MBBs and the Pain Diary

[powermd]

I want to get an idea of how people evaluate patient's following MBB. We do a formal pain diary, which I think is overkill. I don't think we've ever been asked to submit the patient's self-recorded pain scores to an insurance company. To the best of my knowledge, there is no required standard to meet here other than to evaluate their response to the block in some way.

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[DOctorJay]

we do the formal diary, patients complete and fax in. i look at it, if appropriate they get scheduled for #2, rinse and repeat - if both are concordant they get set up for RFA.

I had one insurance company that balked on covering the RFA and once I submitted this stuff it was covered no problem. Overkill? probably, but it has helped me.

if diary comes back equivocal I will see pt in follow up in office and discuss to determine if it really was helpful but they were rating pain from a distant source.

 

[pjuer]

Evaluate patient after block plus formal pain diary reviewed next visit

 

[nvrsumr]

My pain diary says <80% for private pay and <50% for medicare. Thats it.

 

[Ligament]

My pain diary says <80% for private pay and <50% for medicare. Thats it.

could you elaborate? does it track by the hour or is it a one time measurement?

 

[bronchospasm]

This is what I use. Hope it helps

 

[Ducttape]

i like the line in caps.

had a patient that stated that the lumbar MBB did wonders for her headaches.

 

[bronchospasm]

i like the line in caps.

had a patient that stated that the lumbar MBB did wonders for her headaches.

I had a few patients fill out the form incorrectly saying that their pinky finger or ankle was still hurting after the mbb. Hence the change.

 

[SSdoc33]

we do the formal diary, patients complete and fax in. i look at it, if appropriate they get scheduled for #2, rinse and repeat - if both are concordant they get set up for RFA.

I had one insurance company that balked on covering the RFA and once I submitted this stuff it was covered no problem. Overkill? probably, but it has helped me.

if diary comes back equivocal I will see pt in follow up in office and discuss to determine if it really was helpful but they were rating pain from a distant source.

fax? most of my patients can only afford cigarettes, certainly not a fax machine.

in f/u:

me: do you feel better after the shot?
patient: yes
me: ok, we will book the RF

pain diary makes things more complicated than they need to be. patients can barely understand the rationale for an MBB without the pain diary, which will get lost or not filled out 50% of the time. if i happen to burn out a few nerves that possibly shouldnt have been cooked, im willing to accept that, given the safety of the procedure

 

[DOctorJay]

SSdoc
I'm booked out for 4 weeks. How soon do you get patients back to review their response to MBBs? Do you do dual dx blocks or just one.

You'd be surprised how many pts find a fax machine to get this back to us. Many just drop it off.

 

[bedrock]

SSdoc
I'm booked out for 4 weeks. How soon do you get patients back to review their response to MBBs? Do you do dual dx blocks or just one.

You'd be surprised how many pts find a fax machine to get this back to us. Many just drop it off.

I'm booked out as well. I explain all of this including RF at their consult. If they pass the MBB, they go straight to RF

 

[nvrsumr]

They tell my staff on phone then sign the medicare or private insurance MBB diary. I have 5 hours listed with >80 next o

 

[olafa]

i see block patients back that week after their second block to get the ball rolling fast, we are booked out also but these patient dont like sitting around once they know about getting good dreleif they ant it now!! Seems the documentation of their relief needs to be submitted for auth for RFA in most cases, I dont know how you are getting it authed w pain diary only and no documented clinical assessment/discussion etc.
Also medicare is now 80% per this years nordian changes cant to second block unless 80% achieved on first. You may want to revise your 50% cutoff. I imaging you may get stuck for this if they do any chart audits.

 

[Ducttape]

as far as i an aware, no insurance has requested that the assessment can only come through a follow up appointment. the diary directly documents the patient's assessment of their pain. what does a doctor asking the same question and writing down the same results contribute?

 

[DOctorJay]

99213

 

[pmrmd]

I document pain relief and exam changes immediately following the injections. The proof is more in the improvement in ROM and functional changes, i.e. arising and lateral bend, than subjective pain scale. I will brow beat any bureaucrat that tries to challenge me on this.

 

[powermd]

Here's an idea for a new diary, post your opinion!

 

[bronchospasm]

I designed my diary after reading the LCD for Medicare and BCBS. We were getting a lot of reviews from BCBS so my Biller now sends my note along with the 2 medial branch block pain diary even before the RFA. It takes about 30 seconds to fax it out from the EMR. We started doing this in January and so far there has been no issue in getting paid for the MBB Or RFA.

So look at your state specific LCD and make one accordingly.

 

[olafa]

I designed my diary after reading the LCD for Medicare and BCBS. We were getting a lot of reviews from BCBS so my Biller now sends my note along with the 2 medial branch block pain diary even before the RFA. It takes about 30 seconds to fax it out from the EMR. We started doing this in January and so far there has been no issue in getting paid for the MBB Or RFA.

So look at your state specific LCD and make one accordingly.

Thats what we do and have had good luck with the tighter restrictions in place, diary if patient returns along w chart note. BSCS still wants to have attestation form to very pain - for some reason chart note is not enough, but I sign it and no problems

 

[Yo GabbaPentin]

Does anyone do a facet injection as #1 followed by MBB as #2? If the facet injection works for a long time, I try to avoid going to MBB at all.

 

[Taus]

Does anyone do a facet injection as #1 followed by MBB as #2? If the facet injection works for a long time, I try to avoid going to MBB at all.

Depends on the patient age, duration sx and unfortunately insurance- some WILL NOT cover facets w/ steroid. And for those who require two diagnostic blocks- the intra-articular injection does not count. Otherwise agree...if someone gets a decent duration (ie 4+ months) of great relief from a simple facet joint injection....just repeat that and leave them alone IMO.