Geniculate RFA

[Dr. Ice]

What are people's thoughts on this treatment for chronic knee pain that everyone seems be getting wet over? I dont know how I feel about it. Just curious as to what people are finding if they have done any. How is it coded? And are insurance companies actually covering it?

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[BobBarker]

Destruction of peripheral nerve NOS - 62311, maybe? X 3

Medicare is covering but not Medicaid

 

[DOctorJay]

I do it for patients who can't have a TKA or have a TKA with continued knee pain. Do a search, this has been discussed before, especially coding/billing.

 

[Ducttape]

Medicare covers.

N of 5. 1 person got huge hematoma because i did it while he was on coumadin. had severe pain for 3 months on it.

other 4 have had clinically meaningful improvement (im going to start typing in "insurance-ease" as it were).


fyi, your computer mistakenly type 62311 (epidural injection) when you typed in 64681

god help us if you are doing 62311x3...

 

[specepic]

I'm finding it works well for pts

 

[Ducttape]

of note: http://www.ncbi.nlm.nih.gov/pubmed/26066383

Reg Anesth Pain Med. 2015 Jul-Aug;40(4):363-8. doi: 10.1097/AAP.0000000000000269.
Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation.
Franco CD1, Buvanendran A, Petersohn JD, Menzies RD, Menzies LP.
Author information
Abstract
BACKGROUND AND OBJECTIVES:
Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to ensure a successful outcome. The purpose of this study was to reanalyze the innervation to the anterior knee capsule from the perspective of the interventional pain practitioner.

METHODS:
The study included a comprehensive literature review followed by dissection of 8 human knees to identify the primary capsular innervation of the anterior knee joint. Photographs and measurements were obtained for each relevant nerve branch. Stainless-steel wires were placed along the course of each primary innervation, and radiographs were obtained.

RESULTS:
Literature review revealed a lack of consensus on the number and origin of nerve branches innervating the anterior knee capsule. All dissections revealed the following 6 nerves: superolateral branch from the vastus lateralis, superomedial branch from the vastus medialis, middle branch from the vastus intermedius, inferolateral (recurrent) branch from the common peroneal nerve, inferomedial branch from the saphenous nerve, and a lateral articular nerve branch from the common peroneal nerve.Nerve branches showed variable proximal trajectories but constant distal points of contact with femur and tibia. The inferolateral peroneal nerve branch was found to be too close to the common peroneal nerve, making it inappropriate for radiofrequency neurotomy.

CONCLUSIONS:
The innervation of the anterior capsule of the knee joint seems to follow a constant pattern making at least 3 of these nerves accessible to percutaneous ablation

 

[lobelsteve]

Now that is old news...

 

[Dr. Ice]

Too bad it only pays $68 in asc...

 

[ampaphb]

Ignore anything Steve says on this subject. He is an industry shill

 

[lobelsteve]

Actually, I only taught 2 course before SJM bought the company. And I only was asked because the guy who was supposed to had other commitments. I have not had a Neurotherm agreement in over a year.

 

[ampaphb]

You taught last year as PART of SJM

 

[lobelsteve]

You taught last year as PART of SJM

Seattle or DC?

 

[ampaphb]

Orlando

 

[lobelsteve]

Cleveland?