The patient is a 59 year-old male with a 12/31/09 date of injury. A specific injury occurred while performing executive chef duties. Diagnosis was depression.
12/24/15 DWC Form RFA for Sertraline 100 mg, Mirtazapine 15 mg and Adderall 5 mg.
12/17/15 Notice of denial for medications: dextroamphetamine-amphetamine 5 mg # 30, Sertraline HCL 100 mg # 60 and Mirtazapine 15 mg # 30.
12/04/15 request for additional information for medications: dextroamphetamine-amphetamine 5 mg # 30, Sertraline HCL 100 mg # 60 and Mirtazapine 15 mg # 30. Arissa requested current progress report with subjective and objective findings from the requesting physician, IW and IW’s attorney (if applicable).
12/03/15 Progress Report noted that the patient was slightly better with the use of Sertraline. The …show more content…
In addition, ODG identifies that anxiety medications in chronic pain are recommended for diagnosing and controlling anxiety as an important part of chronic pain treatment. This patient has chronic pain and major depression. He has been taking Sertraline and Mirtazapine. Sertraline made the patient feel better, but her depression has been unchanged. An additional month was given to document the continued efficacy of these medications on 11/17/15, considering the ongoing persistent psychiatric symptoms and presence of neuropathic pain. The medications were requested again on 12/03/15 and Arissa denied them later due to lack of information and due to the absence of latest progress notes. Now, the provider is requesting the medications again per 12/24/15 RFA. However, no new progress notes are available for review. There is no documentation of additional benefits derived from Sertraline in combination with Mirtazapine. Medical necessity of these drugs has not been substantiated. Recommend
12/24/15 DWC Form RFA for Sertraline 100 mg, Mirtazapine 15 mg and Adderall 5 mg.
12/17/15 Notice of denial for medications: dextroamphetamine-amphetamine 5 mg # 30, Sertraline HCL 100 mg # 60 and Mirtazapine 15 mg # 30.
12/04/15 request for additional information for medications: dextroamphetamine-amphetamine 5 mg # 30, Sertraline HCL 100 mg # 60 and Mirtazapine 15 mg # 30. Arissa requested current progress report with subjective and objective findings from the requesting physician, IW and IW’s attorney (if applicable).
12/03/15 Progress Report noted that the patient was slightly better with the use of Sertraline. The …show more content…
In addition, ODG identifies that anxiety medications in chronic pain are recommended for diagnosing and controlling anxiety as an important part of chronic pain treatment. This patient has chronic pain and major depression. He has been taking Sertraline and Mirtazapine. Sertraline made the patient feel better, but her depression has been unchanged. An additional month was given to document the continued efficacy of these medications on 11/17/15, considering the ongoing persistent psychiatric symptoms and presence of neuropathic pain. The medications were requested again on 12/03/15 and Arissa denied them later due to lack of information and due to the absence of latest progress notes. Now, the provider is requesting the medications again per 12/24/15 RFA. However, no new progress notes are available for review. There is no documentation of additional benefits derived from Sertraline in combination with Mirtazapine. Medical necessity of these drugs has not been substantiated. Recommend