Where do you perform your spinal medial branch radiofrequency ablations?

[Ligament]

I am curious where and how you all perform spinal medial branch radiofrequency ablations.

You can choose more than one answer. For example, you may choose ASC; Cervical; IV sedation and Clinic; Lumbar; NO IV sedation if that best suits you.

This thread is not intended to be a debate about the need for IV sedation or not, nor the SOS differentials.

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[DrSpine]

Hospital setting. No sedation ever. I am really withholding my tongue on my opinion on sedation - you shut it down before I could add anything.

 

[cowboydoc]

HOPD for all.

 

[deleted131481]

HOPD - not my preference but that's where the machine is.

 

[Baron Samedi]

HOPD, no sedation for any procedures

 

[Ferrismonk]

Office for everything, I offer sedation if desired, but I encourage no sedation.

 

[DOctorJay]

My office has an HOPD suite attached, no IV sedation
PO valium for those who need it

 

[drusso]

I am curious where and how you all perform spinal medial branch radiofrequency ablations.

You can choose more than one answer. For example, you may choose ASC; Cervical; IV sedation and Clinic; Lumbar; NO IV sedation if that best suits you.

This thread is not intended to be a debate about the need for IV sedation or not, nor the SOS differentials.

Clinic with IV sedation for all levels. Once you see the facility SOS on the HOPD side you'll never be able to live with yourself.

 

[painfree23]

Clinic with IV sedation for all levels. Once you see the facility SOS on the HOPD side you'll never be able to live with yourself.

Does the physician fee change for HOPD?

 

[DOctorJay]

Does the physician fee change for HOPD?

yes, physician fee goes down when in facility (ASC and HOPD) compared to in Clinic

https://www.asipp.org/Fee%20Schedules/2020PhysicianFinalRates.pdf

https://www.asipp.org/Fee%20Schedules/2020ASCFinalRates.pdf

https://www.asipp.org/Fee%20Schedules/2020HOPDFinalRates.pdf

edited to include second and third attachments

 

[drusso]

yes, physician fee goes down when in facility (ASC and HOPD) compared to in Clinic

https://www.asipp.org/Fee%20Schedules/2020PhysicianFinalRates.pdf

But the total cost of care goes up substantially. This the dirty secret of health care. The "cover charge" for the facility is often orders of magnitude greater than the professional fee either in the office or the ASC.

 

[Ducttape]

Fortunately the system I work in does all procedures in ASC...

 

[deleted993114]

Hospital setting. No sedation ever. I am really withholding my tongue on my opinion on sedation - you shut it down before I could add anything.

I give pts oral valium. It chills them out and they tolerate procedures better (no vasovagal reactions). Its good PR as well, as I have had pts from other clinics at which they complained they had a significant amount of pain.

I have a rather unpleasant procedure done on me every three months. I wish they would give me something, as it hurts like hell. I have had nearly twenty surgeries done on me and have only taken motrin after those surgeries. Visceral pain, however, really blows.

Thus, given my personal experience, I give people some oral valium whenever they ask. Having pts deeply sedated, of course, increases risk for nerve injury, as the anesthesia closed claims data shows.

For something like a sphenopalantine or trigeminal rf, I always do them in the surg center, as I think they need propofol. For perm stims, of course, they are in the surg center and get IV sedation.

 

[deleted185747]

VA hospital in clinic without sedation. Lots of lidocaine, need to have a driver.

 

[mid|ine]

Done in office, no IV sedation, but typically use preprocedure xanax and vicodin.