RF neurotomy onset of effect

[NJPAIN]

Regarding post RF medial branch neurotomy patients ( cervical, thoracic, lumbar) , what are you telling them about::

1. How long to expect any post-RF neuritis to last?
2. How long before they will see any pain relief (from underlying pathology, not neuritis)?

How soon post-procedure are you scheduling follow-up?

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[Ligament]

1. 3-5 weeks
2. may take up to 8 weeks

FU at 2 weeks post RFA and at 8 weeks post RFA

 

[powermd]

Regarding post RF medial branch neurotomy patients ( cervical, thoracic, lumbar) , what are you telling them about::

1. How long to expect any post-RF neuritis to last?
2. How long before they will see any pain relief (from underlying pathology, not neuritis)?

How soon post-procedure are you scheduling follow-up?

1. Weeks to months. I only see this occasionally.
2. I tell them 7-14 days. The vast majority of my patients coming back in two weeks to start MBBs on the opposite side report relief on the treated side at that point.

 

[powermd]

Regarding post RF medial branch neurotomy patients ( cervical, thoracic, lumbar) , what are you telling them about::

1. How long to expect any post-RF neuritis to last?
2. How long before they will see any pain relief (from underlying pathology, not neuritis)?

How soon post-procedure are you scheduling follow-up?

1. Weeks to months. I only see this occasionally.
2. I tell them 7-14 days. The vast majority of my patients coming back in two weeks to start MBBs on the opposite side report relief on the treated side at that point.
3. Four weeks if unilateral. Two weeks if we're going to start MBBs on the opposite side, or work on any other problem.

 

[bedrock]

1. 3-5 weeks
2. may take up to 8 weeks

FU at 2 weeks post RFA and at 8 weeks post RFA

2 week f/u is unnecessary IMHO. You mentions your revenue vs overhead was not what you had desired. One key thing to consider is your office visit to procedure ratio. The fewer the office visits the better, unless they really need one of course.

I schedule post RF follow-ups at 4 weeks for lumbar RF and 6 weeks for cervical\SIJ RF. If the patient is a repeat RF customer that did great the year before, they just follow-up with me PRN after their second annual RF.
Same thing for my senior patients with stenosis that have done great with an ESI for stenosis in the past. I just repeat the ESI and they follow-up with me when their pain returns, but not automatically, if they've had an ESI for the same stenosis six months ago, and they had great relief for six months.

BTW-(I haven't had a case of post RF neuritis in years since I started started doing the Dreyfuss low slow burn for TON (70 degrees with longer ramp-up time). Every other nerve is 85 degrees for 90 seconds.

 

[Ligament]

2 week f/u is unnecessary IMHO. You mentions your revenue vs overhead was not what you had desired. One key thing to consider is your office visit to procedure ratio. The fewer the office visits the better, unless they really need one of course.

I schedule post RF follow-ups at 4 weeks for lumbar RF and 6 weeks for cervical\SIJ RF. If the patient is a repeat RF customer that did great the year before, they just follow-up with me PRN after their second annual RF.
Same thing for my senior patients with stenosis that have done great with an ESI for stenosis in the past. I just repeat the ESI and they follow-up with me when their pain returns, but not automatically, if they've had an ESI for the same stenosis six months ago, and they had great relief for six months.

BTW-(I haven't had a case of post RF neuritis in years since I started started doing the Dreyfuss low slow burn for TON (70 degrees with longer ramp-up time). Every other nerve is 85 degrees for 90 seconds.

thanks bedrock, I will chew on this.

 

[lonelobo]

1. 3-5 weeks
2. may take up to 8 weeks

FU at 2 weeks post RFA and at 8 weeks post RFA

don't understand the 2 week F/U, I will do 6-8 wk F/U

 

[Ligament]

Generally at the 2 week FU I am dealing with neuritis issues. That the main reason I see them at that point. If they have neuritis I can bill for a office visit vs. calling in a medication and not getting paid for it. That's my rational, though it may not be a good one.

