new LCD from Noridian

[onewithpain]

I just got about 20 pages of new LCD for injections BS from Noridian. They imply that they might not pay if the provider is not appropriately trained, but they do not state that the provider must be a physician. Training can include residency, fellowship, post-grad training, ... Pretty ambiguous. Hopefully they will stop paying the ortho spine who did a weekend ISIS course. He only does "lumbar selective nerve root blocks" but the OR crew shows me his fluoro images and they often are not even transforaminals. Of course with 3 ml of betamethasone and 10 ml of lido and saline I am sure that it is very selective. 3 of those and they go to surgery.

Under the category of cervical and thoracic epidurals they say no steroids without radiculopathy. Maybe it's OK for lumbar.

Under the category of facets they say that if the symptoms are bilateral then both sides need to be done the same day.

These always raise more questions than they answer.

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[emd123]

I've seen the Noridian LCDs. How can they possibly track and enforce these things? There's no way.

 

[onewithpain]

They selectively enforce, kind of like the IRS. If you are busy then they may audit. If they find mistakes then they deny and audit again. If they don't find mistakes then they leave you alone for a while. If they find that you broke the rules then they don't pay. If they plan on enforcing the training requirement then they will need to define it better.

They audited me and withheld payment for about 50 procedures until they OK'd everything and cut me a big check. I get patients who have been seen by other docs who seem clueless as to Noridian's restrictions and so I would assume that those docs haven't been audited.

 

[hyperalgesia]

They should start by requiring an MD/DO. Special training could mean anything.