Fluoroscopy bundled 62310 and 62311

[CATS22]

I saw the ASIPP update today that CMS has proposed to increase the reimbursement of LESI and CESI (62310 and 62311) back to the 2013 levels. At least the RVU values.... work still needs to be done for the reversal of the 2014 cut for those not using RVU. However, this comes at the expense that the Fluoroscopic code will be bundled. I'm not sure how this is a success. Now they can just wait another year to whittle away at the 62310 and 62311 codes. For example the 64483 code is being cut 1.3% for 2015 where fluoro is bundled.....
Any thoughts?

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[emd123]

I saw the ASIPP update today that CMS has proposed to increase the reimbursement of LESI and CESI (62310 and 62311) back to the 2013 levels. At least the RVU values.... work still needs to be done for the reversal of the 2014 cut for those not using RVU. However, this comes at the expense that the Fluoroscopic code will be bundled. I'm not sure how this is a success. Now they can just wait another year to whittle away at the 62310 and 62311 codes. For example the 64483 code is being cut 1.3% for 2015 where fluoro is bundled.....
Any thoughts?

I agree. These are proposed and could change drastically with the final rule in November as we saw shockingly, last fall. The bundling of 77003, eats up most of the supposed increase in the procedure codes themselves. You're right, in that many of our other codes are proposed to go down in the 1% range. The time to act is now, and to not be caught asleep at the wheel again like last fall, when we were all shocked by drastic cuts. Ultrasound looks to be going down again also, as does 77002.

 

[bedrock]

bloody hell. CMS bastards. They completely blasted the pain codes last year and can't fix the obvious mistake to the ILESI codes, without cutting us away at the knees again with the 77003 codes. I swear, I'm may just stop accepting insurance payments for CESI, and go cash only on that one.

If they don't reimburse cervical epidurals at a level commensurate with the risk I'm taking, I'm just not going to do them anymore.

 

[docnyc]

CESI reimbursement is a joke at this point for the level of risk involved.

 

[emd123]

insurance payments for CESI, and go cash only on that one.

As much as I agree with you in theory, I don't think it's legal to charge cash, for an otherwise covered service on a patient whose insurance you otherwise accept. You have to opt out of the insurance altogether to do so. We just went over this in another thread. Legal eagles, correct me if wrong.

 

[bedrock]

As much as I agree with you in theory, I don't think it's legal to charge cash, for an otherwise covered service on a patient whose insurance you otherwise accept. You have to opt out of the insurance altogether to do so. We just went over this in another thread. Legal eagles, correct me if wrong.

I was aware that is is illegal for medicare. I would love to hear legal thoughts as this pertains to commercial insurance.

 

[bedrock]

In the future, cervical epidurals may have a fate shared with the general care of most medicaid patients.

No one in private practice will provide the service, so these patients have to be referred to tertiary teaching hospitals for their cervical epidurals, etc.
I recently started doing this for C1-C2 injections, I previous did C1-C2 under DSA for safety, so had to do them at local ASC, and got paid maybe $95 for my time, which is peanuts for risk and my time. So I gave them up and starting sending all C1-C2 injections to a local tertiary hospital with pain fellowship.

I may seriously start doing this in the future for cervical epidurals. My referral stream is well established, and I'm very busy.
I already disliked doing cervical epidurals, but to get paid pennies for my time, expertise, and risk, is an extra slap in the face.

 

[emd123]

In the future, cervical epidurals , may have a fate shared with the general care of most medicaid patients.

No one in private practice will provide the service, so these patients have to be referred to tertiary teaching hospitals for their cervical epidurals.
I recently started doing this for C1-C2 injections, I did them all under DSA for safety, so had to do them at local ASC, and got paid maybe $95 for my time, which is peanuts for risk and my time. So I gave them up and starting sending all C1-C2 injections to a local tertiary hospital with pain fellowship.

I may seriously start doing this in the future for cervical epidurals. My referral stream is well established, and I'm very busy.
I hate doing cervical epidurals, but to get paid pennies for my time, expertise, and risk, is a slap in the face.

I agree completely, but CESI and LESI are practically the only things you can use 77003 with anymore. Even with bundling it, the CESI code reimbursement will still increase by 22% over the 2014 CESI plus 77003, if the rule goes through in 2015.

Though it's not as much as I'd like, it's still moving in the right direction and we still have 4 months to affect change. Also, the little 0.5%-1% decreases in the other codes could go away if the conversion factor gets set just a smidge higher (which happened this year).

One lesson I learned from last year, is this "proposed rule" doesn't mean jack sh¡t because they can flip it on it's head come November.

Remember, Kypho was supposed to get cut 50% last year and wasn't cut nearly that drastically. Them stim was eviscerated much more than anyone expected. Then rf went up 6% and 77002 went up 20% unexpectedly.