 

[DOctorJay]

How frequently are you seeing post RFA neuritis?

 

[Ligament]

How frequently are you seeing post RFA neuritis?

About 50% in the c-spine patients and 30% in the l-spine patients.

 

[lonelobo]

About 50% in the c-spine patients and 30% in the l-spine patients.

Seems High?
see about 2-3 a year that I will classify as neuritis, probably a couple more that don't call to complain

 

[lobelsteve]

I think I'm at 10-15% C-spine, 1-5% L-spine, and 15% SIJ RF

 

[emd123]

Lots that say there were "just a little more sore" for a few days, likely not true neuritis. Actual clinically significant neuritis? Closer to Lobel's #'s

 

[Ligament]

For those of you not following up within the neuritis timeframe (3-5 weeks), how do you know who is having neuritis?

 

[SSdoc33]

it sounds like ligament does things the right way. big gauge RF needles, higher incidence of neuritis (which means he definitely is killing the nerve), and frequent f/u. while this is commendable, and i'd guess his results are excellent, i dont think it is how most of us do it.

if you have the patients f/u frequently for anything, yes, you can bill for this f/u. but it is peanuts. the more new patients and the more shots you can do the better off you will be financially. when your schedule is cluttered with f/u visits, you will stagnante and growth with stop. clearly, this needs to be balanced with appropriate patient care, however.

like bedrock, i have been trying to minimize office f/u visits. for the repeat RF and LOL with stenosis who gets a shot a few times/year, i am not having them f/u after routine injections unless there is some issue.

also, i have stopped seeing patients in f/u if i have written for PT. if they still have pain, they will come back in. i dont need to see them just to say "glad that PT helped". you dont see surgeons ever see patients for a f/u visit after PT. that is, if they even prescribe it.

these routine f/u would be good for a NP or PA, but your time should be worth a little more.

and if they have post RF neuritis, you'll get a phone call.

im at maybe 5% for both cervical and lumbar RF

 

[nvrsumr]

I also limit follow ups. Unfortunately, wc and auto require and are a large part of my practice.

 

[Ligament]

it sounds like ligament does things the right way. big gauge RF needles, higher incidence of neuritis (which means he definitely is killing the nerve), and frequent f/u. while this is commendable, and i'd guess his results are excellent, i dont think it is how most of us do it.

if you have the patients f/u frequently for anything, yes, you can bill for this f/u. but it is peanuts. the more new patients and the more shots you can do the better off you will be financially. when your schedule is cluttered with f/u visits, you will stagnante and growth with stop. clearly, this needs to be balanced with appropriate patient care, however.

like bedrock, i have been trying to minimize office f/u visits. for the repeat RF and LOL with stenosis who gets a shot a few times/year, i am not having them f/u after routine injections unless there is some issue.

also, i have stopped seeing patients in f/u if i have written for PT. if they still have pain, they will come back in. i dont need to see them just to say "glad that PT helped". you dont see surgeons ever see patients for a f/u visit after PT. that is, if they even prescribe it.

these routine f/u would be good for a NP or PA, but your time should be worth a little more.

and if they have post RF neuritis, you'll get a phone call.

im at maybe 5% for both cervical and lumbar RF

Thanks SSdoc33, this makes sense...I can cut back on many of my FU's without impacting care. You are right, my FU ratio is likely stagnating growth...I need to step back and think about that. thanks much.

 

[emd123]

Thanks SSdoc33, this makes sense...I can cut back on many of my FU's without impacting care. You are right, my FU ratio is likely stagnating growth...I need to step back and think about that. thanks much.

Are you that packed with follow ups you have trouble scheduling new patients or procedures?

 

[Ducttape]

In a fee for service practice, the closer one is to a 1:1 follow up to injection ratio, the better the profits.

Also, time wasted on calling RN managers, patients at home, etc may not make financial sense...