Does anyone have updated TFESI numbers?

[pastafan]

There are a number of local practices using particulates for TFESIs. My data is a few years old concerning complication cases reported with particulate steroids. Does anyone have updated data? Please Private Message data. Thanks.

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[mid|ine]

We still use particulate for TF. Only do about 1% of my ESI via TF route.

 

[mid|ine]

Are there any society opinions out on non-particulate vs particulate for lumbar TF?

Any consensus on which not particulate?

 

[lobelsteve]

100% dex for TFESI.
1 in 100000? 1 in 1000000? Risk is miniscule. Elective procedure. Zero risk with nonparticulate in Lspine, needle alone can do the deed in the neck.

These are elective procedures. Everybody walks home.

 

[bedrock]

We still use particulate for TF. Only do about 1% of my ESI via TF route.

That percentage TFESI seems rather low. I hope you are offering TFESI to your patients, who failed an ILESI or caudal

 

[mid|ine]

Maybe not 1%, but its rare in my practice. I offer it when appropriate and failed ILESI.

 

[bedrock]

Maybe not 1%, but its rare in my practice. I offer it when appropriate and failed ILESI.

The thing is practically any patient who has failed an ILESI is automatically a candidate for TFESI.
Unless you cure all your patients via ILESI (injecting medical weed, or something????), you should do more than 1% TFESI.

 

[lobelsteve]

The thing is practically any patient who has failed an ILESI is automatically a candidate for TFESI.
Unless you cure all your patients via ILESI (injecting medical weed, or something????), you should do more than 1% TFESI.

Or start TFESI and change to ILESI if they fail. 25g vs 17-20G

 

[lonelobo]

Maybe not 1%, but its rare in my practice. I offer it when appropriate and failed ILESI.

At least 20% of my patient candidates for injections are post surgical, so I do a lot more TFESI

 

[bedrock]

Or start TFESI and change to ILESI if they fail. 25g vs 17-20G

I agree. I start with TFESI and dex, and switch to ILESI or caudal with depo, if they get short-lived relief after the TFESI.

 

[exia80]

Or start TFESI and change to ILESI if they fail. 25g vs 17-20G

I Agee with the TFESI being used more...most of my patients have had some kind of spine surgery. Also I find it helps more if symptoms are unilateral or IESI fails ( many times already tried before they come to me)

 

[clubdeac]

100% dex for TFESI.
1 in 100000? 1 in 1000000? Risk is miniscule. Elective procedure. Zero risk with nonparticulate in Lspine, needle alone can do the deed in the neck.

These are elective procedures. Everybody walks home.

Steve are you saying the needle can't do the deed in the lumbar spine? If it can do it in the neck, why not in the lumbar spine? And midline, you really do only about 1% TFESIs?? How can you justify that with the damn cuts in January. I admit, I used to love a paramedian ILESI. Quick and relatively painless compared to a TFESI and I often felt that they worked better. My hats off to you. I only do them if I'm certain an epidural is the way to go and they don't get relief from a TFESI. I can't afford to lose any more money than I have to when I'm getting ****ed by obama and my practice....

 

[Ducttape]

he's saying the vertebral artery to the brainstem is in the cervical, not the lumbar spine.

club, im getting the feeling that you are feeling the pressure of the private practice market. tell me you arent basing your medical decision making on how much money a procedure generates rather than what is most sound medically.

 

[clubdeac]

No I don't duct however I now do TFESIs before considering an ILESI and I use fluoro or US for everthing... well except tpi's. I leave US guided tpi's to the nocs down the street

 

[mid|ine]

Just wanted to bring these 2 questions back up:

Are there any society opinions out on non-particulate vs particulate for lumbar TF?

Any consensus on which non- particulate?

 

[emd123]

Any consensus on which non- particulate?

Haven't heard of any being used other than dex. Otherwise which other non-particulate would you use, a non-particulate betamethasone formulation? I haven't heard any pro's/con's or break down regarding various non-particulates personally, have you?

 

[bedrock]

Agree with deac. Recent cuts were unfair and I do every injection, including peripheral joints/nerve blocks under guidance. I do draw the line at US for TPI, just like deac.

 

[emd123]

Agree with deac. Recent cuts were unfair and I do every injection, including peripheral joints/nerve blocks under guidance. I do draw the line at US for TPI, just like deac.

Agree.

 

[Ducttape]

Agree with deac. Recent cuts were unfair and I do every injection, including peripheral joints/nerve blocks under guidance. I do draw the line at US for TPI, just like deac.

being that you dont take medicaid and see few medicare patients, how long before you noticed a change in reimbursement from the private insurance companies?

i dont have recent data. last is have data for, March, there had been no change in the amount received for LESI from the 2 main private insurances in my area (fyi, this HOPD bills private insurance under office based rates).

 

[emd123]

being that you dont take medicaid and see few medicare patients, how long before you noticed a change in reimbursement from the private insurance companies?

i dont have recent data. last is have data for, March, there had been no change in the amount received for LESI from the 2 main private insurances in my area (fyi, this HOPD bills private insurance under office based rates).

Why are you always on this board implying that private practice docs see "few medicare" patients? Some of us see tons of Medicare. My practice is in an area with an elderly population and I see 70% medicare. So to paint with a broad brush and say private practice isn't affected by draconian cuts in Medicare reimbursement is totally misleading.

 

[Ducttape]

besides Dr. Lobel, it doesnt appear that the majority of posters on this board see medicare. a short survey of the private practices in my area reveals that fully 80% see no medicaid and rare (charity amount of) medicare.

if you are biatching about medicare cutting reimbursements, the advantage as i see it from a PP model is that if you think medicare is screwing you over... stop seeing them.

 

[lobelsteve]

besides Dr. Lobel, it doesnt appear that the majority of posters on this board see medicare. a short survey of the private practices in my area reveals that fully 80% see no medicaid and rare (charity amount of) medicare.

if you are biatching about medicare cutting reimbursements, the advantage as i see it from a PP model is that if you think medicare is screwing you over... stop seeing them.

I see who ever comes in. 26 y/o with PCOS and FMS, welcome aboard.
87 y/o with L3 crunchy due to lifting 5 gallon gas can when her mower died, welcome aboard.
45 y/o dude with 5 knee surgeries, 6 docs, and 170 oxy 15 per month total, welcome to the exit. He no showed. Word on the street.

 

[bedrock]

Why are you always on this board implying that private practice docs see "few medicare" patients? Some of us see tons of Medicare. My practice is in an area with an elderly population and I see 70% medicare. So to paint with a broad brush and say private practice isn't affected by draconian cuts in Medicare reimbursement is totally misleading.

What he said....

I don't take medicaid because most of the patients are entitled, ungrateful, lazy, drug-seeking, and for most, psych disorders are their primary issue, and I'm not a psychiatrist. And medicaid pays horribly, (50% of medicare in my area).

I see plenty of medicare, It's 40% of my patients. Doesn't pay incredible, but way better than medicaid. Most patients aren't drug seeking, most get better with treatment, follow your directions, and somebody needs to take care of grandma.

 

[clubdeac]

I see everything that walks in the door. Been in pp for only a year and must to stay busy. I see 90-100 patients/week. If I only saw insurance that number would drop to 30/week!!! Yikes