I say we sick ASIPP and ISIS on this now rather than play catch up come December.

 

[hyperalgesia]

I was aware that is is illegal for medicare. I would love to hear legal thoughts as this pertains to commercial insurance.

I think for commercial insurance it's a contract violation, not a criminal offense. They could sue you but would probably just kick you off their network of they found out.

 

[bedrock]

I think for commercial insurance it's a contract violation, not a criminal offense. They could sue you but would probably just kick you off their network of they found out.

Ok. Takes me back to plan b.

In the future, cervical epidurals may have a fate shared with the general care of most medicaid patients.

No one in private practice will provide the service, so these patients have to be referred to tertiary teaching hospitals for their cervical epidurals.

I already disliked doing cervical epidurals, but to get paid pennies for my time, expertise, and risk, is an extra slap in the face.

I may try to figure out how to have a full service pain practice, but refer out the CESI to a tertiary hospital.

 

[Ducttape]

One offset advantage of bundling fluoro is hopefully this will reduce some of the fly by nite injections done by non pain trained practitioners. ( family, internal, ortho, noctors, etc). It is a big money hit , don't know if it will balance out...

 

[emd123]

One offset advantage of bundling fluoro is hopefully this will reduce some of the fly by nite injections done by non pain trained practitioners. ( family, internal, ortho, noctors, etc). It is a big money hit , don't know if it will balance out...

If anything it helps them, because now they're getting paid more, for their crappy, non-image guided epidural technique, since they never used fluoro to begin with.

 

[bedrock]

If anything it helps them, because now they're getting paid more, for their crappy, non-image guided epidural technique, since they never used fluoro to begin with.

I don't understand how these noctors and PCPs, don't get busted for billing facets and SIJ which now require fluoro guidance to bill for the injection. Seems they should be busted for fraud if they do these injections without fluoro.

Also not sure what will happen to all the part-time pain docs (anesthesia guys who didn't do a fellowship ) that do blind lumbar ILESI between their anesthesia cases, if fluoro guidance becomes mandatory for ILESI.

 

[Birdstrike]

The government only spends time going after the big fish.

 

[NJPAIN]

Does this now mean that they won't pay if you perform a caudal using ultrasound guidance?

 

[Ducttape]

If anything it helps them, because now they're getting paid more, for their crappy, non-image guided epidural technique, since they never used fluoro to begin with.

sometimes I wonder....

If they bill for injection and don't use fluoro, they should get denial. If they bill for fluoro but don't have, then they could be charged for fraud.

As to your post, from my admittedly limited location, these part-timers have all gone back to 100% gas or retired.

 

[hyperalgesia]

I can't see how they will bundle ILESI and ICESI codes with fluoro. They might call the code "image guided xyz". Then someone will come up with new a imaging technique that uses x-ray glasses. Utilization will skyrocket. Rinse. Repeat.

 

[miamidoc2b]

At the moment, which codes have 77002 and 77003 bundled with them?

 

[emd123]

At the moment, which codes have 77002 and 77003 bundled with them?

Pretty much everything interventional spine related has 77003 bundled except cesi, lesi, and sympathetic blocks. I can't think of any others off the top of my head.

I don't know of 77002 being bundled with much of anything. 77002 is really the only way to get paid for using your machine, starting in 2015.

 

[PinchandBurn]

Pretty much everything interventional spine related has 77003 bundled except cesi, lesi, and sympathetic blocks. I can't think of any others off the top of my head.

I don't know of 77002 being bundled with much of anything. 77002 is really the only way to get paid for using your machine, starting in 2015.

my undrsatnding isthat you can use 77002 for anything 'outside' the spine. So basically trigeminal injections and all joint injections.......

 

[hcrypt]

I know that 77003 is bundled for everything except lesi and cesi for medicare. However, can you bill 77003 for commercial insurance? Or does it apply also to commercial insurance also.

 

[mid|ine]

What about surgical and ob ESI placement, I figured they haven't bundled because those don't typically (and in the case of OB - can't) use imaging.

 

[Ducttape]

there are separate codes for surgical anesthesia, mostly for the anesthesia part. the cpt for the chronic indwelling catheter i think is still 62318-9?

 

[epidural man]

As much as I agree with you in theory, I don't think it's legal to charge cash, for an otherwise covered service on a patient whose insurance you otherwise accept. You have to opt out of the insurance altogether to do so. We just went over this in another thread. Legal eagles, correct me if wrong.

Can you charge both? Dentists do it. The insurance pays up to certain amount, and the patient pays the rest. Why can't that be the same with a procedure?

 

[epidural man]

Anybody ever use 76000 for discograms, or kypho or something that requires diagnostic fluoro?

 

[lobelsteve]

Anybody ever use 76000 for discograms, or kypho or something that requires diagnostic fluoro?

Both have their own fluoro codes in the 70000 series.