Medicare and Provider Qualification

[pmrmd]

So I was perusing the Noridian site and two LCDs effective in February and March specifically state that facet and epidural injections can only be performed by a formally trained physician. Well, its about time. We just had an FP doc get his license suspended here for doing injections. They are going to look at everybody doing them for less than ten years. Maybe this is the first step to getting us paid.

Odd item: Second diagnostic facet block indicated if relief from index pain lasts six weeks and RF indicated only if dual MBBs provide six weeks of relief. WTF? My anesthetics don't last that long.

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[emd123]

How do they define "formal training." That's very vague. Fellowship? ACGME vs non-ACGME? Weekend course? Residency in anesthesia/PMR/neuro/psych?

Im in favor of requiring formal training, but the only concrete "formal training" to hang a hat on would be ABMS Pain Subspecialty certification, whether though ACGME fellowship or grandfather clause. That time has come, but I wonder if the toothpaste is too far out of the tube.

However, any definition other than that muddies the waters in a big way. Is a psych residency alone "formal training" enough to do a spinal stim implant? Most would say no. Is a neurosurgery residency enough "formal training" to so a stim implant? Most would say yes, but it's not an official ABMS "Pain" specialty anymore than Family Practice is.

As far as the LCD, of course that makes zero sense, but nowadays I expect nothing different. 3 months of relief from an MBB not only is unrealistic, but if anything implies more of a placebo effect, which would speak against doing RF. If they're talking about "therapeutic" medial branch block with steroids, that's a different animal, but still absurd to require 3 months of continues relief for RF. In fact, some Lcds out there say steroids in an MBB invalidate it. Whoever wrote that either knows nothing of IPM or wants an LCD so restrictive they have cause to deny any RF at all, or go back and revoke any payment for rf retroactive on ground of "medical necessity." An LCD such as that is equivalent to giving a blanket "non-coverage" determination. They're just getting more and more creative in ways not to pay for anything.

Sign o' the times.

 

[SSdoc33]

If they're talking about "therapeutic" medial branch block with steroids, that's a different animal

no such thing as a therapeutic MBB. lax is FOS

 

[Yo GabbaPentin]

Ever wonder WHY they didn't cut RF this year? Probably because they made sure NO ONE would meet requirements!!!