Frequently Asked Questions

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Procedures and Injections

What happens during an injection?

The patient is placed on a fluoroscopy table or an exam table. The site of the injection is identified using x ray machine or ultrasound machine. The skin and site of the injection area are prepped with antiseptic solution. A local anesthetic is used to numb your skin and subcutaneous tissue. The doctor will then insert a thin needle advancing gently towards the target site. X-ray guidance or ultrasound guidance is used throughout to ensure the safe and proper position of the needle. A contrast dye if needed is injected to ensure correct placement of the needle in the target site. When the needle is confirmed to be in the correct position, the doctor will inject the steroid medication mixture or other therapeutic agent.

How long does an injection take?

The correct positioning on the table, identification of the injection site and skin preparation with antiseptic solution takes 10 minutes or less. The actual injection time varies depending on the type of procedure and is usually completed in 5 minutes or less. The injection can take slightly longer if the anatomy is challenging due to age, previous surgery, presence of hardware, etc.

Do I need insurance authorization or approval before I can schedule the procedure/injection?

Yes! Nearly all commercial insurance payor and Medicare advantage programs require preauthorization prior to proceeding with the injections or procedures. We try our very best to get the preauthorization approvals in a timely manner but there are factors that are beyond our control. Most insurance companies have their own internal teams that review these requests on case-by-case basis.

There is a prerequisite checklist that some insurance companies follow, and these can include but not limited to duration of symptoms, failure of other options, lack of response, medications trialed, imaging results (MRIs or X rays). We must document this information in an accurate and thorough manner in your office visit note, hence, the first visit with the provider is a consultation visit to start the insurance authorization and approval process.

How do I prepare for the injection and how will I feel afterwards?

We start the insurance authorization process at the time of scheduling your procedure after a consultation or evaluation, based on availability. We request most patients to bring an escort to drive them safely. In most cases, patients feel slight discomfort at the injection site which usually resolves with ice and over the counter medications such as acetaminophen or ibuprofen. There may be a temporary sensation of pressure or numbness at the site of the injection. There may also be numbness in your legs from the injection of local anesthetic that usually resolves in couple of hours. Sometimes we request patients to bring their cane or walker to help them get to their cars safely.

The effect from the steroid injection can take 4-7 days to demonstrate its maximum benefit. Some patients feel improvement right away.

How much relief can I expect and how long will the relief last?

These are the most difficult questions to answer as outcomes vary from patient to patient. Some patients get excellent relief that can last months to years, and some unfortunately get no relief whatsoever.

There are various factors at play which result in variable outcomes. These include but are not limited to duration of ongoing symptoms, severity of underlying condition, anatomical variations and challenges, previous history of spinal surgery, age, and their physiologic response to steroid based medications. Most patients require a series of injections a few weeks apart based on their response to an initial injection to maximize benefit and longevity.

What about follow up visit?

You will be scheduled for a follow-up visit in 2 weeks after your initial injection. During this visit, you and your health care provider will discuss the outcome of your previous injection and a plan for the next steps based on the response.

Medications and Exercises

What back exercises I can do to strengthen my back?

Try these back exercises 10 minutes a day to strengthen your back. If pain persists stop the exercise.

These back exercises are brought to you by www.krames.com

Download this back exercises guide

If you have any questions, please contact our office at 703-719-8583.

How should I use Medrol dose pack

Take Medrol does by mouth as directed by your doctor.

Day 1:

2 Tablets before BREAKFAST
1 Tablet after LUNCH & 1 Tablet after DINNER
2 Tablets at BEDTIME

Day 2:

1 Tablet before BREAKFAST
1 Tablet after LUNCH & 1 Tablet after DINNER
2 Tablets at BEDTIME

Day 3:

1 Tablet before BREAKFAST
1 Tablet after LUNCH & 1 Tablet after DINNER
1 Tablet at BEDTIME

Day 4:

1 Tablet before BREAKFAST
1 Tablet before LUNCH
1 Tablet at BEDTIME

Day 5:

1 Tablet before BREAKFAST
N/A
1 Tablet at BEDTIME

Day 6:

1 Tablet before BREAKFAST
N/A
N/A

Take the indicated dosage as described daily
Side effects: Difficulty sleeping, irritable mood, swelling in legs. If you experience any of the following, stop the medication immediately and call our office at the number provided. Please consult your pharmacist for a complete list of known side effects.

Prior Authorizations

Does my MRI or CT require an Authorization?

At DMV Spine and Pain, we strive to provide you the most efficient care. Please note that most MRI imaging requests require a prior authorization from your insurance. We will make a collaborative effort with the facility of your choice to handle this process. We will provide any necessary clinical information that the imaging facility may require to initiate and complete this authorization.

This process can generally take 3-5 days once initiated. Please note that this authorization process can not be started until a date of service is selected with the facility of your choice and an order is provided and attached to a visit justifying its clinical necessity and satisfying the prerequisite clinical checklist as per each individual insurance plan.

Do I need insurance authorization or approval before I can schedule the injection?

Yes. Every commercial insurance payer and most government advantage programs require pre-authorization prior to proceeding with the injection. We try our very best to get this pre-authorization approval in a timely manner but there are factors that are beyond control.

Most insurance companies have their own internal teams that review these requests on a case-by-case basis.

There is a prerequisite checklist that some insurance companies follow, and these can include but are not limited to duration of symptoms, modalities trialed, medications trialed, imaging results (MRIs or X rays).

We must document this information in an accurate and thorough manner in your office visit note, hence, the first visit with Dr. Bhatia is a consultation visit to start the insurance authorization and approval process.

Get in touch

Have any questions? Need more information? Want to request an appointment?