ICD-9-CM codes to establish medical necessity for 64479-64484 include intervertebral disc disorders (), spinal stenosis ( Spinal stenosis in cervical region , ), post-laminectomy syndrome (), and radiculitis ( Brachial neuritis or radiculitis NOS, Thoracic or lumbosacral neuritis or radiculitis, unspecified), among others.